AGENDA. 3. Items of Assurance and Compliance 3.1 Committee and Advisory Group Attachment Committee Chairs. and Performance

Transcription

1 Agenda A Meeting of will be held on, at 9:30am in Conference Room 2, Headquarters, St Cadoc s Hospital AGENDA 1. Opening Business/Governance Matters 1.1 Chairs Introductory Remarks Chair 1.2 Apologies for Absence Chair 1.3 Declarations of Interest Chair 1.4 Draft Minutes of the Health Board Meetings: Attachment Chair - 22 nd November Action Sheet and Action Log Attachment Chair 1.6 Report on Sealed Documents Attachment Chair 2. Patient Experience and Public Engagement Reports 2.1 Patient Story - patient story from the nurse led ward at Ysbyty Aneurin Bevan Verbal Director of Nursing 3. Items of Assurance and Compliance 3.1 Committee and Advisory Group Attachment Committee Chairs Chairs Assurance Reports 3.2 Executive Team Report Attachment Chief Executive 3.3 Integrated Performance Report Attachment Director of Planning and Performance 3.4 Finance Report Attachment Director of Finance 3.5 Risk Dashboard Attachment Chief Executive 4. Items for Decision and Discussion 4.1 Draft Integrated Medium Term Plan 2018 to Clinical Futures Programme Update 4.3 Parliamentary Review of Health and Social Care 5. Closing Matters Dates of Next Meetings: Wednesday 21 st March 2018 To Follow Attachment Attachment and Report previously circulated Director of Planning and Performance Director of Planning and Performance Chair Chair Public Board Meeting - 24th Janury /01/18 1 of 145

2 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November Agenda Item: 1.4 Public Board Meeting Minutes of the Public Board Meeting held on Wednesday 22 nd November 2017, in the Conference Centre, Headquarters, St Cadoc s Hospital, Caerleon Present: Ann Lloyd - Chair Judith Paget - Chief Executive Philip Robson - Vice Chair Dr Paul Buss - Medical Director Glyn Jones - Director of Finance Geraint Evans - Director of Workforce and OD Katija Dew - Independent Member (Third Sector) Nicola Prygodzicz - Director of Planning and Performance Improvement Nick Wood - Chief Operating Officer Bronagh Scott - Director of Nursing Dr Sarah Aitken - Director of Public Health Frances Taylor - Independent Member (Community) Prof. Dianne Watkins - Independent Member (University) Louise Wright - Independent Member (Trade Union) Shelley Bosson - Independent Member (Community) David Jones - Independent Member (ICT) Alison Shakeshaft - Director of Therapies and Health Science Colin Powell - Chair of the Health Professionals Forum Lorraine Morgan - Chair of the Stakeholder Reference Group Claire Marchant - Associate Independent Member (Director of Social Services) In Attendance: Richard Bevan - Board Secretary Bryony Codd - Head of Corporate Governance Andrew Naylor - Assistant Director of Finance Terry Lewis - Wales Audit Office. Jane Hart - MacMillan Lead Cancer Nurse Mr Nicholas Thomas - Patient Dr Ian Williamson - Consultant Physician. Apologies: Catherine Brown - Independent Member (Finance) Pippa Britton - Independent Member (Community) Cllr Richard Clark - Independent Member (Local Government) 1 2 of 145 Public Board Meeting - 24th Janury /01/18

3 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November ABUHB 2211/01 Welcome and Introductions Agenda Item: 1.4 Ann Lloyd welcomed members and guests to the meeting. Three new Independent Members had been announced: Pippa Britton Community Catherine Brown Finance David Jones - ICT Although Pippa Britton and Catherine Brown were unable to attend this meeting, David Jones was welcomed to his first meeting of the Board. This would be the last Board Meeting for Alison Shakeshaft, who would be commencing at the Director of Therapies and Health Science in Hywel Dda Health Board. Ann Lloyd thanked Alison for her contribution to the Health Board and wished her every success for the future. ABUHB 2211/02 Declarations of Interest Frances Taylor declared an interest in the Action Sheet update relating to the Redesign of Older Adult Mental Health Services, as a member of Monmouthshire County Council. Claire Marchant declared an interest in the Action Sheet update relating to the Redesign of Older Adult Mental Health Services, as an employee of Monmouthshire County Council. ABUHB 2211/03 Minutes of the Meetings held on 27 th September 2017 The Board approved the minutes of the meeting held on Wednesday 27 th September ABUHB 2211/04 Action Sheet and Action Log The Board considered the Action Sheet from the meeting held on the 27 th September 2017, the log of previously agreed action items and noted that all actions had been completed, with the following updates provided: ABUHB 2709/11 The Finance and Performance Committee had discussed the ophthalmology deep dive. Further work was being undertaken and a further deep dive review would be undertaken when looking at the specialty review. ABUHB 2709/12 - The Older Adult Mental Health Services Consultation had commenced and would be brought back for decision. This would be accompanied by a statement of what community services would look like, how many people use the 2 Public Board Meeting - 24th Janury /01/18 3 of 145

4 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November ABUHB 2211/05 Award Winners Agenda Item: 1.4 inpatient services and progress in reviewing the use of Chepstow Community Hospital. Ann Lloyd acknowledged and welcomed a number of award winners to the meeting to receive recognition for their awards, saying that the Board was proud of all of the winners and staff who worked for the Health Board, adding that the Awards recognised the high quality care provided and how we engage with patients and carers to deliver services in a holistic and modern way. Tanya Strange MBE, Divisional Nurse for Primary and Community had been awarded the Queen Elizabeth, The Queen Mother's Award for Outstanding Service and the Lifetime Achievement Award and the Innovation in Nursing Award at the RCN Wales Nurse of the Year Awards. The Health Board had also received recognition at the NHS Wales awards. The winning teams were: Torfaen Community Service Integrated Management Approach to Reducing Falls in Older People and Improving Bone Health - Peter Carr, Assistant Director of Therapies and Health Science Clare Younger, Torfaen Falls Lead and Deb Povey, Falls Assessment Nurse. Band 4 Healthcare Support Workers in Complex Care: Developing the Role - Claire Aston, Divisional Nurse/ Head of Complex Care, Sharon Cooke, Senior Nurse Care at Home Team, Mark Ledville-Smith, Lead Nurse for HDU Patients - Care at Home Team, Marie Nixon, Education Lead Complex Care, Emma Hourihane and Becky Lewis - Band 4 HCSWs, Care at Home Team Hospital design versus research and quality initiatives to meet the needs of frail older people, particularly those with dementia - Dr Inder Singh, Consultant, Care of the Elderly and Dr Chris Edwards, Consultant Medical Physicist. On behalf of the Board, Ann Lloyd congratulated all award winners. 3 4 of 145 Public Board Meeting - 24th Janury /01/18

5 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November Agenda Item: 1.4 ABUHB 2211/06 Charitable Funds Annual Accounts and Annual Report 2016/17 and Wales Audit Office Report ABUHB 2211/07 Chairs Action [The Health Board meeting as the Corporate Trustee for Charitable Funds] Andrew Naylor provided an overview of the Annual Accounts and Annual Report for the year ending 31 March 2017 for Charitable Fund and Other Related Charities. Terry Lewis, Wales Audit Office, presented the Wales Audit Office Report which provided an unqualified audit opinion and stated that there were no major issues to report. There was a surplus of 37k in the year. It was noted that the draft accounts had been received by the Charitable Funds Committee on the 19 th September 2017 which had recommended their submission to the Board for approval. The Board, as Corporate Trustee for Charitable Funds, approved the Annual Accounts and Annual Report 2016/17. The Board ratified the actions taken by the Chair since the previous meeting. ABUHB 2211/08 Sealed Documents ABUHB 2211/09 Patient Story The Board noted those documents which had been sealed since the previous meeting. Ann Lloyd welcomed Mr Nicholas Thomas and Jane Hart, McMillan Lead Cancer Nurse to the meeting. Mr Thomas told the Board about his experiences since being diagnosed in 2009, highlighting the excellent care received by all of the staff on Ward B6 North at the Royal Gwent Hospital, and the individualised treatment and programme of care provided. Mr Thomas told of his frustrations at not being able to access specific drugs that had been approved by NICE, but were not available in Wales, but was pleased to confirm that Welsh Government had now made the drugs available. 4 Public Board Meeting - 24th Janury /01/18 5 of 145

6 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November Agenda Item: 1.4 Mr Thomas highlighted some administrative issues that he felt would benefit patients, including informing patients in a more effective way if cancellations were required; multiple appointments in one day, support for carers and colour coding of blood samples between Health Boards. Ann Lloyd thanked Mr Thomas for sharing his story and said that the improvements suggested would be taken forward. ABUHB 2211/09 Cancer Annual Report Dr Ian Williamson presented the Cancer Services Annual Report 2016/17 and highlighted: Good evidence that the organisation continued to provide high quality cancer services; Significant focus on cancer pathways and the possible introduction of a single cancer pathway; Five year strategy for the development of cancer services in the Health Board, including links to Transforming Cancer Services at Velindre NHS Trust, the Health Board being identified as the preferred option for the Satellite Radiotherapy Unit; and local cancer centre at Nevill Hall Hospital. A Cancer Strategy Group had been established with an internal focus on transformation and internal strategy, services and vision for the Health Board. It was important to ensure the right capacity and support was available to progress this work. There was a discussion regarding cancer inequities. It was highlighted that late presentation was driving this and Public Health were undertaking work in this area. The Board noted the report. ABUHB 2211/10 Health Board Committee and Advisory Group Updates The Board received the following Committee and Advisory Group reports and minutes. Quality and Patient Safety Committee Dianne Watkins explained that the Committee would be focusing on bringing together activity that would make a difference to patient quality and safety. The Board received and noted the report and adopted the minutes of the Quality and Patient Safety Committee held on the 13 th September of 145 Public Board Meeting - 24th Janury /01/18

7 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November Agenda Item: 1.4 Public Partnerships and Wellbeing Committee Phil Robson explained that a key focus for the Committee was the effectiveness of Public Service Boards. A key risk was the reduction in funding for Communities First. The Board received and noted the report and adopted the minutes of the Public Partnerships and Wellbeing Committee held on the 14 th September Planning and Strategic Change Committee The Board noted the developmental approach of this Committee and approved the revised Terms of Reference. The Board received and noted the report of the Planning and Strategic Change Committee held on the 11 th October Audit Committee The Board received and noted the report of the Audit Committee held on the 19 th October Stakeholder Reference Group Lorraine Morgan confirmed that the Group had met the previous week and raised concern regarding representation from Local Authorities. It was confirmed that Local Authorities had been contacted. Welsh Health Specialised Services Committee Judith Paget confirmed that new advice had been received from the Positron Emission Tomography (PET) Advisory Group on the opportunities of using PET scanning and there had been a discussion on the in year impact. The Committee recognised the clinical and financial benefits and accepted the proposal. Some resource would be available in the Integrated Commissioning Plan and the issue would be picked up in the new planning round. The Board received and noted the Briefing from the WHSSC Joint Committee held in September 2017 and the minutes of the meeting held on 25 th July Emergency Ambulance Service Committee The Board received and noted the Briefing from the EASC Joint Committee held on 26 th September 2017 and the minutes of the meeting held on 27 th June Joint Regional Planning and Delivery Forum The Board considered the Terms of Reference for the Joint Regional Planning and Delivery Forum. It was agreed that the following issues would be fed back: 6 Public Board Meeting - 24th Janury /01/18 7 of 145

8 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November ABUHB 2211/11 Executive Team Report Agenda Item: Concerns regarding membership; - Relationship with the collaborative; - The articulation of the structure that sits below the group; - The absence of a dispute resolution process. Action: A. Lloyd The Board received and noted the Executive Team Report, which gave an overview of activities within the Executive Team on local, regional and national NHS Wales issues. ABUHB 2211/12 Integrated Performance Report A paper was received providing an update on the performance of the Health Board at the end of April Nicola Prygodzicz highlighted that good progress had been made in the following areas: Continued improvements in diagnostics, with significant improvement since this time last year; Reduction in delayed follow ups, with a focus on this at specialty level; Reduced DNA rates; Improved sickness absence rates; 10,000 th health check completed as part of the Living Well Living Longer programme. There had been a general improvement in all performance measures; however, there were continued concerns in the following areas: Improvement in the 4 hours A&E target, but this remained an area of continued focus; Ophthalmology was the key reason for the RTT performance being off profile. The Plan was to have no more than 145 patients waiting over 36 weeks by the end of March 2018, with plans to sustain through the following year. A clear programme of work was being developed in ophthalmology and would be reported to the next meeting. Action: N. Prygodzicz Primary Care Mental Health measures were below 80% for the first time due to work undertaken to clear the backlog; Ensuring robust plans were in place regarding Healthcare Acquired Infections. A series of HPV deep cleans had been undertaken in the Royal Gwent Hospital with cleans underway in Nevill Hall Hospital. Hospital acquired c.difficile rates were reducing, however a deep dive was being undertaken into community acquired c.difficile, which was an issue across Wales. 7 8 of 145 Public Board Meeting - 24th Janury /01/18

9 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November Agenda Item: 1.4 It was noted that the reduction in compliance with the 72 hours stroke care target related specifically to staffing issues. Alison Shakeshaft, as lead executive for Stroke, did not consider that this would be an ongoing trend. The Board received the report. ABUHB 2211/13 Finance Performance Report Month 7 A report on the financial performance of the Health Board at the end of Month Five 2017/18. It was noted that the financial position at the end of October 2017 was a deficit of 0.136m. The Health Board had received non-recurrent funding of 15m from Welsh Government relating to the financial risk described in the IMTP at the start of the year. An additional 5.58m had also been allocated to support further improvements in waiting times relating to RTT, diagnostic, therapy and sleep services. If these improvements were not met, Welsh Government could recover the funding. The actions required to break even were outlined, including the introduction of a cap for locum and agency staff. The key areas of risk were noted: Operational pressures through the winter period; Funded Nursing Care judicial review; Financial risk share agreement with WHSSC. There was an assumption in the IMTP that there would be a benefit from changes in the risk sharing agreement, which had been signed off by the Joint Committee, but was yet to be implemented. It was agreed that Ann Lloyd would write to the Chair of WHSSC to highlight concerns that the agreement had not been implemented. Action: A.Lloyd It was agreed that the mechanisms of NHS finance would be included as part of the Board member induction programme. Action: R. Bevan The Board noted the report. ABUHB 2211/14 Strategic Risk Report It was noted that the risk reporting and process was currently being refreshed. A dedicated Executive Team session had been held to focus on the risk register and the way risks were framed. This had led to the reduction in the number of risks on the corporate risk register. A risk workshop for Board members was planned. 8 Public Board Meeting - 24th Janury /01/18 9 of 145

10 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November Agenda Item: 1.4 The Board received the report. ABUHB 2211/15 Draft Integrated Winter Plan for Aneurin Bevan University Health Board and Partner Organisations The Board received the updated Integrated Winter Plan for , following a presentation on the Plan at the Development Session in October. The Plan focused on a number of key areas, including: Improving access to services through effective communication with patients to ensure they have clarity about different entry points for service delivery. Pre-planned system escalation clear focus on increasing bed capacity, reducing diagnostic delays for primary care and integrated management of heath professional calls Prioritising more clinical capacity in our whole system to the urgent care pathway at forecasted times of increased pressure Clear pathway of care for patients not requiring an acute hospital stay, through alternative use of increased community beds and green wards. Improved access to social and community services through development of local integrated capacity and delivery plans. The key risk related to the availability of staff across the whole system. The opening of additional capacity had always been included within the plan and there was 550k held in reserve for this. Claire Marchant commented that the workforce risks extended across the social care workforce, but that organisations had been more joined up in their planning than ever before. It was highlighted that the contract for My Care My Home ended on the 31 st December and confirmed that work was underway to develop a service with Monmouthshire, Blaenau Gwent and Torfaen to jointly commission this service. The Board received the report. ABUHB 2211/17 Update on the Nurse Staffing Levels (Wales) Act The Board received an update on the implementation of the Nurse Staffing Levels (Wales) Act (2016). An overarching duty has been in place since April 2017 and the Act comes into effect from 1 st April of 145 Public Board Meeting - 24th Janury /01/18

11 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November Agenda Item: 1.4 Wales will be the first area of the UK to introduce this legislation. The Act does not provide numbers, but a requirement to assess nurse staffing levels using an agreed tool and professional expertise. The levels would fluctuate depending on acuity of patients. The Health Board would be required to report to Welsh Government if the Act was not being met and to explain why and what plans were in place to address deficits. Dianne Watkins commented that this would have significant implications on the delivery of care. Qualified nurses have a direct impact on patient mortality and morbidity, which is the evidence base of the legislation. The key risks related to the number of vacancies, however the Health Board had been successful in recruitment over recent months, with 36 posts being offered following campaigns in local communities. Phil Robson commented that work had been undertaken to increase the nurse staffing establishment following the introduction of the Chief Nursing Office Nurse Staffing Principles a few years ago. The Director of Nursing confirmed this but stated that, given changes in services and the implementation of the Act, establishment reviews were required bi-annually and following any service change. She added that it was likely there would still be gaps. The Board noted the report. ABUHB 2211/18 Capital Programme The Board received an update on the Capital Programme, including the All Wales Capital Programme primarily relating to the Grange University Hospital. It was noted that: The Board approved 8.8m of a 10.8m programme in May 2017; Bids for the remaining 2m had been prioritised and were reviewed by the Board. This left 268k discretionary capital available; The Welsh Government had allocated 32.4m this year and 131m next year for the Grange University Hospital. The Health Board was responsible for managing the 165m across the two years and would be required to pick up any slippage. There was a 2.5m shortfall in 2018/ Public Board Meeting - 24th Janury /01/18 11 of 145

12 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November Agenda Item: 1.4 The Board noted the report and the capital funding available. The Board approved the remainder of the Discretionary Capital Programme. ABUHB 2211/19 Primary Care Estates Prioritisation The Board received an overview of the primary care estates prioritisation exercise, including the approach taken and sought agreement on the schemes to be progressed through The Board noted the progress of the four priority new build schemes for the Health Board. It was reported that the Health Board had allocated its 300k funding to support the completion of the Major Improvement Grants for Cwmbran Village Surgery and Castle Gate Surgery. It was added that the Health Board was successful in securing an additional 370k non-recurrent funding for an additional major improvement grant for Tudor Gate Surgery in Abergavenny. The Board considered and approved the continuation of 300k allocation to support Improvement Grants in Primary Care, and approved the minor and major schemes to be progressed in 2018/19. ABUHB 2211/20 Brynmawr Clinic Declaration of Property Surplus to Operational Requirements A paper was received regarding Brynmawr Clinic. The Board approved the recommendation to declare the property surplus to the Health Board s operational requirements and that an application would now be made to Welsh Government for disposal. Action: N. Wood ABUHB 2211/21 Clinical Futures Delivery Programme Update The Board received an update on progress to date with the Clinical Futures Delivery Programme, noting that overall, the programme was Amber, primarily due to resource and capacity. It was agreed that a timeline would be developed to provide an overall view of the programme, including when decisions were required, engagement events etc. Action: N. Prygodzicz The Board noted the report and endorsed the changes to the discharge to home lounge and the removal of the of 145 Public Board Meeting - 24th Janury /01/18

13 Tab 1.4 Draft Minutes of the Health Board Meeting held on 22nd November Agenda Item: 1.4 histopathology processing laboratory, which had been supported by the Service Redesign Group and Delivery Board. It was agreed that the Resource Plan would be reported to the Planning and Strategic Change Committee. Action: N. Prygodzicz Louise Wright requested information on progress on staffing of the Grange University Hospital as staff were starting to ask these questions. It was confirmed that detailed assumptions regarding workforce, finance and capacity were included within the plans. There would be changes to personnel in departments and it was important that everyone was aware and would understand this. It was noted that 19 staff engagements sessions had been held to date and 32 Change Agents had been identified. It was confirmed that there was a Communications and Engagement Plan in place and was aligned with the overall plan. Frequently Asked Questions and key issues were being collated and would continue to be reviewed and refined. ABUHB 2211/22 Date of Next Meeting The next scheduled Public Board meeting to be held on. 12 Public Board Meeting - 24th Janury /01/18 13 of 145

14 Tab 1.5 Action Sheet and Action Log 1.5 Agenda Item:1.5 Meeting Wednesday 22 nd November 2017 Action Sheet Minute Reference ABUHB 2211/10 Agreed Action Lead Progress/ Outcome Health Board Committee and A. Lloyd Completed. Advisory Group Updates: Joint Regional Planning and Delivery Forum: Ann Lloyd to feedback concerns regarding membership, the relationship with the collaborative, the articulation of the structure that sits below the group and the absence of a dispute resolution process. ABUHB 2211/12 ABUHB 2211/13 ABUHB 2211/13 ABUHB 2211/20 Integrated Performance Report: Nicola Prygodzicz would report the work being developed in ophthalmology to the next Board Meeting. Finance Performance Report Month 7: Ann Lloyd would write to the Chair of WHSSC to highlight concerns that the risk sharing agreement had not been implemented. Finance Performance Report Month 7: Richard Bevan to arrange for the mechanisms of NHS finance to be included as part of the Board member induction programme. Brynmawr Clinic Declaration of Property Surplus to Operational Requirements: The Board approved the recommendation to declare the N. Prygodzicz An update on the position regarding ophthalmology is included in the Performance Report for the January 2018 Board. A. Lloyd Completed. R. Bevan Part of the national induction programme and included in the Health Board forward programme. N. Wood This has been submitted following the approval of 145 Public Board Meeting - 24th Janury /01/18

15 Tab 1.5 Action Sheet and Action Log 1.5 Minute Reference ABUHB 2211/21 ABUHB 2211/21 Agreed Action Lead Progress/ Outcome property surplus to the Health Board s operational requirements and that an application. It was agreed that Nick Wood would now contact Welsh Government for an application for disposal. Clinical Futures Delivery Programme Update: Nicola Prygodzicz would be develop a timeline to provide an overall view of the programme, including when decisions were required, engagement events etc Clinical Futures Delivery Programme Update: Nicola Prygodzicz to provide a Resource Plan and report to the Planning and Strategic Change Committee. N. Prygodzicz N. Prygodzicz This is included on the Board Report on Clinical Futures for the January Board. An update has been incorporated into the Clinical Futures Paper for the January Board Meeting and is to be discussed further at the February Planning and Strategic Change Committee. 2 Public Board Meeting - 24th Janury /01/18 15 of 145

16 Tab 1.6 Report on Sealed Documents 1.6 Agenda Item: 1.6 Report of Sealed Documents Purpose of the Report: This paper presents for the Board a report on the use of the Common Seal of the Health Board between the 10 th November 2017 and 10 th January Recommendation: The Board is asked to note the report of documents sealed on behalf of the Health Board. The Board is asked to: (please tick as appropriate) Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance Note the Report for Information Only Executive Sponsor: Richard Bevan, Board Secretary Report Author: Bryony Codd, Head of Corporate Governance Report Received consideration and supported by : N/A Executive N/A Committee of the N/A Team Board [Committee Name] Date of the Report: 10 th January 2018 Supplementary Papers Attached: N/A 2 Background The common seal of the Health Board is primarily used to seal legal documents such as transfers of land, lease agreements and other contracts. The seal may only be affixed to a document if the Board or another committee of the Board has determined it should be sealed, or if the transaction has been approved by the Board, a committee or under delegated authority. 3 Key Issues Under the provisions of Standing Orders the Chair or Vice Chair and the Chief Executive or Deputy Chief Executive sealed seven documents between the 10 th November 2017 and the 10 th January of 145 Public Board Meeting - 24th Janury /01/18

17 Tab 1.6 Report on Sealed Documents 1.6 Agenda Item: 1.6 Ref: Title Date ABUHB 217 Agreement under Section 278 of the Highways Act 1980, Section 2 of the 28/11/17 Local Government Act 2000 and Section 111 of the Local Government Act 1972 in respect of highway works at Llanfrecha in preparation for the ABUHB 218 ABUHB 219 ABUHB 220 ABUHB 221 ABUHB 222 ABUHB 223 Grange University Hospital. Form of Agreement by deed relating to the appointment of Health Board Cost Advisers Gleeds Management Limited confirmation notice NR2 for Stages 4, 5 and 6 Main Works for the Grange University Hospital. Confirmation Agreement NR2 for Stages 4, 5 and 6 completion of substantial design, construction of the works operational commissioning and project closure of the Grange University Hospital. TR1 Form transfer of the whole registered title of Bryntirion Surgery, West Street, Bargoed. Deed of Covenant lease of Bryntirion Surgery, West Street, Bargoed. For of Agreement by deed relating to appointment of NEC3 Supervisor for the Grange University Hospital. Minor Works Framework Agreement with Mezmirizin Flooring for flooring works. 12/12/17 12/12/17 20/12/17 20/12/17 20/12/17 9/1/18 Assessment of the Impact of the Report: Public Board Meeting - 24th Janury /01/18 17 of 145

18 Tab 1.6 Report on Sealed Documents 1.6 Agenda Item: 1.6 Financial Assessment Link to Integrated Medium Term Plan Risk Assessment Quality, Safety and Patient Experience Assessment Health and Care Standards Equality and Diversity Impact Assessment (including child impact assessment) There are no financial implications for this report. There is no direct link to Plan associated with this report. Failure to report the sealing of documents to the Health Board would be in contravention of the Local Health Board s Standing Orders and Standing Financial Instructions. There is no direct association to quality, safety and patient experience with this report. This report would contribute to the good governance elements of the Health and Care Standards. There are no equality or child impact issues associated with this report as this is a required process for the purposes of legal authentication. 18 of 145 Public Board Meeting - 24th Janury /01/18

19 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Agenda Item: Committee and Advisory Group Update and Assurance Reports Purpose of the Report: The purpose of this report is to provide an update on the work of the Health Board s Committees and Joint Committees of the Health Boards in Wales. Recommendation: The Board is asked to note this report. The Board is asked to: (please tick as appropriate) Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance Note the Report for Information Only Executive Sponsor: Richard Bevan, Board Secretary Report Author(s): Report Received consideration and supported by : Executive Committee of the Board N/A Team [Committee Name] Date of the Report: 12 th January 2018 Supplementary Papers Attached: The following Committee minutes will be available for members on Boardbooks and will be available on the Health Board s website. Quality and Patient Safety Committee 1 st November 2017 Public Partnerships and Wellbeing Committee 9 th November 2017 Finance and Performance Committee 14 th December 2017 Planning and Strategic Change Committee 13 th December 2017 Audit Committee 7 th December 2017 Stakeholder Reference Group 17 th November Public Board Meeting - 24th Janury /01/18 19 of 145

20 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports 2 Background The Health Board s Standing Orders, approved in line with Welsh Assembly Government guidance, require that a number of Board Committees are established. In line with this guidance, the following Committees and advisory groups have been established: 3.1 Audit Committee Charitable Funds Committee Quality and Patient Safety Committee Information Governance Committee Remuneration and Terms of Service Committee Stakeholder Reference Group Healthcare Professionals Forum The Board has established the following additional Committees: Finance and Performance Committee Planning and Strategic Change Committee Public Partnerships and Well Being Committee 3 Assurance Reporting The following Committee and advisory group summary assurance reports are included for adoption by the Board: Audit Committee Finance and Performance Committee Planning and Strategic Change Committee Quality and Patient Safety Committee Public Partnerships and Wellbeing Committee Stakeholder Reference Group 3.1 External Committees and Group Representatives from the Health Board also attend a number of external Joint Committees and Groups. In order to provide the Board with an update on the work of these Committees and Groups the minutes and assurance report are included for the Board for the following Committee: Emergency Ambulance Services Committee: Assurance report for the meeting held on 28 th November 2017 and minutes of the Meeting held on 26 th September of 145 Public Board Meeting - 24th Janury /01/18

21 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports 4 Recommendations The Board is asked to note this report, to adopt the minutes which are available in the Supplementary Papers section of the agenda papers and to approve the identified Terms of Reference. 3.1 Assessment of the Impact of the Report: Financial Assessment There is no direct financial impact associated with this report. Link to Integrated Medium Term Plan There is no direct link to the IMTP associated with this report. Risk Assessment There are no key risks with this report. However, it is good governance practice to ensure that Committee business and minutes are reported to the Board. Therefore each of the assurance reports might include key risks being highlighted by Committees. Quality, Safety and Patient Experience A quality, safety and patient experience assessment has not been undertaken for this report as it is for assurance purposes. Assessment Health and Care This report would contribute to the good Standards Equality and Diversity Impact Assessment (including child impact assessment) governance elements of the Standards. Equality, diversity and child impact assessments have not been undertaken for this report as it is for assurance purposes. 3 Public Board Meeting - 24th Janury /01/18 21 of 145

22 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Audit Committee Name of Committee: Audit Committee Chair of Committee: Catherine Brown Reporting Period: 7 th December 2017 Key Decisions and Matters Considered by the Committee: There were a number of matters considered and discussed by the Committee including the following: WAO Progress Report The Committee was advised that the WAO audit plan would be presented to the Committee in February It was confirmed that the fieldwork for the structured assessment of the Health Board had been completed. The structured assessment would be formally presented to the Board in January WAO Discharge Planning Report The Committee discussed the previous performance of the Health Board in relation to discharge planning. It was acknowledged that a new approach was in the process of being cascaded throughout the organisation which enabled a multi-disciplinary approach. It was agreed that the evaluation review which was due to be presented to the Public Service Boards (PSBs), alongside the anticipated HIW report on discharge planning, would be presented to the Quality and Patient Safety Committee and the Audit Committee, for information, in due course. Collaborative Arrangements for Managing Local Public Health Resources The Committee received the report and considered the findings within it. Although this was a National report, it had wider implications for the Health Board. The Committee was assured that good governance arrangements were in place between the Health Board and Public Health Wales and a detailed programme management plan was in place to ensure all recommendations were implemented. Public Procurement in Wales Report The Committee was advised that National work was underway to enable NHS organisations to work more collaboratively in relation to procurement. Internal Audit Progress Report The Committee was advised that the Health Board s position this year in relation to previous year s performance, had significantly improved and the report was noted. Cardiac Catheter Laboratory Replacement The Committee received the limited assurance report and noted that since the report had been finalised a significant amount of learning had taken place organisationally. A number of processes that were already in place had been refocused and awareness raising and training had taken place within teams. A follow up procurement audit was planned for early Update on Governance, FCPs and Technical Accounting Issues The Chair requested an assurance map to be developed so enable to Board to be confident that the audit resource was being appropriately applied to key areas of risk and to avoid duplication of work between WAO and Internal Audit. The Committee also requested an update on clinical audit and how the clinical audit programme was informed by risk analysis, for the next meeting. The Committee was advised of the recent voluntary disclosure to HMRC with of 145 Public Board Meeting - 24th Janury /01/18

23 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports regard to tax regulations and benefit in kind schemes such as the employee salary sacrifice for technology etc. The financial implication of this could potentially impact the Health Board in this financial year. It was agreed for a report to be developed for the February 2018 meeting that also recognised the risk to staff morale and welfare alongside financial and reputational risks. Corporate Risk Register and Dashboard - The Committee noted the risk register and acknowledged that this was a work in progress. It was agreed that a review of the Risk Management Strategy would be undertaken at the February 2018 meeting. Matters Requiring Board Level Consideration or Approval: There were no matters requiring Board level consideration or approval. Key Risks and Issues/Matters of Concern: There were no key risks and issues/matters of concern. Planned Committee Business for the Next Reporting Period: Laundry assurance note Update on Governance, FCPs and Technical Accounting Issues Risk Management Strategy Annual Review Corporate Risk Register and Dashboard WAO Audit Plan Internal Audit Progress Report Date of Next Meeting: Thursday 8 th February Public Board Meeting - 24th Janury /01/18 23 of 145

24 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Finance and Performance Committee Name of Committee: Finance and Performance Committee Chair of Committee: Shelley Bosson Reporting Period: 14 th December 2017 Key Decisions and Matters Considered by the Committee: Workforce Performance Report Update The Committee agreed a number of key additions to be added for the next report: A trend analysis on vacancies over the last 12 months. A detailed report on the implementation of the sickness absence policy following further development of the Core Skills for Managers. An in-depth review of the quality of data captured via the PADR. A strategic discussion in relation to staff engagement and Clinical Futures. Medical Caps Report Following the recent Welsh Health Circular (WHC) on capping medical agency rates the first interim report was received. A rationale would be included in relation to the Health Board s position regarding the statutory duty. Month 7 Performance Report It was requested that trend analysis be included in future reports. It was also requested that the short term analysis in relation to Ophthalmology be reported to a future meeting. The Committee discussed health inequalities across the Health Board area and that, as a Board, that these concerns were being addressed. It was agreed that the Health Board would identify information in relation to health inequalities was available and incorporate this in to the next performance report. Month 8 Finance Report The Committee requested a further report at the next meeting on efficiency plans and the planning and methodology for deciding which plans are taken forward, current plans alongside anticipated risks and if the cost savings are likely to be recurring or non-recurring. Committee Risk Register The Committee received the risk register and it was noted that a Board Development Session on risk management was planned for 20 th December 2017 and further development work would be undertaken after this session had taken place. Matters Requiring Board Level Consideration or Approval: There were no matters for Board consideration. Key Risks and Issues/Matters of Concern: There were no issues or matters of concern. Planned Committee Business for the Next Reporting Period: Workforce Performance Report Performance Report of 145 Public Board Meeting - 24th Janury /01/18

25 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Efficiencies Report Proposals to Develop the Implementation of a Single Cancer Pathway Committee Risk Register Date of Next Meeting: Tuesday 31 st January 2018 at 9.30am in the Executive Meeting Room, Health Board Headquarters, St Cadoc s Hospital, Caerleon Public Board Meeting - 24th Janury /01/18 25 of 145

26 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Planning and Strategic Change Committee Name of Committee: Planning and Strategic Change Committee Chair of Committee: Professor Dianne Watkins Reporting Period: 13 December 2017 Key Decisions and Matters Considered by the Committee: Transforming Cancer Services The Committee received a presentation and supporting information on the changes to cancer services being proposed by Velindre NHS Trust, and the Health Board s requirements would be articulated into the Outline Business Case. 3.1 Clinical Futures (General Update) The Committee was assured by the general update provided on progress with the programme. Clinical Futures (Delivering and Resourcing the Programme) A paper seeking additional funding to support the programme would be prepared for Welsh Government and discussions were ongoing. Clinical Futures (Service Redesign) The Committee was provided with a presentation on the work to date and supported the pathway and modelling work being undertaken. The Committee was also encouraged by the work completed to date and the proposed next steps. Clinical Futures (Clinical Leadership) The idea of a Clinical Senate was discussed, with further discussion on the value of such a system to follow outside of the meeting. Clinical Futures (Citizen and Stakeholder Engagement) The Committee was assured by the work being carried out on community engagement and generally by the communication and engagement undertaken, and noted the increased importance of social media. IMTP 2018/2019 An update was provided to the Committee in relation to service, workforce and finance, with a number of measures reported regarding population health and wellbeing. The finance aspects were of concern and actions would be required in order to provide a balanced and approvable IMTP by March Matters Requiring Board Level Consideration: There were no items for Board consideration of 145 Public Board Meeting - 24th Janury /01/18

27 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Key Risks and Issues/Matters of Concern: The financial aspect of the IMTP was of concern to the Committee. Planned Committee Business for the Next Reporting Period: Planned Care Programme priorities for Orthopaedics Future delivery of Pathology Services in Wales All Wales Laundry Review Outline Business Case Clinical Futures Resource Plan to be reported Upper GI Services 3.1 Date of Next Meeting: 13 February Public Board Meeting - 24th Janury /01/18 27 of 145

28 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Quality and Patient Safety Committee Name of Committee: Quality and Patient Safety Committee Chair of Committee: Professor Dianne Watkins Reporting Period: 1 November 2017 Key Decisions and Matters Considered by the Committee: Winter Plan (Quality and Safety Contingency Plans to Manage Risk) the Committee received a presentation on the Winter Plan and the further developments made for 2017/2018. Further work was also being taken forward, especially with social care and Third Sector partners to better manage the wider care system. 3.1 The availability of nurse staffing levels was noted to be a risk to the organisation, due to the legal obligation to provide adequate levels of qualified nursing staff and the current workforce availability. Moving Towards a Value Based Organisation The Committee was provided with a presentation on the structure of the Value Based Healthcare Programme and its progress. A presentation on Parkinson s disease was requested at a future meeting. It was noted that enhanced in-house IT capability and capacity would allow the programme to achieve its aim. Quality, Safety and Performance Overview The Committee received the report, together with the relevant updates. The Risk Register and QPSOG Assurance Report were also received. Health and Care Standards Progress Update The report was received and progress noted. It was noted within the management response that the escalation processes would be agreed at the next Health and Care Standards Group meeting. Research and Development Annual Report and Strategy The annual report was provided to the Committee, and the issue of continuity of Welsh Government funding was highlighted. ABCi Update The work undertaken by ABCi was highlighted to the Committee via a presentation, as well as future plans. It was reported that work priorities were now aligned to the IMTP. Cancer Patient Experience Survey Results 2016 National Report The Committee received the results of the Wales Cancer Patient Experience Survey (WCPES) and the actions taken to improve the experience for cancer patients. The actions taken were noted and the Committee received the report of 145 Public Board Meeting - 24th Janury /01/18

29 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Matters Requiring Board Level Consideration: Nurse staffing levels and the plans to respond to the legal requirements given the current availability of qualified staff. 3.1 Key Risks and Issues/Matters of Concern: Issue: In house IT capability and capacity regarding the Value Based Healthcare Programme would further enhance this programme. Planned Committee Business for the Next Reporting Period: Ligature Risk Improvement Programme Update Update on the mid-summer/autumn position of the Quality, Safety and Performance regarding Diabetes Update on Parkinson s Date of Next Meeting: 14 February Public Board Meeting - 24th Janury /01/18 29 of 145

30 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Public Partnerships and Wellbeing Committee Name of Committee: Public Partnerships and WellBeing Chair of Committee: Phillip Robson Reporting Committee 9 th November 2017 Period: Key Decisions and Matters Considered by the Committee: There were a number of matters considered and discussed by the Committee including the following: 3.1 Risk Register - The Committee discussed the Risk Register and noted that the risks were consistent with the Committee s work programme. The Committee discussed the Inverse Care Law and proportionate universalism and agreed for the Committee to receive a presentation at the next meeting to provide assurance regarding the Health Board s position. Gwent Regional Well Being Assessment and Priorities Identification Project Outcome The Committee received an overview and update on the proposed set of indicators for the agreed ABUHB priorities for the five Gwent Public Service Board Well-being Plans. The Committee was advised that the wellbeing plans were currently out for consultation and received assurance that the priories and indicators fitted into the IMTP. Update on the Process for Developing the Health Board s Response to the Gwent PSBs Wellbeing Plans The Committee was advised of the process for developing the Health Board s response. A formal response to each draft plan would be required and the PSB plans would be agreed at the Board meeting in March Independent Members provided feedback from recent PSB meetings and noted that they were all making excellent progress. Plan for a Primary Care Service for Wales up to March 2018 The Committee received an update on the divisional progress in taking forward the broad components of the Primary Care Plan for Wales. The Committee was advised of the issues with the WCCIS roll out and it was recognised that this was an Information Governance Committee issue which potentially needed to be escalated. It was agreed for the Committee to receive progress update reports in the future on a six monthly basis. Primary Care Annual Report The Committee received the Primary Care Annual Report for 2016/17, highlighting the key developments for all Independent Contractors and identified priorities for 2017/18. It was agreed to look into whether the of 145 Public Board Meeting - 24th Janury /01/18

31 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports relaxation in QOF should be re-instated. The Committee discussed the new developments and agreed for an assurance report to be presented to the Committee meeting in February. 3.1 Social Services and Wellbeing Act Regional Partnership Board Minutes - The Committee received and noted the minutes from the Social Services and Wellbeing Act Regional Partnership Board minutes from Thursday 7 th September Matters Requiring Board Level Consideration or Approval: There were none. Key Risks and Issues/Matters of Concern: There were none. Planned Committee Business for the Next Reporting Period: PSB Wellbeing Plans Primary Care Developments School Aged Immunisation Programme Update Date of Next Meeting: Tuesday 6 th February 2018, St Cadocs Hospital, Headquarters 13 Public Board Meeting - 24th Janury /01/18 31 of 145

32 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Stakeholder Reference Group Name of Committee: Stakeholder Reference Group Chair of Committee: Lorraine Morgan Reporting Period: 17 November 2017 Key Decisions and Matters Considered by the Committee: There were a number of matters considered and discussed by the Committee including the following: 3.1 Engagement Current Processes - the Group received an update in respect of the engagement processes for: Thoracic Surgery Services in Wales Older Adult Mental Health Services in Gwent Major Trauma Services in South Wales It was agreed for a presentation on patient engagement to be presented at a future meeting. Clinical Futures Update - The Group were introduced to the new Associate Director for Service Redesign and received an update in relation to Clinical Futures and the redesigning of services for the future. The Group discussed the design principles and a number of suggestions were made regarding the terminology used, which would be considered. It was advised that the SRG would act as a communication group and receive a progress update at each meeting in the future. 111 Update The Group received an update on the 111 programme, including the vision for the service and the National Programme timings. It was acknowledged that ABUHB was ready to go live in February 2018 as originally planned, however this date had slipped to the last quarter of 2018 due to circumstances beyond their control. The Group discussed the next steps and it was highlighted that the baseline was being outlined and benchmarked in readiness for Board in November 2017, with final Board sign off due mid/end Report from the Chair and the Aneurin Bevan University Health Board Meeting Wednesday 31 st May The Group received the Chair s report from the last Board meeting. SRG Work Programme The Group discussed key issues which required addressing in 2018, which would form the work programme for the coming year. Matters Requiring Board Level Consideration or Approval: None of 145 Public Board Meeting - 24th Janury /01/18

33 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Key Risks and Issues/Matters of Concern: None Planned Committee business for the Next Reporting Period: Clinical Futures Update Younger Adult Mental Health, Learning Disabilities and Autism Presentation 3.1 Date of Next Meeting: Tuesday 27 th February 2018, 9.30am, Executive Meeting Room, ABUHB Headquarters, St Cadocs 15 Public Board Meeting - 24th Janury /01/18 33 of 145

34 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports Reporting Committee Chaired by Lead Executive Directors Author and contact details. Emergency Ambulance Services Committee Professor Siobhan McClelland Health Board / Trust Chief Executives Robert.Williams@wales.nhs.uk Date of last meeting 28 November 2017 Summary of key matters including achievements and progress considered by the Committee and any related decisions made. An electronic link to the papers considered by the EAS Joint Committee is provided via the following link: EASC Joint Committee Meeting Agenda & Papers 28 November COMMITTEE MEMBER ATTENDANCE The Chair expressed her concerns regarding Chief Executive attendance as required by the standing orders of the Joint Committee. She confirmed that she had written to some Members regarding their attendance and by exception, if absence was unavoidable, sending Executive Directors as their representative. The Chair expressed her ongoing concern which was discussed in detail with those present. It was NOTED that Cardiff & Vale UHB were not represented at the meeting and that the meeting was not quorate in part, due to insufficient Chief Executive Officers being present. TERMS OF REFERENCE FOR JOINT COMMITTEE SUB GROUPS Members reviewed discussed and APROVED the proposed Terms of Reference for the following two new Sub Groups, agreed following discussion in relation to the Wales Audit Office Report and Recommendations; The Planning, Delivery and Evaluation Group The Joint Management Assurance Group Members discussed the importance of ensuring the right level of representative attended meetings on behalf of Health Boards / Trusts, which would also help to mitigate matters being overly escalated to Joint Committee and allow the Sub Groups to discharge their delegated authority. The Chair expressed her concern that despite direct communication from her, nominations for the sub groups had yet to be received from some Health Boards and had been provided late by others. As a consequence the first meetings of both the PDEG and JMAG were poorly attended. The Chair requested that nominations were sent as a matter of urgency. EASC Committee Chair s report Page 1 of 4 Emergency Ambulance Services Committee 28 November of 145 Public Board Meeting - 24th Janury /01/18

35 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports CHAIR S UPDATE The Chair confirmed that her appraisal with the Cabinet Secretary for Health, Well-Being and Sport, had been postponed and was being rearranged. Members NOTED a scheduled meeting with the Cabinet Sectary and the All Wales Chairs for December CHIEF AMBULANCE SERVICES COMMISSIONER (CASC) UPDATE Mr Stephen Harrhy, CASC, provided an update to the Joint Committee on progress with the following key matters: Healthcare Professional Calls Members received an update from the CASC on discussions that had taken place with Chief Operating Officers, which focused on closer working between Welsh Ambulance Services Trust (WAST) staff and hospital Bed Managers, to better coordinate patient flow. The meeting also discussed options around Direct access and capturing related data. Further discussions were scheduled to take place with All Wales Medical Directors and the All Wales Directors of Planning and that the CASC would also be meeting with the All Wales Primary Care leads in order to progress related work. Hear and Treat Members NOTED that Welsh Government had indicated their intention to fund arrangements for Hear & Treat. The CASC agreed to send a letter of confirmation outlining the funding arrangements to Members. EASC COMMISSIONING INTENTIONS AND ALIGNMENT WITH IMTPs Members received and NOTED the report regarding this matter and discussed in some detail areas for improvement. In APPROVING the document, Members discussed the importance of ensuring more of a shift left in the patient pathway, with increased focus and activity on steps 1 and 2 (activity prior to deployment to Hospital) and the importance that this is more appropriately reflected within commissioning intentions but also organisations IMTPs. There was agreement to also discuss this further within a development session of the Committee. The CASC AGREED to write out to Directors of Planning confirming the agreed arrangements. Non Emergency Transport Services (NEPTS) Update Members received and NOTED an update on NEPTS and the extensive engagement and discussions that had taken place enabling the Assurance Framework to go live in a shadow form from 1 st November Work would continue between Health Boards and WAST on enacting the plurality model, and there is an expectation of at least one Health Board transferring their outsourced arrangements to WAST by 31 st March 2018, Members NOTED that this is likely to be Cardiff & Vale UHB.. EMRTS UPDATE Members received and NOTED the EMRTS update report and NOTED the related connections to the consultation exercise taking place on Major Trauma services in South Wales. EASC Committee Chair s report Page 2 of 4 Emergency Ambulance Services Committee 28 November 2017 Public Board Meeting - 24th Janury /01/18 35 of 145

36 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports WAST RECRUITMENT and RESOURCING Update Members received and NOTED an update from WAST following recent media interest in related WAST staffing issue, following which the Chair had requested an update to Joint Committee, as the matters reported had not been raised by exception to the Committee. Members received assurance from WAST that a successful summer recruitment drive had allowed them to recruit more staff than originally planned, but that this would help improve efficiency in staffing management, with a reduction in overtime and external private provider support. 3.1 IMPLEMENTATION AND BENEFITS REALISATION OF BAND 6 PARAMEDICS IN WALES Members received an update on the progress being made in partnership with Staff representatives to deliver and implement the All Wales agreement. The Committee emphasised the importance of ensuring that anticipated benefits were fully captured and realised, including some of the more immediate benefits that could be realised even in year 1 and it was important to ensure if possible that these are grasped. COMPUTER AIDED DISPATCH SYSTEM Members received an update on progress with implementation of the new Computer Aided Dispatch System (CADS). Members, whilst noting that there would be some impact on performance, the full extent needing to be quantified, congratulated WAST staff for successfully implementing such a significant project. GOVERNANCE & ASSURANCE Members received sub group Chair reports and related minutes, including; Non Emergency Patient Transport Services (NEPTS) Commissioning and Delivery Assurance Group Quality Assurance & Improvement Panel Action Notes EMRTS Delivery Assurance Group Chair s Summary Planning, Development and Assurance Group Chair s Summary. WALES AUDIT OFFICE REPORT AND MANAGEMENT RESPONSE Members received and discussed progress against the Management Action Plan and NOTED actions outstanding. Members NOTED that the Memorandum of Understanding between CASC, EASC, WAST and Welsh Government would need to be progressed and it was felt that conclusion of this item would inform the presentation of the complete set of related revised documentation for adoption by Member Health Boards before the end of the current financial year. The Committee Secretary will liaise with Board Secretaries in order for the revisions to be adopted by respective Health Boards. AMBULANCE QUALITY INDICATORS The Committee received the latest AQIs and discussed their use within respective Health Boards and the need to progress further work as agreed with the Cabinet Secretary on patient related experience and outcomes. FINANCE REPORT Mr S Davies presented the Month 7 EASC Finance report. EASC Committee Chair s report Page 3 of 4 Emergency Ambulance Services Committee 28 November of 145 Public Board Meeting - 24th Janury /01/18

37 Tab 3.1 Committee and Advisory Group Chairs' Assurance Reports JOINT COMMITTEE RISK REGISTER The Committee received, reviewed and endorsed the updated Joint Committee Risk Register NOTING the risks associated with Major Trauma and implications on EMRTS is assessed and added. 3.1 FORWARD WORK PROGRAMME The Committee received and noted the Committee Forward Work Programme, which would be updated further following discussions at the meeting. Key risks and issues/matters of concern and any mitigating actions The Committee NOTED matters considered within the Risk Register and suggested some related further work with WAST on mitigations. Matters requiring Board level consideration and/or approval It is important that generally Boards are aware at Board level and as appropriate, Committee level, of matters relating to the work of the Emergency Ambulance Services Committee and their place within the broader unscheduled care system. Forward Work Programme At its January 2018 meeting, in addition to the routine items that feature at every meeting of the Joint Committee, the following agenda items are planned: o Service Change (Development discussion) o Emergency Ambulance Performance and Winter Planning Committee minutes submitted (insert ) Yes No Date of next meeting 29 January 2018 EASC Committee Chair s report Page 4 of 4 Emergency Ambulance Services Committee 28 November 2017 Public Board Meeting - 24th Janury /01/18 37 of 145

38 Tab 3.2 Executive Team Report Wednesday 22 November 2017 Agenda Item: 3.2 Executive Team Report Purpose of the Report: This report provides the Board with an overview of current activities of the Executive Team, key issues locally, regionally and in NHS Wales. This report also highlights any key risks or matters of interest for the Board. Recommendation: The Board is asked to receive this report for assurance and information. The Board is asked to: (please tick as appropriate) Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance Note the Report for Information Only Executive Sponsor: Judith Paget, Chief Executive Report Author: Richard Bevan, Board Secretary Report Received consideration and supported by : Executive Committee of the Board N/A Team [Committee Name] Date of the Report: 12 th January 2018 Supplementary Papers Attached: N/A Background This report provides the Board with an overview of current activities of the Executive Team and key issues locally, regionally and in NHS Wales. This report also highlights any other key risks or matters of interest for the Board. The report also provides the opportunity to bring forward items to the Health Board to demonstrate in public, areas that are being progressed and achievements that are being made that might not be brought to the Board as key discussion papers. This report also provides an opportunity to highlight areas that can be brought back for future meetings. 2. General Activity of the Executive Team Weekly Executive Team Meetings: The Executive Team continue to meet formally on a weekly basis and our meetings cover a range of strategic, policy, performance, operational, workforce and risk based matters, which require Executive Team consideration 1 38 of 145 Public Board Meeting - 24th Janury /01/18

39 Tab 3.2 Executive Team Report and/or approval. Many of these items are converted into the strategic or performance based reports received by the Board and its Committees. 3.2 The Executive Team has also instigated a series of Executive Team Development Sessions, which are providing opportunities to discuss more informally ways of working and development ideas and approaches. Clinical Futures Programme Delivery Board: One meeting of the Executive Team per month is also converted to a Clinical Futures Programme Delivery Board. This Group monitors and advises the detailed implementation of the Health Board s Clinical Futures Programmes through monitoring of a number of key work streams and associated action plans. A more detailed report on this activity is provided on this Health Board agenda. Following a successful event in August, the next in the series of Clinical Futures Clinical Engagement Events was held on the 5 th December There were 130 attendees at the event, mainly clinical and/or senior leaders and positive feedback was provided. Topics included a programme overview followed by service model speed dating sessions with Clinical Leaders on child health, therapies, emergency department, acute medical take, out of hospital community integrated services. Senior Leaders Events: The Executive Team also organise during the year a programme of events for senior leaders from across the organisations. These are focused on key topics and seek to engage the leadership of the organisations in innovative ways to focus on priority areas for the Health Board. The latest event was attended by 100 staff and focused on the digital delivery of the Clinical Futures Programme. Executive Board Meetings: The Executive Team also meets monthly with the senior leaders from the Health Board s Divisions as an Executive Board, which allows key strategic, performance and investment proposals to be further discussed and where appropriate approved. The last meeting held at the end of November, focused on a review of the Health Board s progress against the recommendations of the Professor Bell Report into the Health Board s unscheduled care system. The meeting also discussed the Health Board s readiness for the Nurse Staffing Act. The Executive Board Meetings also provides a mechanism through which the organisation focuses on the cross cutting themes of the 2 Public Board Meeting - 24th Janury /01/18 39 of 145

40 Tab 3.2 Executive Team Report IMTP and discusses further options and opportunities to deliver the IMTP. Executive Led Talk Health Events: The Executive Team Members have also been actively participating in a range of Talk Health Events in each of the Local Authority areas covered by the Health Board. At these events, Executive Team members along with other colleagues make presentations and engage in question and answer sessions with local people who attend these events. Individual events were held in Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen during National and Regional Meetings: Executive Team Members continue to engage in a range of National and Regional Partnership meetings. Nationally each of the Executive Team Members participate in meetings with their equivalent colleagues from each of the NHS organisations in Wales and professional leads in Welsh Government. They also participate in a range of national and regional planning groups and the products of some of these are key consultations that have been running across South Wales e.g. Thoracic Surgery and proposals for the establishment of a Major Trauma Centre. The Health Board is currently arranging an additional special meeting at the end of March 2018 to consider the feedback from the Major Trauma Centre consultation and agree next steps. Organisational Visits: The Executive Team Members regularly visit sites and services across the Health Board to discuss with staff and teams current developments, key issues and risks. A particular focus of recent visits have been associated with service pressures during the winter to ensure that teams and staff across the Health Board are directly support by the Executive Team and also ensure that information from the front line is fed into our ongoing plans and response. Shadowing: Over the last few years, starting in 2015, the Executive Team have had the opportunity to shadow staff and teams from across the organisation. Feedback from both the Executive Team and staff regarding the visits has been extremely positive, with the Executive Team keen to conduct further shadowing visits. Reports of the shadowing visits have been shared with all staff through posts on our Health Board intranet. The Executive Team is in the process of undertaking a further round of shadowing visits. Suggestions are generated openly through requests to all staff via the Intranet to suggest a shadowing visit of 145 Public Board Meeting - 24th Janury /01/18

41 Tab 3.2 Executive Team Report Recent shadowing visits by Executive Team members have included: Patient Scheduling Team in Urology at the Royal Gwent Hospital Community Neurological Rehabilitation Service Pets in Therapy Neuro Physio Outpatients department at County Hospital District Nursing Team, Newport 3.2 Drop-in Sessions: The Chief Executive undertakes drop-in sessions across the Health Board s sites and services. These sessions offer opportunities for staff to meet with the Chief Executive and to talk about their experience of working with the Health Board and any suggestions they may have. This approach is supplemented by on-line opportunities where staff can raise issues and suggestions through on-line platforms such the Ask the Chief Executive Forum. Current key themes on the on-line forum include: - Car parking on a range of different sites - Policy for carers - Staff counselling and staff well being - General works and estates issues. Clinical Futures Programme Staff Drop-in Sessions: As part of the organisation s approach to our Clinical Futures Programmes and to ensure increased staff awareness and engagement in the next stages of implementation of the Strategy a series of staff drop-in session have started from November and will run over the next few months. These are taking place at venues right across the Health Board, where colleagues are providing an overview of the Strategy and seeking any questions or queries from staff. As a result a Frequently Asked Questions Briefing is also being developed. Regional Gwent Partnership Board Social Services and Well Being Act: The five Local Authorities and the Health Board have established a Regional Partnership Board to implement the Social Services and Well-being Act (Wales). The membership of the Board has been set out in statute and, following a period in shadow form, is now a statutory Board. In addition to the statutory organisational membership, there is representation from the Third Sector, Service Providers and citizens group. The Gwent Regional Partnership Board is chaired by Phil Robson, Vice Chair of the Health Board and the Chair, Chief Executive, Chief Operating Officer and Director of Public Health are all members. 4 Public Board Meeting - 24th Janury /01/18 41 of 145

42 Tab 3.2 Executive Team Report Supporting this Board is a Leadership Group, which is chaired by the Chief Executive of the Health Board. Membership of this Group also includes Directors of Social Services, the Chief Executives of Gwent Association for Voluntary Organisations and Torfaen Voluntary Alliance. A full review of the governance structure has recently been undertaken. 3.2 The Partnership Board met on Thursday 11 th January 2018 and was visited by Huw Irranca-Davies AM, Minister for Children and Social Care. The Minister commended the Partnership on the progress it had made particularly with arrangements for pooled budgets and the business processes for the Integrated Care Fund (ICF). The Partnership Board also discussed the development of a Well Being Area Plan for the Gwent area. Engagement on the plan is currently being undertaken and will be submitted to the Board in March 2018 for approval. Health Board Meetings with Local Authority Partners: In addition to our work as outlined above, the Health Board also undertakes a series of joint meetings with each of the five local authorities. Representatives of the Executive Team and Chair or Vice Chair meet with elected and officer representatives of each Council. This can be with the Council Executive, the Full Council, Scrutiny Committee or specially organised session. The arrangements differ between councils and across time. The latest of these events was held with Torfaen County Borough Council on Monday 15 th January A programme for the coming year is being finalised. 3. Reflections on Current Pressures in Unscheduled Care Breaking the Cycle: Prior to the Christmas and New Year Bank Holidays festive period the Health Board conducted a breaking the cycle week as part of our winter plan. This had a focus on reviewing all patients over 7 days length of stay in acute hospitals and over 14 days length of stay in our community hospitals. The effect of this is our medically fit numbers before Christmas rose to 202 patients, which is what we usually see in the first week of January. Currently however, we are running at 137 patients and our social care partners are aware of keeping this number on track over the next two weeks. This remains a risk specifically around packages of care and we are working on a bridging plan to utilise residential homes for appropriate patients of 145 Public Board Meeting - 24th Janury /01/18

43 Tab 3.2 Executive Team Report The feedback from our leaders in community teams is that this has made a difference in addressing earlier any difficulties in appropriately discharging patients within their agreed pathway of care. We therefore have been able to release all our community beds from the first week of January to enable flow from our acute hospital sites. 3.2 We are launching in mid January a second breaking the cycle period to ensure we have the required flow in the system now that all the capacity is open. Bed capacity: The Health Board opened all our beds as per plan and we did not need to open capacity earlier than outlined in the plan as had happened in previous years. Our referral rates from our emergency departments and assessment units pre-christmas were higher than forecasted. Themes reported were respiratory illness, flu like symptoms and diarrhoea and vomiting. Prior to Christmas our critical care capacity was at full occupancy and this was reported as being similar in other health boards. Emergency Departments: Our clinical director for emergency medicine s views have been sought and his perspective is that whilst there have been periods of delays, congestion and significant pressure, there is definitely an improvement in flow and responsiveness of the wider system this year compared to previous years. Therefore, our escalation and combined plans appear to be having an impact. Clearly there have been long ambulance delays on occasions. This has been compounded by the need of control of infection procedures for patients arriving with infective signs and symptoms. Staff Feedback: Whilst this has been a challenging time for our staff across all of our services the feedback we have received is that the period to date feels a lot better than previous years. Views have been sought from our clinical and operational leaders across the system. Health Care Professional calls: There has been a peak increase in calls from primary care into secondary care as per patterns in previous years. Whilst there has been an increase in demand, it is the type of disease patterns as indicated above that have added the complexity and the need to isolate an increasing number of patients presenting. Escalation levels: On New Year s Day the Health Board reported red escalation with risk scores of 20 on all sites. This de-escalated 6 Public Board Meeting - 24th Janury /01/18 43 of 145

44 Tab 3.2 Executive Team Report to amber and a risk score of 16 or less by the 3 rd of January Last year we remained in red escalation with high risk scores up to 7 days. 3.2 Our overnight activity is on occasions increasing our escalation level, but risk scores remain less than 16 and we have plans in place to maintain escalation levels at amber or below going forward. On the 9 th January our escalation increased to red again for a 16 hour period only. Working with the Welsh Ambulance Services NHS Trust (WAST): It has been positive that WAST have replicated our Gold operational presence approach and this has supported ambulance releases. We have provided WAST with a plan on each night to cover the next day. They are also supporting management of our live demand and we are using our alternative pathways where they clinically considered that this is possible and appropriate. Hear and treat rates have improved from previous low levels over the past three days. This is certainly supporting our handover responses. Elective activity: The Health Board has continued to treat all cancer patients as planned. We have an elective plan that is specific for January but due to the requirement of additional capacity we have cancelled some non-urgent cases, but our elective surgery has now returned to plan. Communication: The Health Board has also been actively engaging with the media and social media to highlight the pressures on our services, respond to patient queries and requests for more information and also to highlight the developments and initiatives put in place within the Health Board and in partnership. A series of media releases and video pieces have been developed and are being used by the media. Dedicated Discharge Coordinators helping to keep hospitals running smoothly: Discharge Coordinators are a small but increasingly vital part of the Health Board s workforce. Discharge co-ordinators pave the way for patients to go home by carrying out a variety of tasks, from ensuring that care and support packages are in place for patients, to ensuring they are discharged at an appropriate time of the day. They also help organise transfers, 7 44 of 145 Public Board Meeting - 24th Janury /01/18

45 Tab 3.2 Executive Team Report for instance if a patient requires a period of rehabilitation at a different hospital. In itself, the role is nothing new but has more traditionally been carried out by nursing staff as part of their duties. At the Royal Gwent, Nevill Hall and Ysbyty Ystrad Fawr hospitals, however, none of the discharge coordinators are qualified nurses, but instead are tasked specifically to plan patients' discharges or transfers, a process that begins on admission. 3.2 has led the way in making the role a dedicated one, freeing up nursing staff on medical wards so they can concentrate on delivering care. A year ago, older patients had an average length of stay in hospital approaching two weeks, but since the introduction of discharge coordinators this has been reduced by four days. Endocrine patients stay in the Royal Gwent an average of two-anda-half days less than they did a year ago, while since last May average lengths of stay in gastroenterology and cardiology have fallen by one-and-a-half days. 4. Key Issues and Notable Achievements and Updates Incident at Ysbyty Aneurin Bevan On Thursday 11 th January at Ysbyty Aneurin a vehicle was driven into the front entrance of the hospital. Following this, the entrance has been made secure, however further work is required for the specialist installation of a new front door, which may take up to 6 weeks. During this period, access to the hospital will be via the Cwm Coch entrance and appropriate signage has been provided for all visitors and patients who visit. An alternative entrance to outpatients, therapies and radiology is available for disabled patients and this is also signposted from the road. Colleagues within partner agencies, including WAST, are fully briefed and are working closely with the Health Board. Car parking is not affected and the disabled parking provision both in front and to the side of the hospital is still available. Wheelchairs will be provided by the temporary entrance. Members of the Executive Team have visited, or will be visiting, the hospital over the coming days to engage with staff and to show direct support for the hospital. 8 Public Board Meeting - 24th Janury /01/18 45 of 145

46 Tab 3.2 Executive Team Report Newport to be a Pilot Site for the Buurtzorg Approach: It has been agreed by the Cabinet Secretary that three areas of Wales should pilot the Buurtzorg approach, testing Neighbourhood District Nursing in Urban, Rural and Valley locations in the following areas. This is based on a Dutch model of integrated health and personal care delivered by small teams of self-managed nurses working in the community. 3.2 In announcing the selection of Newport, Dr Andrew Goodall, Director General for Health and Social Services and Chief Execuitive of the NHS in Wales indicated that primary care in the Newport area has already expressed an interest in Buurtzorg and is not only an urban area but one with significant deprivation and a city regeneration programme that is developing schools and neighbourhoods. The Health Board also has a track record of successful integrated neighbourhood based services. Befriending initiative is bringing generations together: A recently developed partnership which has brought together schoolchildren and older patients is bringing benefits for local communities. The intergenerational befriending initiative involves Year 6 pupils from Griffithstown Primary School visiting units for older patients. This has proved very successful with positive outcomes. Research shows that when generations come together that everyone can benefit. This initiative is in line with Welsh Health Policy, the Older People s Commissioner for Wales and The Children s Commissioner for Wales, promoting Intergenerational activities. The Health Board has provided Dementia Friend Awareness sessions to all the teachers of the school and Year 6 pupils. Such Intergenerational activities can reduce any negative stereotypes of the older person, reduce loneliness and isolation, and improve people s wellbeing and sense of self-worth. Activities during visits have ranged from learning how to play dominoes, arts, crafts, getting to know you talking, singing, dancing, and decorating zimmer frames with the patients. A multidisciplinary team is now being planned to sustain and improve this initiative. Staff have spoken to the children about their jobs to enhance their understanding of their roles, with some stating that they now want to become a nurse or doctor of 145 Public Board Meeting - 24th Janury /01/18

47 Tab 3.2 Executive Team Report Tredegar set to get new health and social care 'supersurgery' within four years: A proposal to build a new health and social care centre in Tredegar has been approved for funding by the Welsh Government. A business case for the new centre was developed by the Health Board and has been approved by the Welsh Government. The centre will host family doctors and a range of other health and social care services and is estimated to open its doors within four years. The Health Board is now working with Blaenau Gwent County Borough Council, the town's GPs, and other interested parties to develop the scheme. 3.2 Sixth Form students given a helping hand into medicine: The Health Board is helping Sixth Form students across Gwent to prepare for a career in medicine. The Health Board s 12 Neighbourhood Care Networks (NCNs) have provided funding for students to take a course run in partnership with Mediprep UK, who usually only run courses in London or Manchester. This initiative forms part of a wider drive by the Health Board to recruit more GPs and associated health professionals to help provide sustainable Primary Care services across Gwent. There are 25 sixth form education providers in Gwent and of those 20 schools sent students on the MediPrep programme. In total, 43 students attended. Earlier in the year, the first MediPrep session was held with students in Ysgol Gyfun Cwm Rhymni and evaluation from the day identified that 95% of the students would not have taken up the programme personally if it had not been organised and funded through the Health Board. Radiotherapy and cancer unit plans for Nevill Hall Hospital: Plans are underway to develop a satellite radiotherapy unit and local cancer centre at Nevill Hall Hospital. The hospital was identified last year as the preferred site for a satellite radiotherapy unit to complement work done at the Velindre Cancer Centre, increasing capacity and enabling many patients to receive treatment closer to home. An outline business case for the project is currently being drawn up, which will go the Welsh Government for funding approval. The Health Board set up a Transforming Cancer Services delivery group last year, which oversaw the bid along with Velindre Cancer Centre and the Welsh Government to host a satellite radiotherapy unit in the area. Omnicell: The Health Board and its Theatre Teams have been successful in securing 2.2 million funding from Welsh Government to purchase the automated procurement and storage system - Omnicell. Our project team is busy managing the installation in all Theatre suites across the Health Board. 10 Public Board Meeting - 24th Janury /01/18 47 of 145

48 Tab 3.2 Executive Team Report Not only is the system expected to improve efficiency, it will also cut waste and improve patient safety. The automated process will allow us to release more personnel into clinical areas and make revenue savings to further improve and support the delivery of care to patients. 3.2 New Year Honour for Senior Nurse: Senior nurse Louise Rooney received a MBE for services to nursing and prison healthcare in Monmouthshire in the Queen s New Year s Honours List. Louise was managing a ward at Chepstow Community Hospital when in 2011 she was asked to review health services at Usk Prison from an NHS perspective. The following year she was seconded there, with responsibility for the prison s health services transferring to the Health Board and identified an urgent need for improvement in several areas. Louise transformed the service, addressing issues including outpatient appointments and appointment cancellations for prisoners, and driving the improvement of the skills of the prison nursing workforce. Securing in-reach mental health, optometry and dental services, and the development of palliative care services to ensure prisoners are better supported at the end of their lives. Louise has previously won Royal College of Nursing Wales and Nursing Times Awards for her work. Paul Ridd Foundation Awards: Julie Kendall, who recently retired as Senior Nurse in Learning Disabilities, won an award at the recent Paul Ridd Foundation Awards. The Foundation promotes better healthcare for people with a learning disability and the award was for Julie s campaigning to gain funding for the ABUHB Health Liaison Service for individuals with a Learning Disability and for securing further funding to undertake a pilot in GP surgeries. Staff Awards recognise excellent NHS work in Gwent: The seventh Staff Recognition Awards Ceremony was held by the Health Board on Friday 15th December at the Christchurch Centre, Newport. More than 300 members of staff attended the event that celebrated the achievements of staff from across the Health Board. The winners are as follows: Health and Wellbeing The Chaplaincy Team of 145 Public Board Meeting - 24th Janury /01/18

49 Tab 3.2 Executive Team Report Improving Patient Experience The Austin Friars Treatment and Referral Centre Leadership Dr Nadeem Syed, Consultant Paediatrician Partnership Working Cedar Unit, County Hospital General Wards and Griffithstown Primary School Quality, Sustainability and Efficiency - The Osteoporosis Unit Dexa Team Team of the Year Neonatal Intensive Care Unit Team, Royal Gwent Hospital Going the Extra Mile Rebecca Westbury, Community Midwife Education, Research and Innovation The Specialist Palliative Care Team and Hospice of the Valleys Patient's Choice Award Dr Abbie Nelson, ST4, Oakdale Ward 2:1, YYF 3.2 The Chair s Award Dr Andy Gray, GP NCN Lead South Monmouthshire The Chief Executive s Award The Paediatric Medical Team at Nevill Hall Hospital The Aneurin Bevan Community Health Council Award The Engagement Team Living Our Values: Linda Hodges, Ward Clerk, Pen-y-Cwm Ward Dr Andrew Gray, South Monmouthshire Neighbourhood Care Network Jane Cheadle, Facilities Manager Lisa Hammet, Midwife, YYF June Lindsay, Healthcare Support Worker, RGH Natalie Skyrme, Senior Nurse, RGH Special Recognition Awards: The following recipients have demonstrated outstanding dedication, commitment and resilience in the face of very difficult and unusual circumstances. Susan Davies, School Nursing Service (posthumous award) Estates, Maintenance and Operations Team IT Security Team Older Adult Mental Health Pubic Consultation: Representatives of the Older Adult Mental Health (OAMH) Directorate and Divisional Management Team are currently involved in an ABUHB wide public consultation on proposals to redesign OAMH services. The proposal, if supported, would lead to a reconfiguration of inpatient services to 12 Public Board Meeting - 24th Janury /01/18 49 of 145

50 Tab 3.2 Executive Team Report reduce the number of in-patient units from the current five to four units and the enhancement of community services and support for older people with Mental Health problems. Over twenty public and staff events have already been held across the Health Board with more planned up until the end of January Following these consultation events, feedback will be provided to the CHC and Health Board in March to consider the outcome of the consultation. 3.2 Ysbyty Ystrad Fawr: Both MAU and Risca ward at YYF will be undergoing changes in layout thanks to an approved capital scheme. The MAU will be provided much needed additional waiting space for patients. Over recent years the GP Out of Hours service has expanded and the Medical Assessment Unit, during periods of high demand lacks space to assess and treat patients resulting in patients being treated in the corridor and using GP OOH consulting rooms when available. The changes in layout will provide clinical areas fit for purpose that maintain patient s privacy, dignity and ensures that they are monitored and observed safely. Risca ward will be provided with a day room to enhance patient care by improving social interaction and counter potential isolation as patients are nursed in single rooms. This development will allow patients to take their meals in a shared environment and provide space for group activities. This will also compliment the ongoing work towards the hospital achieving dementia friendly status. Vacant Practices Six Bells Medical Centre (Dr Hossain): The Division has received notification from Dr Hossain, a single handed practitioner in Six Bells Medical Centre, Blaenau Gwent on the 29 th December 2017 that he wishes to terminate his GMS contract with effect from the 31 st March Six Bells Medical Centre has a list size of 5,034 patients. The options for this practice will be considered by the Vacant Practice Panel, in line with the Vacant Practice process on the 11 th January Pengam Health Centre (Dr Mahto): Dr Mahto is a single handed GP based in Pengam Health Centre. She tendered her resignation to the Health Board on 30 th October 2017 as she wishes to retire. The GMS contract will cease on 31 st March Following receipt of Dr Mahto s resignation, a sustainability meeting was held with neighbouring practices to discuss the matter and to gauge their reaction to the prospect of another practice closing in the area. The meeting was very positive with two practices expressing a keen interest in taking the patients of Dr Mahto s practice of 145 Public Board Meeting - 24th Janury /01/18

51 Tab 3.2 Executive Team Report As per the Vacant Practice process, the Health Board convened a Vacant Practice panel on 8 th November 2017 to discuss options for the practice. Representatives on the panel include Senior Divisional staff plus CHC and LMC members. It was agreed that the practice would be advertised locally to practices within two of the immediate NCN areas. 3.2 One expression of interest was received but unfortunately withdrew before the interview date. A reconvened panel met on the 11 th January to discuss remaining options. Primary Care Operational Support Team (PCOST) and Managed Practices Bryntirion Surgery: Bryntirion Surgery came into direct Health Board Management from the 1 st December All directly employed staff have TUPE transferred into Health Board employment. The Pharmacy Team has provided extra support in Bryntirion surgery to help deal with the Medicines Management issues and the team are considering options, including offering extra hours and utilising bank staff, to work through the admin backlog. Following approval from the executive team, a joint recruitment initiative between Aneurin Bevan and Cwm Taf is underway to recruit to the Clinical Lead posts within PCOST and the directly managed practices. Four applications have been received by Aneurin Bevan. PCOST continues to explore and develop additional extended roles that will support these clinical lead. Store and Scan: The Patient Medical Record Storage and Scan Service have successfully completed Phases 1 and 2 with nearly 40 practices utilising the service. The service provides off-site secure storage and management of live patient medical records. This is for all GP practices within Wales and is run in partnership with NHS Wales Shared Services Partnership. The remaining practices who initially indicted they wished to participate will be contacted in January for confirmation of their continued commitment to the service. All interested practices will need to have completed transfers by 31 st March Recommendations 14 Public Board Meeting - 24th Janury /01/18 51 of 145

52 Tab 3.2 Executive Team Report The Board is asked to receive this report for assurance and information. Assessment of the Impact of the Report: Financial Assessment There is no direct financial impact associated with this report. Link to IMTP There is no direct link to the IMTP associated with this report. Risk Assessment A risk assessment has not been undertaken for this report as it is for information. Quality, Safety and Patient Experience A quality, safety and patient experience assessment has not been undertaken for this report as it is for information. Assessment Health and Care This report would contribute to the Standards Equality and Diversity Impact Assessment (including child impact assessment) governance elements of the standards. Equality, diversity and child impact assessments have not been undertaken for this report as is for information of 145 Public Board Meeting - 24th Janury /01/18

53 Tab 3.3 Integrated Performance Report Agenda Item: Integrated Performance Report Purpose of the Report: To provide an update on the current performance of the Health Board at the end of Quarter 3 of 2017/18 in delivering key performance measures outlined in the National Outcomes and Performance Framework within the overall context of the delivering the key milestones outlined within the IMTP. Recommendation: The Board is asked to: Note the current performance and trends against the national performance measures and action being taken to improve performance where targets are not currently being met. The Health Board is asked to: (please tick as appropriate) Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance Note the Report for Information Only Sponsor: Nicola Prygodzicz, Director of Planning and Performance Report Authors: Sue Shepherd, Interim Head of Performance & Compliance Jennifer Keyte, Corporate Planning Manager Date of the Report: 8 January 2018 Supplementary Papers Attached: Appendix A National Performance Framework Scorecard and Trends 1 Public Board Meeting - 24th Janury /01/18 53 of 145

54 Tab 3.3 Integrated Performance Report Agenda Item: Introduction This report provides a high level overview of performance at the end of Quarter 2 against the Integrated Medium Term Plan (IMTP) with a focus on delivery against key national targets. 3.3 The NHS Outcomes and Performance Framework was released at the end of March 2017 and details the indicators and measures that are used to provide an annual view of the impact that health services are having in improving health outcomes at a population level and the relative success in planning and delivering those services. The Delivery Framework sets out 39 outcome indicators and 96 performance measures under 7 domains, against which the performance of the Health Board will be measured There is a good match between many of the national measures and the local milestones and priorities described within many of the Service Change Plans (SCPs) outlined within the Health Board s approved Integrated Medium Term Plan (IMTP). The Welsh Government (WG) national performance measures have therefore been mapped against the relevant SCPs. As there is close alignment between many of the SCPs and Divisional accountability, some key local divisional measures are also considered within the report. These will continue to be expanded as the reporting framework is developed. This will also help to demonstrate the impact of delivering service change plans on performance in a number of key areas. 2. Background The IMTP is a statutory requirement placed upon Health Boards and provides the organisation with a process and vehicle to review and articulate the organisation s values, future strategy, key priorities and delivery actions over a three year timeframe. In March 2017 the Health Board submitted a refreshed IMTP to Welsh Government which received formal approval by Welsh Government at the end of June The plan outlined the ways in which both national and local strategic priorities are to be met over the next three years in providing safe, high quality, patient centred services to meet the needs of the population. Central to the strategic vision underpinning the IMTP was the continued implementation of the Clinical Futures Strategy which was to be supported by key service changes identified over the next three years of 145 Public Board Meeting - 24th Janury /01/18

55 Tab 3.3 Integrated Performance Report Agenda Item:3.3 The IMTP also sets out the governance and assurance arrangements established within the Health Board to support delivery. 3.3 The Welsh Government published a revised NHS Outcomes and Delivery Framework to demonstrate annual improvement in the health and wellbeing of the population through the delivery of NHS services. The Delivery Framework identifies key outcomes, outcome indicators and performance measures under seven domains developed through public and stakeholder engagement. The planning approach outlined in the IMTP identifies three tiered programmes of work that support operational efficiency, service change and improvement and broader whole system strategic change as set out below. It is important that the performance reporting framework is able to capture the outputs and measures that demonstrate delivery against all three tiers. It is equally important to ensure that the reporting system connects these with relevant performance outcomes, indicators and measures outlined in the National Outcomes and Delivery Framework. 3 Public Board Meeting - 24th Janury /01/18 55 of 145

56 Tab 3.3 Integrated Performance Report Agenda Item: Summary of Performance against WG Measures For 2017/18 some of the performance measures have been revised or replaced from last year and therefore, some of the measures and the data collections are still being developed. 3.3 It should be noted that some lag measures may be reported quarterly, six monthly or annually and will therefore not be measurable against the submitted IMTP profile at the current time. An overview of performance against a range of key national and local targets is described below. Key Areas of Good Progress An overall improvement in the number of HCAI but particularly in confirmed clostridium difficile and S. aureus bacteraemia cases. The number of outpatient appointments overdue their follow-up target date has decreased in November. Ambulance response time within eight minutes to Category Red Calls continues to be above the 65% target. A sustained improvement in stroke performance for the percentage of patients who have been assessed by a stroke consultant within 24 hours A significantly lower level of Did Not Attend (DNA) rates for outpatients is being maintained in comparison to last year. Sustained performance of the CAMHs measure of 80% of patients waiting less than 28 days. Urgent Suspected and non urgent cancer treatment times have improved from October with 90.6% and 94.6% compliance in November Sustained performance of over 95% for children who received 3 does of the 5 in 1 vaccine by age 1. A significant reduction in the backlog has resulted in an improved referral to treatment performance for the CAMHS Neurodevelopmental pathway in November with 73% compliance against the target of 80%. Primary Care Mental Health Measures for assessment and intervention measures have recovered the 80% target. Key Areas of Concern Four hour A&E target performance remains below the national target and outside of the IMTP profile in November and December. An increase in the 12 hour A&E target over the last 2 months and is outside of the IMTP profiles. A deterioration in November and December in the number of ambulance handovers over 60 minutes. The number of RTT 36 week breach patients has increased from quarter 2 to an estimated 1629 at the end of December of 145 Public Board Meeting - 24th Janury /01/18

57 Tab 3.3 Integrated Performance Report Agenda Item:3.3 Sickness absence rate has dropped in November to 5.4% and is above both the target of 5% and IMTP profile of 5.1% 3.3 The following sections highlights performance of the key measures against the relevant SCPs, where there remain challenges to improve performance to the required standards across all relevant domains. 4. Service Change Plans and Performance There are 7 Service Change Plans included in the IMTP and these are summarised below: SCP Title SCP Title 1 Improving Population Health 5 Urgent and Unscheduled Care and Well Being 2 Care Closer to Home 6 Planned Care 3 Management of Major Health 7 Service Sustainability Conditions 4 Mental Health and Learning Disability Progress against each national performance measure relevant to each SCP is set out below in addition to progress against key process milestones for each SCP. Any figures that are indicative are highlighted red in the relevant section. 4.1 Service Change Plan 1 Improving Population Health and Well Being Performance against WG outcome and Performance Measures Childhood immunisation and smoking cessation are quarterly measures and the table below relates to the latest data available for the end of quarter 2 for both measures. Uptake of influenza vaccinations are updated on a monthly basis with the latest data available for the end of December. However, this is likely to change as data becomes more complete. 5 Public Board Meeting - 24th Janury /01/18 57 of 145

58 Tab 3.3 Integrated Performance Report Agenda Item: WG Measures - Childhood Immunisation The performance measures for childhood immunisation for 2017/18 have changed with the focus on immunisation of children age 1 and age 5, as set out in the table above, although immunisation take up information will still be available for all age ranges. At the end of Quarter an uptake of 96.1% was achieved for children who received three doses of the 5-in-1 vaccine by the age of 1 (5-in-1), meeting the Welsh Government target of 95%. Although not a WG national measure, coverage of one dose of MMR was 97.9% for children reaching five years of age for the same period. Uptake of two doses of MMR was 91.5%, just above the Wales average of 90.5%. There is variation in uptake rates across NCNs and within an NCN area at General Practice level. There are a number of actions within the Childhood Immunisation Action Plan that are being implemented to improve performance of uptake of MMR 1 and MMR 2 at age 2 and 5 years respectively. The Health Board has good performance for childhood immunisation rates in the year 1 age group. A breakdown of take up rates for 2 doses of MMR by age 5 by NCN cluster is shown below 6 58 of 145 Public Board Meeting - 24th Janury /01/18

59 Tab 3.3 Integrated Performance Report Agenda Item: Whilst the overall take up rates have improved on the comparative quarter 1 periods, the table highlights the variation in take up rates with the lowest rates in Newport West (84.7%) and the highest in Caerphilly East (94.8%), with all NCN areas below the target of 95%. Regular monitoring of performance and escalation processes are in place to understand reasons for any decline in uptake below 95%, and if any support is required. Actions include: Presenting performance figures in monthly NCN Summary and Quarterly Core NCN Report to ensure NCN Leads are aware and can feed back to their NCNs Real time data from the Child Health System data is reviewed by the Health Board s Immunisation Coordinator on a weekly basis. Any practice queues identified of children waiting to be invited for vaccination are reported to Practice Managers and to the Deputy Medical Director for Primary Care for consideration and action Explore reasons for low uptake to look for areas requiring improvement Regular communication with practices to understand reasons for immunisation queues; and support from Immunisation Co-ordinator to resolve issues Action plans requested from specific General Practices where queues are identified Development of practice guidelines for examining pre-school immunisation queues. 7 Public Board Meeting - 24th Janury /01/18 59 of 145

60 Tab 3.3 Integrated Performance Report Agenda Item:3.3 In the past Quarter, 2 General Practices have been asked by the Deputy Medical Director to develop action plans to reduce the number of children awaiting scheduled childhood immunisations. These are being implemented and their progress is monitored. 3.3 National uptake of MMR vaccination in two year olds remains slightly below 95% this quarter, reaching 95% in four of the seven HBs, including ABUHB. There has been a generally decreasing trend in uptake of routine immunisations in four and five year olds over the past two years, with variation seen at Health Board and Local Authority levels. A Measles Eradication Task Group has been convened by Public Health Wales in the context of rubella and measles elimination in the UK and to address a declining trend in MMR uptake since 2015/16, to consider action to maintain disease control. The programme is focusing on a number of defined area including: infant and pre-school, school age, young people not in education, training or employment, surveillance and laboratory work, case management and outbreak control and occupational health. ABUHB representatives are contributing to this programme of work. WG Measures 8 & 9 Smoking Cessation Smoking cessation services (including Community pharmacy level 3, Stop Smoking Wales, Hospital Smoke Free Support Service and Prisons) have treated 0.8% (726) of the adult smoking population by the end of September This is an increase in performance with services treating 1.7% of the adult population from April to September 2017, compared to 1.4% during the same period in 2016/17. The CO Validated quit rate for quarter 1 was 40%, in comparison to 39% for the same quarter in 2016/17 and for quarter 2 has decreased with 34% in the second quarter compared to 45% for the same period in 2016/17. The following local actions have been particularly successful in supporting uptake of local smoking cessation services: NCN Smoking Cessation profiles supported improvements in specific clusters. Local Help 2 Quit campaign over 450 quit kits issued and individuals referred to local NHS services over a 3 month period. A detailed IMTP improvement plan is being implemented, the main actions being taken to continue to improve cessation rates include: 8 60 of 145 Public Board Meeting - 24th Janury /01/18

61 Tab 3.3 Integrated Performance Report Agenda Item:3.3 Continued expansion of the Community Pharmacy Level 3 Smoking Cessation Further support to the 12 NCN clusters to embed the Tier 1 target within their plans and ongoing expansion of GP Smoking Cessation Champions. Conducting a smoking cessation in pregnancy audit to review maternal smoking cessation services, and develop an improvement plan. Supporting national and local campaigns such as No Smoking Day and HelpMeQuit/Help2Quit. Conducting a review of the Hospital Smoke Free Support Service Place based targeting approach to maximise awareness of services in areas where smoking prevalence is highest. 3.3 WG Measure 5- Uptake of influenza vaccines Reported uptake rates of flu vaccine in vulnerable groups shows that current uptake levels overall appear similar to last year s achieved rates. A breakdown by patient group is shown below. 9 Public Board Meeting - 24th Janury /01/18 61 of 145

62 Tab 3.3 Integrated Performance Report Agenda Item: A summary by local authority area shows that Monmouthshire currently has the highest uptake rate across all categories and Blaenau Gwent has the lowest. The uptake in ABUHB has generally been above the Wales average in the vulnerable groups included in the WG Performance Measures. The total number of ABUHB staff vaccinated to the 8 th January is 6,758 (48%) with considerable variation across the Divisions. Only 421 no thank you forms have been completed by staff who have declined the vaccine which means there are still 6,906 staff unaccounted for in terms of their seasonal flu vaccination status. Further steps are being taken across the Health Board to increase immunisation rates with a key focus on delivering more flu clinics at ward and department level using the 199 Flu Champions and therefore making the vaccine more accessible for staff Delivery against SCP milestones The key areas of progress for Quarter 3 relate to the areas already described above with key milestones in other areas to be delivered by March of 145 Public Board Meeting - 24th Janury /01/18

63 Tab 3.3 Integrated Performance Report Agenda Item: Service Change Plan 2 Primary and Community Services Care Closer to Home Performance against WG outcome and Performance Measures A number of the primary and community performance measures have been updated for 2017/18. Timely Care There are several measures relating to the GP Out of Hours Service (OOH) but two measures have been included in the delivery and performance framework for 2017/18. The latest data that has been published for October 2017 highlights that the service achieved 85.7% of urgent calls that started definitive clinical assessment within 20 minutes of the call being answered. Service performance for November and December estimate a similar performance of 85% and 86% respectively. The service achieved 73.1% for patients prioritised as very urgent and are seen within 60 minutes of the clinical assessment. However, performance is estimated to deteriorate to 72% in November and 62% in December. Both measures remain below the national target level, however the call volume is increasing above previous years in most months in 2017/18 to date as set out in the following graph. 11 Public Board Meeting - 24th Janury /01/18 63 of 145

64 Tab 3.3 Integrated Performance Report Agenda Item: Unfilled hours remain an ongoing concern for both the medical and nursing parts of the rota. A series of actions are being carried out to look at staffing the models in the interim period whilst sustainable service rotas are developed through new models of care. During the recent period the service tested the use of paramedics to cover unfilled shifts during peak times on weekends, the response to this has been positive and the service is reviewing how this is integrated into future service provision. There remains significant variation in compliance with response targets during the week. Mid-week (Monday to Friday) typically sees greater compliance with the target timeframes but the shorter operating times mean that this is based on less demand. Weekends consist of longer operating hours and more demand but poorer compliance with performance targets. Weekend performance therefore has an impact and pulls down the overall compliance. Therefore the new models of service being looked at will have a focus on weekend provision as our most challenged area. The service has reviewed the key reasons for not delivering this target of 98% which include: Inappropriate prioritisation of calls as urgent. Capacity to handle calls at busy times and to ability to cover a large geographical area. Continued proportion of medical hours unfilled during the month (14%) Unfilled nursing hours during the month of 13%. Increased home visits due to lack of primary care centre appointments. The OOH service continues to be a key priority for the Health Board and ensuring the wider re-design plan delivers the anticipated improvements. A number of local access indicators are considered below: My Health Online (MHOL) - 99% of all practices in Gwent are now utilising either the appointments or repeat prescriptions elements of of 145 Public Board Meeting - 24th Janury /01/18

65 Tab 3.3 Integrated Performance Report Agenda Item:3.3 MHOL, the second highest in Wales. ABUHB currently has over 53,000 patients who have signed up to use the MHOL system. 3.3 Further actions during this year will include working with nursing homes in Blaenau Gwent (to be rolled out across Gwent) to reduce medicine waste by using MHOL for repeat prescriptions. The Health Board also records local data on the 5As GP Access performance measure which has maintained the percentage of practices fully compliant with the scheme with 79% meeting the standards in the third quarter of 17/18. Out of the 80 Practices across Gwent, 62 are accredited with the 5A's for Access scheme. The Health Board s Primary Care Team is assessing the current statistics and is contacting practices to ascertain their ability to attain the 5A status. The Extended Hours Local Enhanced Service (LES) is offered to practices that have attained the 5 A is for Access standards. The Health Board has invested in this LES and there are currently 36 practices commissioned to provide this service. The number of hours provided by each practice is dependent on list size. The additional hours can be provided by the GP and practice nurse, primarily in the evening but with some practices providing early morning and evening sessions based on 50:50 basis. As a result of the LES, an additional 83 clinical hours per week are provided outside of core hours (08:00am 6:30pm). This has improved from 81 hours last year. Safe Care For 2017/18 there are four prescribing measures included within the national performance framework. The measures set challenging benchmarks for improvement to the lower quartile (upper in one measure) and based on national GP practice prescribing. The latest data for prescribing of co-amoxiclav, quinolone and cephalosporin as a percentage of all antibiotics have decreased from the end of March. Cephalosporin prescribing measure has exceeded the target of 2.1% for the first time this year Delivery against SCP milestones Good progress has been made across a range of milestones in improving access to services within primary/ community settings and building sustainable capacity. Key achievements in Quarter 3 include: Optimising GMS Access Quarter 3 has seen the continuation of the Access Quality Improvement (QI) scheme which was implemented in January The scheme is managed in two phases and will fund Practices to fully review their demand and capacity for appointments using recognised quality 13 Public Board Meeting - 24th Janury /01/18 65 of 145

66 Tab 3.3 Integrated Performance Report Agenda Item:3.3 improvement methodology. An external provider, Operasee, has been commissioned to work with 6 local practices to use LEAN methodology to assess the demand and capacity of practices and opportunities to optimise access. There will be a three month pilot to run December to February with an analysis of results expected in March Care Closer to Home Strategy In Quarter 2, a strategic lead was appointed to consolidate and further develop the Care Closer to Home Strategy, and to lead work on the development of a corporate planning framework for an Integrated system, of primary, community care and wellbeing. An outline framework has been produced, with a programme plan and outcomes framework due for completion early The framework will inform the content of relevant service change plans, and will align with the Gwent Area Plan, and Wellbeing Plans. Integrated Well-being Networks, endorsed by the Regional Partnership Board, will form the foundation of our joint framework and requires very significant changes in the way services are planned, commissioned and delivered, and is wholly consistent with implementation of the Social Services and Well-being (Wales) Act and the Wellbeing of Future Generations (Wales) Act This is fully aligned with our ambition to deliver new models of primary care that increase reliance on self-care, healthy living and the use of community assets that support people outside of the traditional medical approach. Delivering this strategy will form a key focus for this SCP over the next three year planning cycle. Our Care Closer to Home strategy is the key enabler for the successful delivery of the University Health Board s Clinical Futures Strategy. Supporting People to Stay Well and Independent at Home The Discharge to Assess model has been piloted at Nevill Hall Hospital and Shaw Healthcare have been commissioned through the Integrated Care Fund to conduct social work assessments in hospital and, where appropriate, arrange discharge with a short term home care packages while further assessments are carried out at home. To date, they have conducted 244 assessments, all within 5 hours of referral. The team have subsequently discharged 114 patients from hospital with care, 69% of whom were discharged the same day, while the remaining 31% were discharged within 2 7 days following liaison with local authorities or while waiting for patients to become medically stable. An evaluation of the Falls Response Service indicates that the FRS team succeeded in keeping 79% of patients at home directly following contact, compared with just 35% of the core service. Initial findings of 145 Public Board Meeting - 24th Janury /01/18

67 Tab 3.3 Integrated Performance Report Agenda Item:3.3 estimate that this may have succeeded in avoiding up to 210 conveyance to hospital and 1,685 bed days in an ABUHB hospital between October 2016 and March Service Change Plan 3 Management of Major Health Conditions Performance against WG outcome and Performance Measures The WG measures for chronic conditions relate primarily to Stroke Care and chronic condition admissions. The table above provides a summary of performance against the four QIM bundles and the four individual elements of those bundles included within the performance framework for November WG Measures Acute Stroke Care Against the Sentinel Stroke National Audit Programme (SSNAP) audit, ABUHB performance continues to be best in Wales, with the RGH (site of HASU) consistently operating at B level since the Stroke Redesign implementation in January In terms of the WG measures, performance is generally good but with an increased focus on the two measures where further improvements are 15 Public Board Meeting - 24th Janury /01/18 67 of 145

68 Tab 3.3 Integrated Performance Report Agenda Item:3.3 required. Firstly whilst the percentage of patients who have a direct admission to an acute stroke unit within 4 hours (Measure 69), has maintained the improved level of performance since the Stroke Redesign implementation in January 2016 and is currently in line with the IMTP profile, performance against this measure is challenging with current service constraints, limiting the ability to admit patients directly to a stroke bed at times of high emergencies demands at the RGH. 3.3 In another of the main WG performance measures, the percentage of patients diagnosed with a stroke and who are thrombolysed within 45 minutes, also known as door to needle time (Measure 70), the performance for ABUHB is more volatile. This measure only applies to those patients who are deemed clinically appropriate to receive thrombolysis when they present at the Emergency Department. In most cases, patients presenting at the Emergency Department with a confirmed stroke are already out of the time window when clinicians assess the precise onset of the stroke or in some cases it is not even possible to determine the onset of the stroke. In some cases the patient is unable to have thrombolysis due to other medical reasons. This means that the denominator for the percentage performance is typically only two or three patients per week. In some weeks performance has been 100% but in others as low as 30% or zero. The Stroke Directorate continue to review each case where a patient deemed appropriate was not thrombolysed within 45 minutes, with a view to identifying opportunities for improvement. Delays with CT scanning, out of hours, has already been identified as a factor and improved access for stroke patients is being explored. In addition to the four specific WG performance measures (69-72), ABUHB s achievement of the other four Quality Improvement Measures for stroke care (QIM bundles) has also been maintained since implementation of the Stroke Services Redesign programme early in 2016 as illustrated in the following graphs of 145 Public Board Meeting - 24th Janury /01/18

69 Tab 3.3 Integrated Performance Report Agenda Item: Delivery against SCP milestones Specific priorities for 2017/18 were identified in each Local Delivery Plan aligned to nationally agreed priorities and local need. Based on principles of Prudent Healthcare, the aims of these plans are to tackle the root causes of ill health, improving the early detection and management of chronic conditions and offering optimal treatment and ongoing support across the care continuum. It includes plans to support self-management though patient and community education programmes. Stroke Participation in the Stop a Stroke programme incorporating elements of the Cardiff and Vale University Health Board s project and the Living Well, Living Longer Programme aims to increase the number of patients identified with Atrial Fibrillation (AF). By ensuring appropriate medication is then provided, the desired outcome is to reduce the number of strokes caused by unidentified AF. During quarter 3 a project 17 Public Board Meeting - 24th Janury /01/18 69 of 145

70 Tab 3.3 Integrated Performance Report Agenda Item:3.3 plan has been developed for the implementation of a Stroke Helpline to enable primary care clinicians to request and receive advice from secondary care consultants within 4 working days. 3.3 The Stroke PROMs R&D Project aims to deliver a validated stroke PROMs tool for use in Wales which will improve information on patient outcomes and maximise the benefits of stroke research. The study has been granted approval by the Health Research Authority (HRA) and the research team are liaising with the site principal investigators on Waleswide recruitment to provide study support. A look back exercise and review of the re-design Stroke pathway has been undertaken in quarter 3 to assess performance against national standards, patient flow and LOS targets. This will be evaluated and reported back to the next Stroke Board in February. Cancer Actions have been taken to speed up diagnosis along the Single Urgent Cancer Pathway with more staff recruited alongside introduction of longer working days. 7 day working was introduced in MRI and CT with a view to eliminating on-call. Progress has been made on the development of 7 day services for acute oncology and a pilot lung cancer pathway was developed. A strategic Cancer Services Planning and Delivery Group is now established with discrete sub-groups being formed to take forward work on a new radiotherapy unit and SACT/Haematology following confirmation from Velindre NHS Trust that Nevill Hall Hospital is the preferred site for the location of a new satellite radiotherapy centre. The Cancer Services Planning and Delivery Group is working with Public Health Wales and the Local Public Health Team to determine the actions and priorities for reducing inequities in cancer outcomes. Diabetes Further work is ongoing to finalise a business case for increased psychological support for children and young people with diabetes which will be considered as part of the IMTP process for 2018/19. Additionally a review of multi-disciplinary workforce across the health board sites has been undertaken during quarter 3 which will be considered as part of the 2018/19 IMTP process. Patient education opportunities and resources are being developed for roll-out to address low attendance rates at structured education sessions for newly-diagnosed patients with diabetes. The Pocket Medic, of 145 Public Board Meeting - 24th Janury /01/18

71 Tab 3.3 Integrated Performance Report Agenda Item:3.3 application has also been implemented. This is a digital platform that allows clinicians in primary, secondary or community care, to send filmbased prescriptions to patients to help manage their diabetes, which can then be watched on mobile phones, tablets or PCs. 3.3 End of Life Care The End of Life Care Board has pro-actively widened representation across the divisions, primary and secondary care as well as the third sector, promoting the ethos that end of life care is everyone s business. End of Life Care priorities have been established through partnership working and task groups are taking these priorities forward to determine the specific delivery actions. During the quarter, an e-learning programme has been finalised and uploaded to ESR and NHS Wales to provide training and education for staff. The Advanced Care Planning Facilitators are currently undertaking a pilot project in respiratory and have undertaken a retrospective audit of notes, paying particular attention to ACP. Heart Conditions Currently working with value based health care and the ICHOM team to pilot the use of Patient Recorded Outcomes Measures (PROMs) in two outpatient settings initially at RGH and YYF nurse led heart failure clinics. A patient focus group will run for 8 weeks to help understand if we are able to roll out PROMs to all nurse led clinics and how we may change our clinics dependent on outcomes. Cardiac Rehabilitation Teams have been re-organised to ensure clear leadership and move towards the vision of a single cardiac rehabilitation service. During quarter 4 the team will be considering its capacity with the aim to provide a service across the whole week and make full use of its premises and staff resources. During quarter 3, the service continued to progress the implementation of additional sessions to deliver cardiac interventions to support a reduction in diagnostic waits. The service aims to achieve improving timely access to Cardiac diagnostic treatment and meeting the 8 week component target. Additional community cardiology clinics have been established in GP practices during quarter 3 with the aim of providing more accessible patient services closer to home. Further progress is being made to support practices with ECG Echocardiography and ambulatory monitoring. Neurological Conditions 19 Public Board Meeting - 24th Janury /01/18 71 of 145

72 Tab 3.3 Integrated Performance Report Agenda Item:3.3 The Health Board continues to work with a broad range of partners to raise public awareness including timely and appropriate education and training for patients and their families. 3.3 The Health Board is leading a national research and development study to compare methods of obtaining Patient Reported Outcomes Measures (PROMS) for patients with neurological conditions. The study captures the impact of common health related problems shared by people living with neurological conditions and compares the findings of 15 Patient Reported Health Status Questions against the generic PROM EQ5d and three condition specific PROMs for Multiple Sclerosis, Acquired Brain Injury and Parkinson s Disease. During quarter 3 this research study was rolled out to all Parkinson s clinics. Respiratory Conditions Additional sessions have commenced in Caerphilly borough after recruitment of a pulmonary rehabilitation Coordinator to improve access and expand pulmonary rehabilitation across the Health Board. A 3 month pilot of a non-invasive ventilation retrieval service (NIV) started in September 2017, the main goals of which are to rapidly assess patients in the Emergency Department at the Royal Gwent Hospital. Re-design of the respiratory nursing service across primary, secondary and community services is ongoing with an in-depth assessment being carried out by the senior nurses from primary and secondary care assessing the integration of specialist respiratory nurses across the Health Board. It is anticipated that the outcomes of the assessment will be completed and implemented by late of 145 Public Board Meeting - 24th Janury /01/18

73 Tab 3.3 Integrated Performance Report Agenda Item: Service Change Plan 4 Mental Health and Learning Disabilities Performance against WG outcome and Performance Measures Mental Health and Learning Disabilities are currently meeting seven of the active WG performance measures. WG Measure: 80 & 81: Local Primary Mental Health Specialist Services (LPMHSS) Assessment and Intervention Performance Performance has remained above the 80% target and has shown a sustainable position following implementation of the recovery plan last year. The service has been committed to maintaining the target with focussed weekly performance and assurance meetings held with senior divisional and team lead representation to track patients and to identify any issues. However, following a drop in quarter 2 performance has improved and the target of 80% exceeded for November for both measures with 86.1% of patients being assessed within 28 days and 81.1% of patients receiving an intervention within 28 days. Compliance above 80% is expected to continue in December despite the challenges that the service face with staff shortages and increasing demand. In October 2017, 1835 referrals for assessment were received the highest number of monthly PCMHSS referrals and 20% above the monthly average (for the previous 12 months). 21 Public Board Meeting - 24th Janury /01/18 73 of 145

74 Tab 3.3 Integrated Performance Report Agenda Item:3.3 In November 2017, the number of assessments carried out (931) was the highest number of assessments undertaken in a month by the PCMHSS and 21% above the monthly average In November 2017, the number of interventions started (458) was 8% above the monthly average 3.3 Key achievements for the service include: Implementation of progressive stepped care model for interventions. This involves patients attending self-help classes as the first stage of interventions. This is being trialled (and will be evaluated) in agreed areas to address backlogs of patients awaiting initial / ongoing interventions. Multi-agency workshops re: integration to improve service provision for Children and Young Person held in Caerphilly, Torfaen, Blaenau Gwent. Recruitment of Counsellors to staff bank. The main risks for the service are: Ongoing staff vacancies and long term sickness which is reducing capacity. It is anticipated to be of particular concern for January. Availability of primary care estate and room availability to carry out clinical work Performance against both measures is shown in the following graph. Discussions are underway with Primary Care to consolidate the number of sites to make the model more sustainable for the future. Performance against both measures is shown in the following graph of 145 Public Board Meeting - 24th Janury /01/18

75 Tab 3.3 Integrated Performance Report Agenda Item:3.3 Local Measure - Child and Adolescent Mental Health Service (CAMHS) Waiting Times 3.3 The implementation of the choice and partnership system (CAPA) model in 2016/17 has improved the management of demand and capacity within CAMHS and provides a more sustainable model for the future. Since the work was undertaken to refocus the core business of the specialist CAMHS service, waiting times have reduced. The current performance measure has been revised and is included in the strategy Together for Mental Health. The measure does not form part of the Delivery Framework for 2017/18, however, given the high priority of this service it is expected that 80% of referrals will be seen within 4 weeks. Additional data tools have been developed and made available to the service for use on a daily basis to monitor and manage the cohort of patients. Performance has continued to improve although a slight drop is expected for the end of quarter 3 due with 88.4% compliance compared to 90.8% in November. This is mainly due to available capacity over the bank holiday periods. The improved performance has been attributed to the new Pan- Gwent triage /treatment system introduced through CAPA to ensure CAMHS can meet the demands placed on the service. In addition, a dedicated CAMHS consultation telephone line has been introduced for professionals to seek support or guidance before making a referral. Feedback to date has been very positive from referrers. Performance against the RTT 4 week measure is shown in the following graph: 23 Public Board Meeting - 24th Janury /01/18 75 of 145

76 Tab 3.3 Integrated Performance Report Agenda Item:3.3 In October 2016 a new integrated Service for Children with Additional Needs (ISCAN) was set up in each of the children s centres across Gwent. All neuro-developmental (ND) referrals are now managed through this multiagency/multi-disciplinary team. Reporting of this service was formally suspended in October 16 whilst the details of the new measure were developed by Welsh Government. Health Boards were required to submit performance data with effect from October 2017 against a 26 week waiting time target for referral to neurodevelopment assessments of ADHD and ASD for children and young people. 3.3 Health Boards will be expected to have treated 80% of patients within the 26 week target. The service has had to deal with a significant backlog of patients since last October and whilst there have been plans in place to manage the backlog the service has achieved 73.0% compliance in November which is below the 80% target. This is a significant improvement where the challenge has been to manage the backlog alongside maintaining compliance against the CAMHS 4 week target. The service is currently reviewing its capacity and demand model having made progress on addressing the backlog of patients waiting treatment. This will include the review of specialised treatments and the capacity available for more complex patients, who whilst low in number require specialised treatment expertise. Current performance based on this proposed measure can be seen in the following graph: of 145 Public Board Meeting - 24th Janury /01/18

77 Tab 3.3 Integrated Performance Report Agenda Item: Delivery against SCP milestones Key achievements in Quarter 3 not highlighted above include: 3.3 Whole Person, Whole System MH Crisis Transformation: Comprehensive data analysis has been completed and stakeholder engagement processes commenced. A Stakeholder engagement and communications strategy and plan has been developed and approved. Staff surveys for inpatient services has been prepared and the Value Team and Shared Lives project have engaged with Host Families. ICF funding has been secured in order to undertake a feasibility study for Crisis House and Sanctuary. Inpatient Substance Misuse Detoxification Development: Currently there is limited access to inpatient beds for detoxification and stabilisation programmes within the Health Board. A programme of multi-agency and service user stakeholder involvement workshops have been held. During these workshops a systematic review has been undertaken of the desired outcomes and benefits for developing an improved pathway and centre of excellence which would enable more clients to receive more timely and effective care closer to home and a much improved patient experience. Improving Access to Psychological Therapies: Work has been undertaken with informatics to ensure the ongoing improvement process around measurement and data capture. Phase one of the improvement plan has consisted of piloting an efficiency of a broader skill mix and new interventions ensuring efficiency and absence of harm. The outcome from the pilot has demonstrated that the interventions are effective and acceptable. Phase two has also commenced in quarter 3 which has resulted in the reduction of unnecessary and disproportionate use of Part two of the MHM by locating Building resilience series in Part One of the MHM. Older Adult Mental Health (OAMH) inpatient reconfiguration: This project is a reconfiguration of Older Adult Mental Health services within the five boroughs of Gwent in order to reduce reliance on hospital based services, proving a range of community based alternatives to admission. During quarter 3 a 12 week consultation programme commenced which provides robust stakeholder engagement and public consultation on the reconfiguration of inpatient services. 25 Public Board Meeting - 24th Janury /01/18 77 of 145

78 Tab 3.3 Integrated Performance Report Agenda Item:3.3 Low Secure Unit, PICU and HDU: The Strategic Outline Case proposing the development of a new integrated service model and facility encompassing low secure, high dependency and assessment and treatment services for people with mental health and learning disabilities has been supported by the Executive Team. Engagement has commenced with other Health Boards on an option to develop a regional unit with regular meetings held with members of the project team. Additionally in quarter 3 an approval to award tender was received for works on the extended PICU. 3.3 Better Outcomes for LD Clients in Community and Specialist Services: In quarter 3 a review of community and specialist services for learning disabilities was undertaken and good progress was made on the data analysis and analysis of feedback from the comprehensive stakeholder engagement process. This process is expected to be concluded and reported back towards the end of the year. Service model reconfiguration options will then be developed with a view to formal consultation in 2018/ Service Change Plan 5 - Urgent and Emergency Care Performance against WG outcome and Performance Measures The Health Board is currently achieving two of the active six WG performance measures of 145 Public Board Meeting - 24th Janury /01/18

79 Tab 3.3 Integrated Performance Report Agenda Item:3.3 The key areas of good progress include: Ambulance response time within eight minutes to Category Red Calls continues to be above the 65% target throughout the year. The number of Mental Health DToCs shows a continued improvement since September. 3.3 The number of Total Delayed Transfers of Care (DToC) improved in November, however increased again in December. The reason for the increase was attributed an increase focus in hospital delays through the winter planning action of breaking the cycle, that identified the delays we normally see in January s figures. Again the number of bed days lost were lower than the same period last year. This indicates that hospital flow has generally improved. The main reasons for the increase were in the community hospitals setting due to patient choice issues and continuing healthcare issues delays for example, assessments being carried out by care homes. It was agreed that Commissioning Managers from the 5 Local Authorities would re-iterate their expectations around the timeframe for assessment by care homes. The measures where performance is not meeting the WG target are highlighted below. WG Measure 74: Ambulance Handover 60 minute Target The December position shows a deterioration from the previous month with 487 patients being reported as delayed handovers of 60 minutes or more compared to 309 in November. This is also above the IMTP profile of 113. We have reviewed and had clinical sign off for a revised Local Escalation Action Plan (LEAP) with WAST. This is intended to address the issues of ambulance delays through a series of times actions that are carried out sequentially. We have a process for addressing the clinical risk of patients in ambulances waiting which includes a nurse and medical assessment of the patients in the ambulance and a treatment commencement process where deemed appropriate ensuring care is not delayed. WG Measure 74 & 76: Emergency Department (ED) 4 and 12 Hour Target Performance The performance against the four hour ED target in December is expected to have deteriorated with an estimated 79.2% compared to 84.9% in November. This is slightly below the performance for the same period last year of 80.9% and is below the IMTP profile of 88.8%. The 12 hour ED target for December is anticipated to show a deterioration with 554 patients being reported compared to 393 for November. However, this is still an 27 Public Board Meeting - 24th Janury /01/18 79 of 145

80 Tab 3.3 Integrated Performance Report Agenda Item:3.3 improvement on the position for December 2016 of 572 patients waiting over 12 hours but above the IMTP profile of In December an additional 1000 patients required the major s stream of our Emergency department compared to the previous month. This can be the location of care for some of the sickest patients. Performance against the 4 hour and 12 hour target compliance continue to be outside the profiled positions within the IMTP profile as shown in the graph below. The improvement in the provision of urgent and emergency care remains a top priority within the Health Board. The urgent and emergency care plan (SCP5) has delivered a number of its key actions within the six essential steps. Details of these are covered in the milestones section below Delivery against SCP milestones Clinically Focused and Empowered Management: Triumvirate management structures continue to develop and operational site leads have been recruited to commence in post in January Escalation plans have been updated through Urgent Care Board and regular site (Health Care management group) meetings established to support leadership on our main emergency sites. Capacity and Patient Flow Re-Alignment: The Unscheduled Care Collaborative facilitated by ABCi continues to see improvements in LOS and early discharges, but it is recognised that this needs to be embedded and scaled up across all wards at RGH, to NHH and in community wards. A cohort of coaches and measurement leads have now been trained to support ABCi at an operational and clinical level to introduce quality improvement to a wider audience to enable this spread of 145 Public Board Meeting - 24th Janury /01/18

81 Tab 3.3 Integrated Performance Report Agenda Item:3.3 The cross-cutting organisational capacity plan in 2017 encompassed a set of cross-divisional workstreams which delivered improvements in flow that benefitted performance rather than bed reductions. However, quarter 3 has seen the elimination of trolleys in ED as normal capacity and reduction in the use of additional capacity in areas throughout the hospital. This has been reviewed in light of the deteriorating ambulance handover performance and additional capacity identified through the aforementioned LEAP. 3.3 Work to develop a bed plan for the organisation has now linked in with work to develop plans for the GUH and elghs as part of clinical futures which will now be tracked as a single planning/clinical Futures product. Patient Management: Wards with Discharge Co-Ordinators (DiSCos) and those that consistently apply the SAFER flow bundle continue to see success in terms LOS and discharges. Since the commencement of this action we have seen in unscheduled care wards an average of a 2 day reduction in LoS for patients. Medical and Surgical Processes: The Front Door Redesign project at NHH is supported in principle by Welsh Government. Whilst capital availability will be a key consideration the business case is development is being progressed to the next stage. The Front Door Redesign project at RGH has focussed on improving flow through MAU to improve the patient experience and support the Emergency Department. The introduction of 2 hourly patient safety huddles and the Emergency Physician in Charge (EPIC) role has helped focus attention on patients experience and the timeliness of their care, highlighting those particularly at risk of experiencing delays and this has supported improved escalation and de-escalation during pressure periods. As a key component of the organisational capacity plan, this is a key contributor to the reduction in use of additional corridor and non-ward capacity. 7 Day Working: Therapies staff have contributed to the improved flow, working as part of a pilot at the front door in the RGH. Therapists are able to identify patients that can be discharged earlier in MAU with their input or be admitted with therapy plans to support earlier discharge planning on wards. Of those assessed by therapies at the front door in RGH and NHH, around one third are discharged (with follow up plans where necessary) and half are admitted with a therapy plan. Ensuring the Patient is cared for in their own home: Much of the progress of this part of the plan can be seen in SCP2, which continues to improve community responses to maintaining patients at home and in care homes with advanced care planning and stay well plans. We have also continued to see improvements in complex discharges (8% increase) at NHH as a result of the Discharge to Assess service. Primary care 29 Public Board Meeting - 24th Janury /01/18 81 of 145

82 Tab 3.3 Integrated Performance Report Agenda Item:3.3 sustainability remains a concern, although plans are in place to support practices and use new roles within Primary Care. The ability to recruit GPs in the Primary Care out of hours service is addressed elsewhere in this report. 3.3 Key Concerns Sustaining the improvement at RGH by embedding the changes in MAU and maintaining five day Ambulatory Care. Establishing clear agreement with all specialities to support the assessment and flow of patients from ED/Assessment areas. Sustaining service developments that reliant on non-recurrent funding (e.g. ICF), such as the expansion of Model Wards across the UHB, and the therapies at the front door pilot. Ensuring system wide support for the Discharge to Assess model to be rolled out across the UHB. Availability of nursing and junior doctor workforce to ensure the skill mix required for the redesign programme to succeed. 4.6 Service Change Plan 6- Planned Care Performance against WG outcome and Performance Measures Based on latest performance data, Aneurin Bevan is currently achieving 1 of the 9 active WG performance measures in planned care of 145 Public Board Meeting - 24th Janury /01/18

83 Tab 3.3 Integrated Performance Report Agenda Item: Key areas not currently meeting the performance targets are highlighted briefly below: WG Measure 65 & 66: Referral to Treatment Times The Health Board s performance for RTT at the end of November has deteriorated slightly on the October position with 1529 patients breaching 36 weeks compared to 1517 but a slightly improved 26 week compliance for November of 89.8%. Revised profiles have been submitted to Welsh Government at the beginning of December and the position at the end of November is in line with the revised profile of 1700 patients breaching 36 weeks. The December position is currently estimated to increase slightly as expected to 1629 which is below the revised profile of week compliance is estimated at 88.7%. The Health Board s is expected to achieve 145 patient s waiting over 36 weeks at the end of March and the revised profiles have been produced to provide assurance that the Health Board will be able to achieve this challenging target at the end of March. 31 Public Board Meeting - 24th Janury /01/18 83 of 145

84 Tab 3.3 Integrated Performance Report Agenda Item: The current concerns are mainly in Orthopaedics and Ophthalmology, with Ophthalmology being the key reason for the variation from plan. The main reason for this had been the timescales of the microscope replacement scheme and the long term sickness of nursing and consultant staff. These remain particularly challenging with the service unable to recruit into key substantive specialist posts e.g. paediatric, glaucoma care. The service has developed plans through further external commissioning and local efficiencies and is regularly reviewing the demand and capacity plans to meet the challenges. Progress has been made with the service ending November and an estimated December position of 573 that is aligned to the plans of 581. The service has indicated that the plans will deliver a zero 36 week breach position at end of March. The risks remain around staff sickness within the department and cancellations due to bed availability during the winter months. In Orthopaedics the concern this year has been the prolonged waits for spinal patients. The service has implemented plans to reduce the number of long waiting spinal patients waiting for treatment by March Focus has been on seeing the spinal patients awaiting outpatient appointment with MRI diagnostics being undertaken prior to the outpatient attendance. Additional weekend lists are also being planned and the revised profile of 145 patients waiting at the end of year means that micromanagement of capacity is required. The Health Board has been able to reduce the longest waiting patients to zero in all specialties apart from Orthopaedics and Ophthalmology at the end of November The number of patients waiting in excess of 52 week decreased slightly from 179 patients waiting over a year for treatment at the end of October to 177 at the end of November. This is estimated to of 145 Public Board Meeting - 24th Janury /01/18

85 Tab 3.3 Integrated Performance Report Agenda Item:3.3 remain the same for December. The longer waits are related primarily to subspecialty and co-morbidity issues in Orthopaedics (spinal, some arthroplasty and shoulder) and Ophthalmology. 3.3 WG Measure 67: Diagnostic Waiting Times Eight Week Target Reducing the number of patients waiting in excess of 8 weeks has been a challenge for the Health Board particularly in the first part of the year. However, there has been a steady reduction in the numbers since June The improvement has continued in November with 1485 patients waiting over 8 weeks compared to 1780 in October. The majority of the patients breaching the 8 week wait are in endoscopy, with smaller numbers in nuclear medicine, CT, and MR. The position is expected to deteriorate slightly in December with an estimated 1525 patients waiting over 8 weeks. However, this is still a significant improvement on the same period last year with an end of December position of 6075 patients waiting over 8 weeks. The following graph shows performance against a draft IMTP profile. Diagnostic waiting times have had a significant impact on RTT and cancer performance, in particular CT, ultrasound and endoscopy waiting times, and the delivery of sustainable diagnostic services is a Health Board priority for 2017/18. As part of the Endoscopy Transformation programme, outsourcing capacity has been in place since May for diagnostic endoscopy at Emerson s Green. A robust demand and capacity tracker has been developed with weekly assurance meetings taking place to review delivery against the plan and escalation where required. It is anticipated that the service will maintain the weekend additional sessions in January. The service has secured 4 additional lists in YYF which are now in place. The service still 33 Public Board Meeting - 24th Janury /01/18 85 of 145

86 Tab 3.3 Integrated Performance Report Agenda Item:3.3 maintains that the plan along with the outsourced capacity will deliver zero 8 week waits by the end of March The number of 8 week breach patients in radiology reduced in November from 160 patients. This is expected to increase for December but should improve in the last quarter with the additional capacity that has been put in place. There has been significant improvement in Nuclear Medicine despite a shortage of radiopharmaceuticals and the reliance on consultant cardiology cover for the sessions. Alternative diagnostics have been put in place aligned to NICE guidance. The demand on CT have increased both through the change in practice but also with particular pressure from patients who are on cancer pathways. Although additional sessions have been put in place, the impact on CT is being closely managed to ensure that the service can deliver on its 8 week plans. The service has also provided additional MR capacity from the end of November through a mobile MR scanner which will help reduce the backlog and also assist with delivering the Orthopaedic spinal plan. As part of the additional funding allocation by Welsh Government the Health Board has agreed to further improve the diagnostic waiting times position by ending the year with no more than 1700 waiting over 6 weeks and zero 8 week breach patients. This is particularly challenging and based on the latest assessment there are still risks to achieving zero breaches in all modalities in radiology. WG Measures 68: Delayed Follow Up Outpatient The number of delayed follow ups past target date has continued to decrease in November with 20,218 patients delayed past their target compared to 20,955 in October. This is still above the IMTP profile of 18,333 but is a significant improvement on the same period last year of 29,296 patients past target of 145 Public Board Meeting - 24th Janury /01/18

87 Tab 3.3 Integrated Performance Report Agenda Item: Risks have been reviewed by each clinical directorate with plans in place to address the key issues and measures have been developed to support and accelerate their approach. Each service has been allocated a stretch target for the end of the year which aims to focus on addressing the service issues and this is reviewed at the monthly meeting of the Delayed Follow up Improvement Group. The challenge remains for the Health Board to achieve 15,000 delayed follow ups against the IMTP plan. WG Measures 77 and 78: Non Urgent Suspected Cancer (NUSC) (31 day) and Urgent Suspected Cancer (USC) (62 day) Cancer Treatment Performance in 2017/18 has been consistent for the NUSC pathway. However, there has been a reduction in performance since August with a slightly improved positon of 94.6% in November compared to 93.5% in October against the target of 98%. The USC pathway has been more challenging although November s positon has improved with 90.6% compared to 86.7% in October. This is also above the same period last year of 84.8%. The graph below illustrates the performance of both pathways for 2017/ Public Board Meeting - 24th Janury /01/18 87 of 145

88 Tab 3.3 Integrated Performance Report Agenda Item: There continues to be a focus on improving performance and eliminating the backlog despite a number of key challenges l and the actions and plans in place include: Implementation of the early diagnosis pilot in Lung, providing direct to CT scan from primary care for pilot GP practices. Direct to CT scan from abnormal chest x-rays also being piloted. The pilot will be extended to Monmouthshire South, Newport West and Torfaen South. One stop neck lump clinic commenced in Head & Neck. Patients will now receive an Outpatient consultation with an ENT surgeon and if necessary an Ultrasound scan/biopsy with a radiologist at the same time. Thoracic Surgery waiting times escalated to WHSCC. Direct booking from OPD to Endoscopy being piloted in Nevill Hall Hospital. Plan to roll out to other Hospitals. Demand and Capacity review of endoscopy services for USC patients has been completed and dedicated appointment slots and LGI Surgical slots have been made available for USC patients in line with clinical pathways. Ongoing waiting list initiative clinics in LGI, Breast & Skin Urology one stop MRI & Transrectal Ultrasound Scan (TRUS) biopsy clinics now in place. Ongoing demand & capacity review for USC Ultrasound, CT & MRI. This with the aim to increase dedicated slots for each Tumour site and align with agreed pathways. Red flag system developed in RADIS to help prioritise and improve Cancer reporting times in Radiology Special Measures meetings in situ for non-compliant Tumour sites of 145 Public Board Meeting - 24th Janury /01/18

89 Tab 3.3 Integrated Performance Report Agenda Item:3.3 Diagnostic waiting times can be a factor in elongating the cancer pathway and ongoing monitoring of radiology and histopathology reporting times ensures that patients are not delayed. In addition the Radiology Directorate are reviewing the booking process to ensure the appropriate prioritisation of cancer patients and an escalation process is in place. 3.3 Roll out of the Tracker 7 system has been completed to all tumour sites which helps services to monitor all cancer and suspected cancer patients and to ensure that patients are tracked more efficiently through each stage of pathway. A suite of tools is also being developed through cancer services and Information Business Intelligence team that will provide meaningful data to help services improve performance and in preparation for the Single Cancer Pathway. Single Cancer Pathway: The aim of the Single Cancer Pathway is that all patients are treated and reported equitably within a single 62 day pathway as opposed to the two different measures currently reported. The next few months will be particularly challenging when the service will be required to shadow report performance of the Single Cancer Pathway from January The current cancer waiting times have been in place for approximately 10 years and are part of the NHS Outcomes and Performance Framework and measure the cancer pathway from referral to the start of the first definitive treatment. These will still be reported on until the Single Cancer Pathway is fully implemented which is expected to be from April Delivery against SCP milestones The following progress during Quarter 3 has been made in transforming Planned Care: The extension of Ophthalmic Diagnostic Treatment Centres to six locations, with the scope now extending to new patients. Successful recruitment to key specialties, including Spinal and Upper GI Surgeons. The introduction of Seen on Symptoms Clinics for ENT, augmenting the adoption of the Health Board ENT follow up guidelines across Wales. The commencement of a One-Stop PSA service encompassing MRI, assessment and biopsy within urology. The implementation of a number of initiatives to transform radiology services, including the extension of One-Stop Clinics, increased home reporting (70,000 plan film reports), implementation of electronic request vetting and successful recruitment of 12 Radiographers. Continued progress has been made in implementing text and reminder services, reducing DNA rates by 30%. 37 Public Board Meeting - 24th Janury /01/18 89 of 145

90 Tab 3.3 Integrated Performance Report Agenda Item: Service Change Plan 7 - Service Sustainability 3.3 There are no performance measures within the National Framework that relate specifically to this work programme. Whilst the sustainability of a number of acute specialties will ultimately be achieved through their consolidation on to a single site through The Grange University Hospital, the Service Sustainability SCP identifies how the Health Board will sustain a number of its services prior to the planned opening of The Grange University Hospital. This encompasses a review of the actions to sustain paediatric, obstetric and neonatal services following the implementation of a new service model to sustain services at Nevill Hall Hospital, together with plans to deliver key deanery deadlines for strengthening medical education training. Key Achievements in the last quarter are outlined below: Paediatrics/Obstetrics/Neonates Detailed transition plans have been developed to reconfigure Paediatric services within the Health Board prior to the opening of The Grange University Hospital and these are being taken forward in collaboration with Cwm Taf and Powys Health Boards. Changes in patient flows have been modelled and the Health Board is working with the two health boards on the timetable for potential change, aligned to the anticipated completion date for enabling capital developments. The Health Board applied contingency measures in October 2017 with a full paediatric obstetrics and neonatal service maintained 24/7 on weekdays, with limited changes to the provision of services at Nevill Hall on weekends. These have successfully allowed the Health Board to manage patient safety within available workforce and minimise disruption to patients. Surgical Specialties Plans have been implemented across Surgical Specialties to achieve the revised Educational Contract, though 1:11 rotas are not being achieved consistently across all sites. The potential to centralise General Surgery and Trauma services prior to the advent of The Grange University Hospital has been appraised but is not considered operationally feasible due to the clinical interdependencies across acute services with actions focussed on standardising pathways and in retesting clinical models as part of the Clinical Futures Service Redesign programme. Breast services To improve critical mass and thereby improve and sustain performance, plans have been developed to centralise breast services at Ysbyty Ystrad Fawr. These have been subject to engagement with both Aneurin Bevan University Health Board, Powys Community Health Council and a design of 145 Public Board Meeting - 24th Janury /01/18

91 Tab 3.3 Integrated Performance Report Agenda Item:3.3 team has been appointed and detailed work will commence in quarter 4. It is anticipated that an Enhanced Business Justification Case will be completed late spring of 2018 for consideration initially as part of the Health Board s Discretionary Capital programme 3.3 Medical Specialties Plans have been implemented across Medical Specialties to achieve the revised Educational Contract, though 1:11 rotas are not being achieved at Nevill Hall Hospital. Through its Service Redesign programme, the review of the Clinical Futures medicine models has been prioritised, in particular those related to the emergency department and acute medical intakes. Regional Planning The Health Board is playing an active role in the development of regional plans to strengthen ophthalmology, orthopaedic and diagnostic services and is leading the ophthalmology work programme. Relevant project structures have been established, and terms of reference agreed. A baseline assessment has been completed and the work plan has been split into actions to deliver waiting time performance improvement in 2017/18 across south east Wales and to inform 2018/19 IMTP s. Vascular Services There is a well-established Emergency Vascular Network in South East Wales, with the Out of Hours Service focussed on the University Hospital of Wales (UHW) with the rota comprising Vascular Surgeons from each of the component Health Boards. There is a strong evidence base for the further centralisation of arterial surgery, with an option appraisal undertaken in October 2014 identifying UHW as the preferred hub location, with spoke services retained within Aneurin Bevan and Cwm Taf University Health Boards. Whilst good progress has been made in agreeing the final model, this is dependent on an enabling plan to deliver the new service model, and in particular theatre and bed capacity at the UHW hub, including a hybrid theatre, which has an indicative date of 2020 for completion subject to Welsh Government funding approval. To maintain momentum, and address clinical priorities, an interim plan is being developed with initial outputs considered by Chief Executives in December This has identified that the creation of a South East Wales 24/7 Interventional Radiologist out of hours rota comprising consultants from Aneurin Bevan, Cardiff and Vale and Cwm Taf UHBs is a priority for 2018/19, and detailed planning work to enable this has commenced. The scope and timetable for the centralisation of arterial surgery and enabling actions will be considered with clinicians in January 2018 and a resultant implementation plan agreed. To support the process, the governance arrangements to manage the change process 39 Public Board Meeting - 24th Janury /01/18 91 of 145

92 Tab 3.3 Integrated Performance Report Agenda Item:3.3 are being strengthened. 4.8 Quality and Patient Safety 3.3 The Health Board is compliant with 4 out of the 14 current reportable measures. It should be noted that figures for WG 19 measure (number of preventable hospital acquired thrombosis) are included but include all cases of hospital acquired thrombosis. The establishment of whether a thrombosis was preventable is subject to individual clinical review. This measure will be updated once the data reporting has been further developed. The Quality and Patient Safety Committee receives detailed reports against a range of quality and safety indicators including national framework measures. A summary of the measures based on the latest available performance data is shown below: WG Measures 21, 23 and 24: Infection Control The Health Board has had a challenging period since the start of the year of high levels of hospital acquired infections. However, there has been a general improvement across all of the infection measures. The November rate of infection for C. difficile is 22.9 per 100,000 population with December looking to improve further with 16.1 per 100,000 population. This currently exceeds the special target set this financial year which expects a reduction to 25.2 cases per 100,000 population by March of 145 Public Board Meeting - 24th Janury /01/18

93 Tab 3.3 Integrated Performance Report Agenda Item:3.3 Plans that have been put in place have had an impact on the number of non inpatient cases which dropped significantly in November. This improvement is outlined in the numbers below. 3.3 Comparison of monthly numbers of C.difficile for April to December 2017 Comparison of monthly numbers of S. aureus bacteraemia for April to December The Strategic Infection Prevention & Control action plan has been updated. Outstanding actions from the previous plan and new actions related to recent outbreak learning & root cause analysis meetings have been compiled. These include, hand hygiene, environmental cleanliness and ward maintenance issues, deep cleans, antibiotic compliance and education and engagement. The action plan which has been developed and agreed will be monitored via Infection Prevention Committee and within Divisions via the Quality and Patient Safety Forum. There is an additional measure under safe care for 2017/18 in relation to the number of E.coli cases per 100,000 population, with a target set for Aneurin Bevan Health Board of no more than 61 laboratory confirmed E.coli 41 Public Board Meeting - 24th Janury /01/18 93 of 145

94 Tab 3.3 Integrated Performance Report Agenda Item:3.3 cases per 100k per month. This target differs from the All Wales target of 67 cases per 100k. The November position reported 77 cases per 100k which is an improvement on the October position of 84.6 with December expected to further improve to The service will need to ensure that the plans in place will deliver this continued improvement. 3.3 WG Measure 40 - Crude Hospital Mortality The crude hospital mortality data has now been adjusted to align reporting with the <75yrs mortality rate in the national target. Overall the rate has remained stable but has improved slightly in November. WG Measures 26 and 27 - Patient safety alerts and notices There is a revision to the measure for this year with compliance based on the number of alerts and notices as opposed to the percentage compliance. For October 2017 the position shows that there were 2 breaches of compliance for Alerts and 4 Notices. The service is confident that all outstanding alerts are being addressed either by individual actions or being led by a Task and Finish group. One of the alert beaches is part of an extensive training exercise being undertaken in the use of the safety device. Once all staff have been trained compliance can be declared. With regards to the second alert non-compliance (Nasogastric tube misplacement), a revised Policy will be presented at next Clinical Standards and Policies group. Due to the recent withdrawal of the preferred ph indicator strips currently no Health Board in Wales is compliant with this alert of 145 Public Board Meeting - 24th Janury /01/18

95 Tab 3.3 Integrated Performance Report Agenda Item:3.3 WG Measure 28 - Percentage of serious incidents assured on time 3.3 Performance deteriorated in November with only 30% of serious incidents being assured within the agreed timescale compared to 32% in October. This is well below the 90% target. The reason for performance has been in part due to a focus on the backlog of investigations taking precedent over the current ones. Complex investigations have also taken longer than the 60 day target which Welsh Government have been notified of and which have been accepted. There is a continued focus on ensuring further improvements against this measure. 4.9 Finance and Workforce There is currently one financial and four workforce measures included within the national outcome and performance framework for 2017/18. PADR compliance in November has decreased slightly with 75.9% compliance compared to 77.6% in October. This is above the IMTP profile of 70%. PADR compliance is an organisational priority and support will continue to be provided to areas to enable them to develop improvement trajectories. Sickness absence the sickness absence rate has increased in November with 5.4% compared to 5.2% in October. This is above the IMTP profile of 5.10%. Support will continue to be provided in areas to help highlight sickness patterns and trends and which Divisions will need to consider and action. Statutory and Mandatory Training compliance Compliance has slightly improved in November with 58% of staff completing statutory and mandatory training compared to 56% in October. Further work is underway to increase these rates with a focus on the e-learning approach. 43 Public Board Meeting - 24th Janury /01/18 95 of 145

96 Tab 3.3 Integrated Performance Report Agenda Item: Performance Overview Compared to 2016/ Whilst the report mainly focuses on performance against the Welsh Government target and the IMTP performance trajectories, the position has also been compared to the same period last year to provide greater insight into the improvement trajectory year on year. There are 18 measures that have information available for November 2017 that is comparable to November 2016 and this information is summarised in the following table. Monthly Performance Comparison November 16 to November 17 WG Measure No. Performance Measure Target November 16 November 17 Did We Improve or Sustain? 24 Rate of laboratory confirmed clostridium difficile cases per 100k population (Number of cases shown) 65 Patients waiting less than 26 weeks for treatment (RTT) 25 per 100k % 87.3% 89.8% 66 Patients waiting more than 36 weeks for treatment (RTT) Patients waiting less than 8 weeks for a specified diagnostic intervention 68 Patients waiting for a follow-up delayed past their target date Reduce 29,296 20, % of patients waiting < 4 hours in all A&E Facilities until transfer, admission or discharge 73 % of emergency ambulance response times to category red 95% 83.2% 84.9% 65% 75.0% 72.0% of 145 Public Board Meeting - 24th Janury /01/18

97 Tab 3.3 Integrated Performance Report Agenda Item:3.3 WG Measure No. Performance Measure Target November 16 November 17 Did We Improve or Sustain? 3.3 calls up to and including 8 minutes. 74 Number of ambulance handovers over one hour 76 Number of patients waiting 12 hours or more in all A&E facilities until transfer, admission or discharge % of patients who receive a CT scan within 12 hours SSNAP UK average 95.5% 96.2% 80 Assessment by Local Primary Mental Health Specialist Services within 28 days of referral 81 Therapeutic intervention 28 days following assessment by Local Primary Mental Health Specialist Services 90 % of secondary care mental health service users who have a valid Care Treatment Plan (CTP) 91 People assessed under Part 3 of the MH measure who are sent a copy of their assessment report 10 days 94 Patients who DNA a new outpatient appointment - specific specialties 80% 80.8% 86.1% 80% 68.6% 81.8% 90% 90.9% 90.2% 100% 100.0% 100.0% Reduce 6.3% 5.4% 45 Public Board Meeting - 24th Janury /01/18 97 of 145

98 Tab 3.3 Integrated Performance Report Agenda Item:3.3 WG Measure No. Performance Measure Target November 16 November 17 Did We Improve or Sustain? Patients who DNA a follow-up outpatient appointment - specific specialties 100 % of staff undertaking a performance appraisal development review (PADR) in the previous 12months 104 % sickness absence rate of staff Reduce 7.0% 6.2% 85% 68.8% 75.9% 5% 5.4% 5.4% 7. Conclusion Progress has been made across the range of measures, as highlighted in the report, however while there have been positive indicators, there remain significant challenges to improve areas where performance is below anticipated levels including the Emergency Department four and 12 hour targets, RTT, 8 week diagnostic waits and overdue outpatient follow-up appointments. These continue to be areas of both organisational and national priority and significant operational management action is being taken to continue to improve performance. 8. Action The Board is asked: To note current Health Board performance against key measures and targets and the actions being taken to improve performance. Assessment of the Impact of the Report: Financial Assessment The delivery of key performance targets and risk management is a key part of the Health Board s service and financial plans of 145 Public Board Meeting - 24th Janury /01/18

99 Tab 3.3 Integrated Performance Report Link to IMTP Risk Assessment Quality, Safety and Patient Experience Assessment Standards for Health Services Wales Equality/Diversity/Children Impact Assessment) Agenda Item:3.3 This paper provides a progress report on delivery of the key operational targets The report highlights key risks for target delivery. There are no adverse implications for QPS. This proposal supports the delivery of Standards 1, 6 and 22. There are no implications for Equality and Diversity impact Public Board Meeting - 24th Janury /01/18 99 of 145

100 Tab 3.4 Finance Report Agenda Item: 3.4 Finance Performance Report Month Purpose of the Report: This report updates the Board on the: financial performance of the Health Board for the year to date, forecast position for the 17/18 financial year, and Actions to deliver financial balance during 17/18. Recommendation: The Committee is asked to note: 1. The financial position reported for the month to date and the forecast position for the 2017/18 financial year, and 2. Actions to support financial balance in 2017/18. The Board is asked to: (please tick as appropriate) Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance Note the Report for Information Only Executive Sponsor: Glyn Jones, Director of Finance & Procurement Report Author: Hywel Jones, Assistant Finance Director (Financial Planning & Performance) Report Received consideration and supported by : Executive Team Committee of the Board: Finance & Performance Date of the Report: 11 th January 2018 Supplementary Papers Attached: Report & Appendices attached The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page of 145 Public Board Meeting - 24th Janury /01/18

101 Tab 3.4 Finance Report Agenda Item: 3.4 Assessment of the Impact of the Report: Financial Assessment This paper provides details of the financial position of the Health Board as at Month 9 and the forecast position for 2017/ Link to Integrated Medium Term Plan Risk Assessment Quality, Safety and Patient Experience Assessment Health and Care Standards Equality and Diversity Impact Assessment (including child impact assessment) This paper provides details of the financial position that supports the Health Board s 3 year plan. The Health Board has a statutory requirement to achieve financial balance over a rolling 3 year period. Risks of delivering a balanced financial position are detailed within this paper. This paper links to AQF target 9 to operate within available resources and maintain financial balance. This paper provides a financial assessment of the Health Board s delivery of its IMTP priorities. This paper links to Standard for Health services One Governance and Assurance. Not applicable. The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page 2 Public Board Meeting - 24th Janury /01/ of 145

102 102 of 145 Public Board Meeting - 24th Janury /01/18 Agenda Item: 3.4 Initial Analysis of Revenue Financial Performance: As at 31 st December 2017 (M9 2017/18) Key statutory financial targets: Ensure expenditure does not exceed the aggregate of funding allotted to it over a period of 3 financial years, and Receive approval by Welsh Ministers for a plan which improves the health of the population and provision of healthcare in accordance with planning directions. Month 9 Key Messages 0.676m surplus at the end of December 2017 (Month 9) an improvement of 0.3m during December. In-month variance ( '000) (301) Declared WG Forecast ( '000) (1,283) Delivery Risk YTD variance ( '000) (676) Current forecast ( '000) (1,283) Forecast Trend The Health Board has an approved IMTP which is conditional on delivery of financial balance at the year-end. Based on current performance, without further actions, the Health Board is tracking to a year-end surplus of 1.283m. It remains essential that service and financial plans are delivered in order to achieve our approved plan and manage delivery risk. The additional performance monies received must be used effectively to ensure the revised performance targets are achieved. A number of specialities are indicating significant delivery risks to achieving targets, despite the additional performance funding. Tab 3.4 Finance Report Medicines Management: the growth assessment for specialist NICE-HCD treatments from Velindre Cancer Centre has significantly reduced again in December. This has resulted in an in-month improvement of approximately 0.140m and a further improvement in year-end forecast of 0.4m. Savings delivery: 22.4m (increase of 0.1m in-month) of savings plans are implemented of which approximately 21.6m of savings plans are forecast to be achieved in full (green / amber). A review of savings plans in month 7 was undertaken to remove high risk red schemes from the forecast. Green savings plans are 16.6m ( 16.3m forecast achievement) and Amber plans are 5.8m ( 5.3m forecast achievement). The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page 3 3.4

103 Key financial performance headlines: Agenda Item: 3.4 Tab 3.4 Finance Report Public Board Meeting - 24th Janury /01/18 o o o o Medical workforce costs: Medical expenditure decreased in December. Medical agency spend reduced, compared to the previous month, but locum spend increased. Specific areas include: Ophthalmology (sickness cover), COTE and Gastroenterology. Scheduled Care specialities microbiology sickness cover, orthopaedic cover of rota coupled with actions to increase activity. Obs & Gynae / Paediatrics: costs of sustaining existing rotas across sites coupled with medical model changes ( 1.54m expenditure year to date). Unscheduled care specialties issues remain sustaining rotas across multiple sites, covering vacancies and sickness ( 1.66m expenditure year to date). Medical rate caps were introduced on the 13 th November Further analysis is being undertaken to evaluate the impact on service and financial performance. Orthopaedics: Spend is 0.369m higher than plan at the end of December, which reflects an increased case mix - major treatments represent 25.8% of all treatments compared to 23% in the original plan. Delivery of the revised RTT position in line with additional funding received is critical in relation to IMTP delivery. The specialty are 290 cases behind the original case mix plan (23%) - ahead by 81 major cases and behind by 371 non major cases. Ophthalmology: Along with additional costs being incurred, the planned activity is not being delivered and the Health Board has commissioned further treatments externally to support RTT delivery. Nursing temporary staffing costs: Expenditure for nursing bank & agency increased in December ( 1.1m registered, 0.635m HCSW bank & agency costs), In December agency costs increased for a number of specific packages of care within Continuing Healthcare Care. Other key pressure areas remain in relation to Unscheduled Care and A&E, as well as RGH and YYF wards due to vacancy cover and specialling. Within elective services, temporary nursing costs remain high across a number of wards in NHH. Shifts up until 27 th December have been included and therefore the effect of additional capacity and other pay incentives will impact in future months. 103 of 145 The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page 4 3.4

104 104 of 145 Public Board Meeting - 24th Janury /01/18 o o o o o Agenda Item: 3.4 Discretionary Capital: at Month 9, spend against the Discretionary Capital programme (DCP) is 3.927m against the full year allocation of m (36%). Whilst historically spend is weighted towards the last quarter of the year (spend in March 17 equated to 39% of DCP), planned spend in 2017/18 has slipped by approx. 1m over the first 9 months. Divisions will need to progress schemes in order to reduce the risk of non-utilisation of capital resource at year end. Grange University Hospital scheme: The Grange University Hospital scheme is currently forecast to be 0.480m over spent against the 2017/18 approved allocation of million. This figure includes circa 0.242m of costs relating to Fire Cladding works (which are outside the scope of the original scheme but are anticipated to be refunded by WG in 2019/20) and a remaining Health Board contingency pot of 0.2m. Expenditure for the last quarter is being closely monitored with Gleeds and Laing O Rourke to minimise any impact on the Discretionary Capital Programme. Savings performance: An increase of 0.1m in-month of savings plans due to off-patent medicines management savings. Forecasted savings also increased by 0.1m due to reduced costs resulting from the revised medical model in NHH for paediatrics. Approximately 25% of savings plans are amber in nature which provide some risk for future financial performance. Further detail is shown on page 9 which includes a summary of the amber schemes as at December. Improved contract performance: further improvements in forecasts for services commissioned with other NHS Wales providers, specifically Cwm Taf and Cardiff & Vale Health Boards, as well as some English Trusts. Medicines Management: growth for current and new NICE-HCD treatments remains below forecasted levels for secondary care, mainly due to reduced Hepatitis C costs and specialist cancer service treatments provided by the Velindre Cancer Centre. A number of new NICE indications assumed in the forecast for Velindre Cancer Centre have not been implemented as originally predicted. Given the high cost nature of these treatments, the forecast has significantly reduced over the last two months ( 0.6m in-year improvement over last two months with a 1.4m forecast decrease). Costs continue to increase for secondary care Crohn s treatments in Unscheduled Care above forecasted levels. Tab 3.4 Finance Report o Prescribing: NCSO (No Cheaper Stock Obtainable) costs are approximately 4m for the year to date but have decreased in the last couple of months. o Mental Health Continuing Health Care: There were a number of admissions and increases in packages of care for CHC within Mental Health which has resulted in an in-month pressure of 0.2m, this pressure is forecast to continue for the remainder of the financial year. The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page 5 3.4

105 Key Risks / Opportunities: Agenda Item: 3.4 Tab 3.4 Finance Report Public Board Meeting - 24th Janury /01/18 o o o o o o Actions required: Delivery of performance targets within the funding allocated. This is a key pressure for T&O, Ophthalmology and diagnostics performance. WHSSC risk share, financial benefit of 1.5m is assumed in 2017/18. This issue has not been concluded, Delivery against savings programme ( 30m target; 21.6m green/amber plans forecasted to deliver), with recurrent actions. Management of additional costs associated with increased capacity and plans over the winter period. Management of operational delivery pressures (over and above plan). A number of operational Divisions have increased their forecast which indicates operational pressures which require further actions to mitigate. The Health Board hosts some national plan arrangements which may contribute to the Health Board s improved year-end position. The Health Board may look to re-provide for a small number of specific issues, where these have been planned and agreed. Continue to develop and deliver recurrent savings (cost reduction) and cost avoidance plans to ensure financial balance this year and recurrently, Ongoing review of current savings to ensure delivery of plan, Delivery of RTT and diagnostic plans within agreed resources, including necessary actions to ensure performance targets are achieved in line with the revised positon agreed with Welsh Government, Delivery of targeted actions on: o Medical workforce costs, o Nursing agency costs, o Other staff agency costs and non-clinical posts, o Review of Mental Health/LD CHC processes and options to manage cost growth, and o Discretionary areas of non-pay spend. Development of sustainable financial break-even plans across each Division and Corporate Directorate in order to improve financial sustainability, particularly given the non-recurrent nature of some of the funding and cost reductions actions this year. 105 of 145 The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page 6 3.4

106 m (Surplus) / Deficit m m 106 of 145 Public Board Meeting - 24th Janury /01/18 Month: - Month Nine (December 2017) Financial Year: /18 Overall Revenue Position At A Glance This month Last month This month Last month (Surplus) / Deficit in month (301) (3,472) (Surplus) / Deficit savings in month against current plan (Surplus) / Deficit year to date (676) (375) (Surplus) / Deficit savings year to date against current plan Current year end forecast (1,283) 77 (Surplus) / Deficit savings forecast against IMTP requirement 7,929 8, Trajectory of (Surplus) / Deficit 2017/18 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Cumulative Variance Non Pay Movement M09-M08 Current forecast This month Last month Average Per Month 16/17 Workforce Movement M09- M08 Agenda Item: 3.4 This month Last month Average Per Month 16/17 '000 '000 '000 '000 '000 '000 '000 '000 Total Non Pay Spend 25,107 67,688 42,581 62,073 Total Pay Spend ,289 42,502 41,571 Drugs ,651 5,158 4,469 Substantive Pay Spend ,944 38,667 37,291 CHC 720 6,478 5,759 5,347 Variable Pay Spend 511 4,345 3,835 4, Savings Cumulative summary of savings schemes delivery 2017/178 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Initial financial plan Cumulative Actual & Forecast IMTP Savings Requirement Tab 3.4 Finance Report 50 Workforce Actual Spend /16 to 2017/ Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Total workforce costs 2015/16 The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page 7 3.4

107 '000s '000's Month: - Month Nine (December 2017) Financial Year:- 2017/18 Agenda Item: 3.4 Tab 3.4 Finance Report Nurse Bank & Agency Spend 2,500 2,000 Public Board Meeting - 24th Janury /01/18 1,500 1, ,400 1,200 1, April May June July August September October November December January February March Axis Title Medical & Dental Agency & Locum Spend 2016/17 Nurse Agency & Bank 2017/18 Nurse Agency & Bank 2016/17 Average 2017/18 Average 2016/17 M & D Agency & Locum 2017/18 M & D Agency & Locum /17 Average /18 Average April May June July August September October November December January February March 107 of 145 The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page 8 3.4

108 108 of 145 Public Board Meeting - 24th Janury /01/18 Month: - Month Nine (December 2017) Financial Year: /18 Summary Reported Position - Delegated Budgets Agenda Item: 3.4 Month 9 - December 2017 M9 Previous Reported Variance Month Variance Movement in Month M12 Forecast as at M9 M12 Forecast as at M8 Movement 000s 000s 000s 000s 000s 000s Operational Divisions:- Primary Care and Networks (2,894) (2,793) (101) (1,905) (1,708) (197) Community Services (242) (205) (37) 0 (0) 0 Community CHC & FNC (3,446) (3,008) (438) (4,155) (4,145) (10) Mental Health ,033 1,033 0 Scheduled Care 4,787 4, ,113 5,634 (521) Unscheduled Care 4,374 4, ,949 4,948 0 Family & Therapies ,081 1,424 (343) Estates and Facilities (175) (221) 45 (200) (90) (110) Chief Operating Officer (57) (32) (26) 0 (0) 0 Total Operational Divisions 3,692 3, ,916 7,096 (1,180) Tab 3.4 Finance Report The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page 9 3.4

109 Month: - Month Nine (December 2017) Financial Year: /18 Agenda Item: 3.4 Tab 3.4 Finance Report Summary Reported Position continued Public Board Meeting - 24th Janury /01/18 Month 9 - December 2017 M9 Previous Reported Month Movement M12 Forecast M12 Forecast Variance Variance in Month as at M9 as at M8 Movement 000s 000s 000s 000s 000s 000s Corporate / Exec budgets:- Corporate Departments (828) (785) (43) (593) (526) (66) Total Corporate Divisions (828) (785) (43) (593) (526) (66) Specialist Services WHSSC & EASC (342) (656) 314 (312) (497) 185 Total Specialist Services (342) (656) 314 (312) (497) 185 External Contracts LTA's & ACCESS (1,481) (1,015) (466) (2,340) (1,703) (637) Total External Contracts (1,481) (1,015) (466) (2,340) (1,703) (637) Capital Charges (1) (0) (1) Total Capital Charges (1) (0) (1) Total Delegated Position 1, ,671 4,370 (1,698) Total Reserves (1,731) (950) (781) (3,954) (4,293) 339 RINC Total Income Total Income Total Reported Position Month 9 (676) (375) (301) (1,283) 77 (1,360) 109 of 145 The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page

110 110 of 145 Public Board Meeting - 24th Janury /01/18 Month: - Month Nine (December 2017) Financial Year: /18 Division savings target to 15m deficit Granular Identified Green Shortfall vs Green Division Amber Forecast Savings Delivery Division Red Total Green & Amber Total Green & Amber Shortfall on Total Target vs Green & Amber '000 '000 '000 '000 '000 '000 % '000 Primary Care 7,756 6,431 1,325 1, , Community 1, , ,175 CHC 1, Mental Health 3,167 2, , Unscheduled Care 2, , ,835 Scheduled Care 5,900 1,419 4,481 2, , ,080 Family & Therapies 2,817 2, , Estates and Facilities 1, Operations Director Corporate 2, , ,878 External commissioning 1,000 1, , Reserves Total 30,369 16,335 14,034 5, , ,794 Agenda Item: 3.4 Type of Scheme Division / Scheme Number of schemes Plan Forecast Variance Family & Therapies (12) 9 Primary Care - various Medicines Management Primary Care - Diabetes Scheduled Care 1,475 1,605 (130) 15 Unscheduled Care (207) 13 Sub-total 2,630 2,798 (168) 45 Community - variable pay Primary Care - GP Out of Hours Estates and Facilities Pay / Primary Care Family & Therapies Scheduled Care Unscheduled Care Sub-total 1,805 1, Estates and Facilities Family & Therapies Non-pay / Procurement Mental Health Scheduled Care Unscheduled Care (75) 7 Sub-total 1,199 1, Unscheduled Care Commissioning / Income - 0 Sub-total Mental Health CHC Adult CHC Agency 17 (17) 1 Sub-total Total 5,768 5, Tab 3.4 Finance Report Savings forecast delivery has increased by 0.1m in December, due to Medical staffing improvement for paediatrics in NHH and off-patent medicines management in Haematology. The table above indicates the outline category and value of all amber schemes included in month 9. The largest number of schemes relate to non-pay schemes. This table indicates that a number of pay schemes are categorised as amber but are not being realised in full (i.e. they are being partially achieved). These mainly relate to variable pay in both medical and nursing. The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page

111 Month: - Month Nine (December 2017) Financial Year: /18 Agenda Item: 3.4 Tab 3.4 Finance Report Discretionary Non-Pay The Executive Team agreed further actions in order to support delivery of the required break-even position. This included a 20% reduction target on the discretionary non-pay, the table below shows and update on current performance for the Health Board: Public Board Meeting - 24th Janury /01/18 All Divisions Area / subjective costs baseline profile to M9 YTD Month 9 ( ) costs Variance % change Printing Costs 226, , , ,294 (41,422) (24.4%) Stationery 714, , , ,738 (47,659) (10.0%) Postage & Carriage 1,027, , , ,581 93, % Telephone Call Charges 1,157, , , ,052 66, % Travel & Subsistence 2,627,439 2,101,951 1,751,626 1,967, , % Training Expenses 1,254,432 1,003, , ,668 (120,620) (14.4%) Conferences And Seminars 750, , , ,964 (52,593) (10.5%) Contract : Photocopying Rental & Charges 609, , , , , % Furniture & Fittings 671, , , ,183 (212,581) (47.5%) Office Equipment & Materials : Purchase 355, , , ,772 15, % Computer Hardware Purchases 1,834,804 1,467,843 1,223, ,140 (401,062) (32.8%) Grand Total 11,230,139 8,984,112 7,505,617 7,144,978 (360,639) (4.8%) The Health Board has reduced expenditure in comparison to but is currently not achieving the 20% reduction target (currently about 15% reduction). This is primarily due to travel & subsistence, photocopying, postage and telephone spend for the year to date. It remains expected that each delegated area makes progress to deliver financial balance on a recurrent basis. 111 of 145 The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page

112 Velindre English Providers Welsh Providers Income C&V Saving Care UK Underlying Surplus Year End Forecast 000s 112 of 145 Public Board Meeting - 24th Janury /01/18 Month: - Month Nine (December 2017) Financial Year: /18 Contracting and Commissioning LTA Spend & Income At Month 9 the financial performance for Contracting and Commissioning is a year to date under spend of 1,481k. The key elements contributing to this position at Month 9 are as follows: Forecast Commissioned Services in NHS England ,500,000 8,000,000 7,500,000 7,000,000 6,500,000 6,000,000 5,500,000 5,000,000 NHS England Forecast 8,200,052 Budget 8,328, ,879,790 Commissioned Services (NHS England) YTD Variance 70k (f) The current forecast reflects the IMTP submission which identified an increasing trend in activity in NHS England. This forecast has been reduced following analysis of the latest available data. Non-recurrent savings at Moorfields and North Bristol Trust have been reflected in the YTD position. Forecast Commissioned Services in NHS Wales ,000,000 70,000,000 65,000,000 60,000,000 55,000,000 50,000,000 NHS Wales Forecast 69,043,217 Budget 70,060, ,431,828 Commissioned Services (NHS Wales) YTD Variance 812k (f) The current forecast and YTD position reflects the IMTP submission which identified cost pressures in Velindre for NICE drugs, plus an increasing trend in activity at Cwm Taf LHB. Radiotherapy growth and non-velindre NICE drug pressures have been funded from month 4. 19,000,000 18,000,000 17,000,000 16,000,000 15,000,000 14,000,000 13,000,000 Forecast Provider Income Provider Income YTD Variance 599k (f) The current forecast reflects the IMTP submission which included the risk of an income reduction from Powys, the full impact of which is not expected to materialise. The remaining variance relates to additional income received for overseas visitors and English residents treated in ABUHB. Outsourcing YTD Variance nil A favourable variance of 400k is expected against the outsourcing budget in 2017/18 after validating the final invoices from 2016/17. The planned activity for 2017/18 is 1,574 Ophthalmology treatments and 1,700 Endoscopy treatments. The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page 13 Provider Income Forecast 18,135,345 Budget 17,340, ,465,220 7,000,000 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 Forecast Outsourcing of Services Care UK Forecast 2,125,000 Budget 2,525, ,622, Agenda Item: 3.4 Overspend Underspend Forecast Surplus Bridge Analysis - Key Forecast Variances Savings Requirement Savings Target M Status- GREEN There is a target to deliver 1m of cash releasing savings which has been achieved in full, predominantly by negotiating a reduction in the Cardiff and Vale LTA resulting from reduced demand for emergency activity. Key Issues All LTAs have successfully been signed with other organisations by the Welsh Government deadline of 30 th June 2017 with the exception of the Cardiff and Vale LTA, delayed due to disinvestment negotiations. We understand C&VUHB have now signed. Velindre NICE drug cost forecasts have been revised down significantly for this month, but are volatile and may move towards year end. We are working with Velindre to assess pressures. Tab 3.4 Finance Report 3.4

113 A&C Administration & Clerical Glossary Agenda Item: 3.4 Tab 3.4 Finance Report AWCP All Wales Capital Programme AME (WG) Annually Managed Expenditure Public Board Meeting - 24th Janury /01/18 AQF Annual Quality Framework AWCP All Wales Capital Programme B/F Brought Forward C/F Carried Forward C&V Cardiff and Vale CHC Continuing Health Care CRL Capital Resource Limit DHR Digital Health Record EASC Emergency Ambulance Services Committee EDCIMS Emergency Department Clinical Information Management System EoY End of Year F&T Family & Therapies 113 of 145 FBC Full Business Case The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page

114 114 of 145 Public Board Meeting - 24th Janury /01/18 FNC Funded Nursing Care GMS General Medical Services HCD - High Cost Drugs HCHS Health Care & Hospital Services HCSW Health Care Support Worker HSDU Hospital Sterilisation and Disinfection Unit IMTP Integrated Medium Term Plan IPTR Individual Patient Treatment Referral I&E Income & Expenditure LTA Long Term Agreement MH Mental Health Agenda Item: 3.4 Tab 3.4 Finance Report NCSO No Cheaper Stock Obtainable NICE National Institute for Clinical Excellence NHH Neville Hall Hospital PCN Primary Care Networks (Primary Care Division) PICU Psychiatric Intensive Care Unit The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page

115 PrEP Pre-exposure prophylaxis PSPP Public Sector Payment Policy RGH Royal Gwent Hospital Agenda Item: 3.4 Tab 3.4 Finance Report Public Board Meeting - 24th Janury /01/18 RTT Referral to Treatment SCCC Specialist Critical Care Centre SC Scheduled Care (Division) SLF Straight Line Forecast SpR Specialist Registrar T&O Trauma & Orthopaedics USC Unscheduled Care (Division) WG Welsh Government 115 of 145 WHSSC Welsh Health Specialised Services Committee WLI Waiting List Initiative WRP Welsh Risk Pool YAB Ysbyty Aneurin Bevan YTD Year to date The Finance Department - To lead, enable and support the organisation to achieve service and financial excellence. Page

116 Tab 3.5 Risk Dashboard Aneurin Bevan University Health 24 January 2018 Agenda Item: Purpose of the Report: Strategic Risk Report This paper provides an overview of the profile of the current risks of the organisation as at the end of December The risk profile of the Health Board is continuing to be revised and reworked. Further rationalisation and redevelopment work continues and will further developed prior to the end of the financial year. This report is provided for assurance purposes to highlight for the Board the risks that are assessed as the key risks to the Health Board s successful achievement of our strategic objectives within the IMTP. Recommendation: The Board is asked to note this report for assurance purposes. The Board is asked to: (please tick as appropriate) Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance Note the Report for Information Only Executive Sponsor: Judith Paget, Chief Executive Report Author: Richard Bevan, Board Secretary and Bryony Codd, Head of Corporate Governance Report Received consideration and supported by : Executive Committee of the Board N/A Team [Committee Name] Date of the Report: 12 th January 2018 Supplementary Papers Attached: - Risk Dashboard Reports 1. Background Risk management is a process to ensure that the Health Board is focusing on and managing risks that might arise in the future. Also, situations where there are continuing levels of inherent risk within current issues within the organisation or in our partnership work. Active risk management is happening every day throughout all sites and services of the Health Board. Nevertheless, the Health Board s risk management system and reporting also seeks to ensure that the Board is aware, engaged and assured about the ways in which risks of 145 Public Board Meeting - 24th Janury /01/18

117 Tab 3.5 Risk Dashboard Aneurin Bevan University Health 24 January 2018 Agenda Item: 3.5 are being identified, managed and responded to across the organisation and our areas of responsibility. 3.5 The strategic risks referenced within this report have been identified through work by the Board, Committees, Executive Team and items reported through the Health Board s management structures with regard to the implementation of the IMTP. Key risks and issues are regularly considered at each of the Board s Committees and at Executive Team. There is also a range of specific divisional, departmental and project based risk registers, which inform the Health Board s strategic risks and are reflected in Executive Team, Committee and Board papers. The Health Board s Public Health Team continues to undertake work on a bespoke public health and partnerships risk register, which reflects the medium to longer term nature of these risks and these risks are currently being reflected in the Health Board s overall corporate risk register. The risk dashboard reports are generated from the Health Board s Corporate Risk Register which continues to be maintained and redeveloped. The Executive Team held a workshop in October 2017 facilitated by NHS Shared Services and our Internal Audit Service to begin the process of rationalising and reworking the Health Board s approach to risk management and its reporting. Further work is being completed with regard to the Health Board s assessment, treatment and reporting of risks. Views were sought from Board Members regarding risk management at a workshop with the whole Board held in December The Board Secretary and the Chair of the Audit Committee also attended an all-wales NHS workshop on the 12 th January 2018 to discuss the development of Board Assurance Frameworks in NHS Wales and to progress the proposals for a new risk management reporting system with the concept of One Risk on a Page approach. In line with the Strategy approved by the Board in 2017 the risks within the Corporate Risk Register are assessed by using the following assessment table. These are reflected in in the full Corporate Risk Register and area referenced in the Risk Dashboard, which is reported to the Board. 2 Public Board Meeting - 24th Janury /01/ of 145

118 Tab 3.5 Risk Dashboard Aneurin Bevan University Health 24 January 2018 Agenda Item: 3.5 Table from the updated Risk Management Strategy January Consequence Score 1 Rare 2 Unlikely Likelihood Score 3 Possible 4 Likely 5 Almost certain 5 - Catastrophic Major Moderate Minor Negligible Corporate Risk Register and Dashboard Report As outlined above, the dashboard reports are generated from the Health Board s Corporate Risk Register. The reports seek to provide in-overview: The key risks relating to each of the stated strategic objectives for the Health Board, with current risk level, the risk owner and oversight committee or group; The current profile of risks in that strategic objective area and their potential impact; Whether risks have worsened, remained unchanged or had been mitigated since the last assessment; Historical context of each risk i.e. how long it has been at its level on the Corporate Risk Register; The report will also show any risks that have been withdrawn in the last reporting period or whether there are new risks. The risks for the purposes of the dashboards have been summarised to make them more accessible to the Board. However, the detail of the risks, their assessment, controls and mitigating actions continue to be expressed within the full Corporate Risk Register, which is presented to the Audit Committee at each meeting. There are currently 29 risks on the Corporate Risk Register. These are broken down by the following levels of risk severity of 145 Public Board Meeting - 24th Janury /01/18

119 Tab 3.5 Risk Dashboard Aneurin Bevan University Health 24 January 2018 Agenda Item: 3.5 Risk By Severity Extreme (20-25) 9 High (12-16) 16 Moderate (6-10) Low (1-5) 1 3 Severity of Risk Extreme (20-25) High (12-16) Moderate (6-10) Low (1-5) 3.5 In relation to the changes to the assessed risks since the last report, the following changes have been made: Risks with an increased risk score: The risk with regard to the fragility of the GP Out of Hours Service has increased from a risk score of 12 to 16 to reflect the increasing difficulty of securing the required workforce to cover shifts. Risks with a reduced risk score: The risk with regard to capacity and resources for the Clinical Futures programme has a reduced risk score of 16 from the previous report of 20. This is as a result of additional investment and the appointment of additional staff. The risk on the financial impact of the IR35 legislation has a reduced score of 8 from the previously reported 12. This is as a result of further work with HMRC and internal control arrangements. The risk of not achieving financial balance at the end of the 2017/2018 financial year has reduced to a score of 4 from the previously assessed score of 8. This is as a result of the forecast position. Risk of not complying with the Social Services and Well-being Act has reduced to a score of 8 from the previously reported 12. This is as a result of the further governance work 4 Public Board Meeting - 24th Janury /01/ of 145

120 Tab 3.5 Risk Dashboard Aneurin Bevan University Health 24 January 2018 Agenda Item: 3.5 undertaken and the actions on the Integrated Care Fund and also pooled budgets. 3.5 Risk of inadequate fall prevention has reduced to an assessed score of 15 from the previously reported score of 20. This has been assessed due to the reduced number of fractures reported with a reported cause as a fall. Risks Withdrawn: Financial allocation for 2017/18 is not confirmed by Welsh Government. Risks Added: The Grange University Hospital is not delivered as per programme and within approved capital cost/cost profile. 4 Recommendations The Board is to note the redevelopment work that is underway with the corporate risk arrangements and is asked to consider this report and note the identified risks as the current strategic risks for the Health Board as at the end of December Assessment of the Impact of the Report: Financial Assessment and link to Financial Recovery Plan There is no direct financial impact associated with this report. Risk Assessment The coordination and reporting of organisational risks are a key element of the Health Board s overall assurance framework. Link to the IMTP The risks against delivery of key priorities in the IMTP, will be outlined as specific risks on the risk register. Health and Care Standards Equality Impact Assessment This report would contribute to the good governance elements of the Health and Care Standards for Wales. There are no specific equality issues associated with this report at this stage, but equality impact assessment will be a feature of the work being undertaken as p-art of the risks outlined in the register of 145 Public Board Meeting - 24th Janury /01/18

121 Tab 3.5 Risk Dashboard Aneurin Bevan University Health 24 January 2018 Agenda Item: 3.5 Child Impact Assessment There are no specific issues related to this report Public Board Meeting - 24th Janury /01/ of 145

122 122 of 145 Public Board Meeting - 24th Janury /01/18 IMTP STRATEGIC OBJECTIVE: Corporate Risk Dashboard Report as at December 2017 Enabler Risks Associated with Delivery of IMTP KEY THEME ACTIONS: No specific SCPs these areas overarch and underpin the IMTP These areas are not directly associated with SCPs, but will if mitigated, facilitate the delivery of the plan. Impact RISK PROFILE REPORT Key: Likelihood = Risk Worsened = Risk Unchanged = Risk Mitigated 20 Since Oct Since Oct 2017 Description of Risk and Action and if Risk Mitigated, Unchanged or Worsened Since Last Assessment RISK: Poor patient experience and quality of care in hospital and community settings IMPACT: Deteriorating patient outcomes and quality of care resulting in increasing patient safety incidents, serious incidents, complaints, claims and legal cases ACTION: Monitoring of quality measures are in place via Quality and Patient Safety Committee, patient experience is being captured and specific spot checks are being undertaken. Pressure Ulcer Collaborative launched and continued monitoring of HIW/CHC/Complaints/incidents to identify any areas of concern. Temporary staffing and Recruitment Strategy in place. OWNER: Director of Nursing OVERSIGHT: Quality and Patient Safety Committee RISK: Failure to implement and deliver the IMTP IMPACT: The Health Board will not be meeting its objectives to respond to assessed population needs and Welsh Government Targets. ACTION: Monitoring of performance through divisional structures and Board oversight via Finance and Performance Committee continues and detailed plans have been developed. OWNER: Director of Planning and Performance OVERSIGHT: Executive Team and Finance and Performance Committee Tab 3.5 Risk Dashboard 3.5

123 Corporate Risk Dashboard Report as at December Since Sept 2017 RISK: Malware or ransom ware attack compromising ICT systems. IMPACT: Significant disruption to patient care. Potential loss of patient data. ACTION: Local business continuity plans are in place and systems are recoverable over an undetermined timescale. OWNER: Director of Planning and Performance OVERSIGHT: Information Governance Committee. Tab 3.5 Risk Dashboard Public Board Meeting - 24th Janury /01/ RISK: Risk of insufficient capacity and resources to deliver the planned Clinical Futures Programme. IMPACT: The delivery timetable could be compromised and the quality of the design work and engagement could be affected. ACTION:Programme Management arrangements have been put in place, Areas of work being prioritised and additional funding sought from Welsh Government. Additional roles have been identified and appointed to over the last period. OWNER: Director of Planning and Performance OVERSIGHT:Finance and Performance Committee RISK: Financial risk to the Health Board related to employment status and tax allowances with regard to the IR35 Legislation and the contravention of tax regulations. IMPACT: The potential impact of reduced ability of the organisation to secure required workforce (particularly GP sessions) ACTION: Financial impact has been mitigated but service issues in Primary Care have arisen as a result. OWNER: Director of Finance OVERSIGHT: Audit Committee and Finance and Performance Committee of 145

124 124 of 145 Public Board Meeting - 24th Janury /01/18 Corporate Risk Dashboard Report as at December Since Sept Since March 2017 RISK: How the organisation and partners respond to the outcome of the Supreme Court Judgement in relation to Funded Nursing Care. IMPACT: Potential significant financial impact dependent on uplift agreed and any backdating. ACTION: The Uplift is being agreed on an All Wales basis and the Health Board is fully involved with national discussions OWNER: Chief Operating Officer OVERSIGHT: Finance and Performance Committee RISK: Failure to achieve financial balance at end of 2017/18 IMPACT: The Health Board would breach its statutory duty. ACTION: Monthly review of savings plans/cross cutting themes at Executive Board. Deep dive reviews in place to review specific areas of spend. Support for financial delivery will continue to improve the underlying financial position. OWNER: Chief Executive and Finance Director OVERSIGHT: Finance and Performance Committee and Board RISK: Fragility of the Care Home Sector service provision IMPACT: Reduction in Care Home bed capacity which will delay patient discharges. Reduce approrpriate care options for local people. ACTION: Care Home Executive Liaison Group enables dialogue and agree support with Care Home Registered Individuals regarding the future of this sector. This has resulted in one provider developing a new EMI Unit. Three Year Fee strategy agreed to align fees with LA rates and deliver equalisation across LA areas. Working with 5 Local Authorities to implement Part 9 of the Social Services and Wellbeing Act, working towards Pooled budgets being in place for older people in Care Homes from 1 st April. Tab 3.5 Risk Dashboard 3.5

125 Corporate Risk Dashboard Report as at December 2017 OWNER: Director of Nursing/Associate Director of Efficiency & Effectiveness OVERSIGHT: Finance and Performance Committee Tab 3.5 Risk Dashboard Public Board Meeting - 24th Janury /01/18 16 Since Sept Since Nov 2017 RISK: Introduction of the General Data Protection Regulation IMPACT: Potential complaints, reputational damage and financial losses including fines from the ICO of up to 4% of organisational budget. ACTION: Information Governance Division Groups created to assist with implementation and prepare at local departmental level. Awareness session have taken place. Current consideration of additional resources required for implementation. OWNER: Director of Planning and Performance OVERSIGHT: Information Governance Committee. RISK: Lack of improvement in Healthcare Associated Infections IMPACT: Increase in Hospital Acquired Infections placing patients at risk and increasing costs and reducing quality of care. ACTION: There is an annual programme of HPV cleaning for all clinical areas and a ward refurbishment programme in place. Root cause analysis for all HCAIs. Deep Dive for primary and community acquired infection in November OWNER: Director of Nursing OVERSIGHT: Quality and Patient Safety Committee of 145

126 126 of 145 Public Board Meeting - 24th Janury /01/18 Corporate Risk Dashboard Report as at December March New Risk RISK: Compliance rates of statutory and mandatory training of staff IMPACT: Risk of undermining the quality and safety of Health Board services. ACTION: Compliance monitored by the Health and Safety Committee. Access to on-line training has been simplified via ESR and training compliance rates are steadiliy improve. OWNER: Director of Therapies and Health Science OVERSIGHT: Quality and Patient Safety Committee RISK: The Grange University Hospital is not delivered as per programme and within approved capital cost/cost profile IMPACT: Clinical services will not be configured in line with overall clinical futures programme. Significant impact on discretionary capital programme. ACTION: Project management and governance arrangements in place. Monthly progress and commercial meetings established. Project design changes frozen. OWNER: Director of Planning and Performance OVERSIGHT: Planning and Strategic Change Committee Tab 3.5 Risk Dashboard 3.5

127 Corporate Risk Dashboard Report as at December 2017 IMTP STRATEGIC OBJECTIVE: Reducing Health Inequalities and Improving Population Health (SCP 1) KEY THEME ACTIONS: SCP 1 Improving Population Health and Well Being Tab 3.5 Risk Dashboard Public Board Meeting - 24th Janury /01/18 This SCP seeks to improve the health and well being of the Health Board s population, reduce health inequalities and benefit individuals and ensure the sustainability of our healthcare system. RISK PROFILE REPORT Impact Since Nov 2017 Likelihood 16 Since July 2017 RISK: Public Health priorities are not aligned to Health Board planning processes and policies IMPACT: Services will not be responsive or suitable for current and future service arrangements will not be contributing to improving population health. ACTION: Public Health advice to continue to contribute to SCPs to ensure follow through actions following the completion of the needs assessment. Public Health a key feature of IMTP planning processes. OWNER: Director of Public Health OVERSIGHT: Public Partnerships and Well Being Committee RISK: Communities First is planned to be phased out by March IMPACT: There is risk of reduction in community provision of health improvement and wellbeing resilience, which would place greater demand on health services. ACTION: Close partnership working is underway through the Public Service Boards (PSBs). Welsh Government have announced the availability of a legacy fund, to be introduced in April OWNER: Dircetor of Public Health OVERSIGHT: Public Partnerships and Well Being Committee of 145

128 128 of 145 Public Board Meeting - 24th Janury /01/18 Corporate Risk Dashboard Report as at December Since July Since Nov 2017 RISK: Failure to prevent and control communicable disease outbreaks and provide immunisations IMPACT: There would be an impact on general public health and also increased demand for services and the ability of the NHS to respond. ACTION: A Health Protection Team is in place and incident and outbreak plans established. OWNER: Director of Public Health OVERSIGHT: Public Partnerships and Well Being Committee. RISK: The Health Board will not comply with the Social Services and Wellbeing Act. IMPACT: Opportunities will be lost for providing integrated health and social care for local people. ACTION: Ongoing development of local governance and partnership arrangements in support of service integration for Health and Social Care. Review work recently undertaken to strengthen governance. Further work underway on pooled budgets. OWNER: Chief Executive OVERSIGHT: Public Partnerships and Wellbeing Committee RISK: Lack of understanding in relation to the needs of citizens if key stakeholders not appropriately engaged. IMPACT: Citizens will not be aware of service developments and profile. Health Board will not be aware of citizens views to the shape of services. ACTION: Recent work undertaken in relation to the Clinical Futures Programme and the Grange Univeristy Hospital. Service and locality based engagement continues to be undertaken in line with the Engagement Strategy. A range of service engagement and consultation processes underway. Tab 3.5 Risk Dashboard 3.5

129 Corporate Risk Dashboard Report as at December 2017 OWNER: Director of Planning and Performance and Board Secretary OVERSIGHT: Executive Team and Board Tab 3.5 Risk Dashboard Public Board Meeting - 24th Janury /01/18 8 Since May 2017 RISK: The Health Board does not meet the requirements of the Well- Being of Future Generations (Wales) Act 2015 IMPACT: The Health Board does not maximise opportunities to improve services for local people. ACTION: Key stakeholder engagement has been undertaken and comments have been incorporated and the Wellbeing objectives were approved at the March 2017 Board. Further development work continues to be undertaken with regard to implementation through an organisational steering group and work with Public Service Boards. OWNER: Director of Public Health OVERSIGHT: Public Partnerships and Wellbeing Committee of 145

130 130 of 145 Public Board Meeting - 24th Janury /01/18 Corporate Risk Dashboard Report as at December 2017 IMTP STRATEGIC OBJECTIVE: Supporting a further shift of services closer to home through building a NCN foundation for delivery of care (SCPs 2, 3 and 4) KEY THEME ACTIONS: SCP 2 Care Closer to Home SCP 3 Management of Major Health Conditions SCP 4 Mental Health and Learning Disabilities The overall aim of these Service Change Plans (SCP) is to facilitate the development and sustainability of service improvement models that support the delivery of care closer to home. It also aims to deliver more systemic and proactive management of chronic disease to improve health outcomes, reduce inappropriate use of hospital services and have a significant impact on reducing health inequalities. The Mental Health and Learning Disabilities SCP seeks to provide an integrated, whole system model of care that improves the mental health and well being of our population. RISK PROFILE REPORT Impact Likelihood 12 Since Nov RISK: Re-modelling of crisis services in Mental Health. IMPACT: Risk to patient safety if re-modelling services is not staffed and resourced appropriately. ACTION: Review of models of care has been undertaken and senior nurse has been allocated to develop work programme. OWNER: Chief Operating Officer OVERSIGHT: Quality and Patient Safety Committee RISK: Inadequate falls prevention on in-patient wards IMPACT: Failing to protect patients and risk of increased fractures and harm. ACTION: Prevention and Management of Inpatient Falls Policy has been updated updated and disseminated widely across the Health Board. Training ongoing on wards/sites targeting hot spot areas in the first instance. Monthly review and learning from all inpatient falls resulting in a fracture. Numbers of fractures from inpatient falls is reducing. Owner: Deputy Director of Therpaies and Health Science Oversight: Quality and Patient Safety Committee Tab 3.5 Risk Dashboard 3.5

131 Public Board Meeting - 24th Janury /01/18 Corporate Risk Dashboard Report as at December Since Oct 2017 RISK: Potential fragility of GP Out of Hours Services linked to the overall unscheduled care services of the Health Board. Particular risk focuses on the availability of GP sessional staff out of hours and impact of IR35. IMPACT: Additional demand on other elements of the urgent care system if GP Out of Hours cannot be appropriately staffed and the risk that service provision will not meet urgent needs of local people. ACTION: All aspects of this risk is currently being responded to as part of the Winter Plan, particularly the securing of additional staff. OWNER: Chief Operating Officer OVERSIGHT: Executive Team and Unscheduled Care Board RISK: Risk that the current Primary Care estate is not fit for purpose to meet the needs of the local population. IMPACT: Services will be provided from not fit for purpose facilities and new service opportunities will not be realised. ACTION: Close working with Welsh Government to ensure all opportunities are maximised. Estates strategy to be reviewed as part of the IMTP. OWNER: Director of Planning and Performance OVERSIGHT: Finance and Performance Committee Tab 3.5 Risk Dashboard of 145

132 132 of 145 Public Board Meeting - 24th Janury /01/18 Corporate Risk Dashboard Report as at December 2017 IMTP STRATEGIC OBJECTIVE: Improving access and flow and reducing waits (SCP 5 & 6) KEY THEME ACTIONS: SCP 5 Urgent and Emergency Care SCP 6 Planned Care To develop coherent, co-ordinated, high quality urgent and emergency care that works seven days a week, and where possible 24 hours a day. In accordance with patient expectations whilst delivering the best clinical outcomes. To secure improvements in efficiency and productivity that in combination woth prudent healthcare, will improve access and deliver high quality, affordable and sustainable services. RISK PROFILE REPORT 20 RISK: Failure to meet the needs of the local people in relation to emergency care provision including WAST provision. IMPACT: Not meeting Welsh Government targets and patients Since 4 March will not receive services they require in a timely way ACTION: Ongoing monitoring is provided on a weekly basis at 3 meetings with the Divisions and through the Urgent Care Board. New models of care have been introduced. Winter Plan developed 2 and implemented. OWNER: Chief Operating Officer 1 OVERSIGHT: Finance and Performance Committee Impact Likelihood 20 Since Sept 2015 RISK: Unsustainable model of care in Primary Care services IMPACT: Not meeting Welsh Government targets and patients will not received the services they require in a timely way. ACTION: Welsh Government sustainability framework has been implemented and is in use. A range of policies and procedures are in place and in some instances, the Health Board directly manages some Practices. New roles being introduced to support care delivery OWNER: Chief Operating Officer OVERSIGHT: Quality and Patient Safety Committee Tab 3.5 Risk Dashboard 3.5

133 Public Board Meeting - 24th Janury /01/18 Corporate Risk Dashboard Report as at December March Since March 2017 RISK: Failure to efficiently manage out-patient demand. IMPACT: Patients undertake unneccesary journeys to hospital, Inappropriate use of capacity and delays which could result in patient harm. ACTION: A range of improvements being developed; Care Closer to Home Strategy, Out-patient transformation and planned care programme. OWNER: Director of Planning and Performance OVERSIGHT: Finance and Performance Committee RISK: Safety and support for local people compromised due to not having sufficient emergency plans in place for a major incident. IMPACT: Services would be undermined and Health Board unable to meet service demand and be responsive to patient needs. ACTION: A major incident plan has been agreed and is regularly tested and exercised. IT processes have been improved to reduce the risk of failure. OWNER: Director of Planning and Performance OVERSIGHT: Executive Team Tab 3.5 Risk Dashboard of 145

134 134 of 145 Public Board Meeting - 24th Janury /01/18 Corporate Risk Dashboard Report as at December 2017 IMTP STRATEGIC OBJECTIVE: Service Sustainability (SCP 7) 1 KEY THEME ACTIONS: SCP 7 Service Sustainability To ensure that the Health Board focuses on the transition of services that are fragile and present sustainability issues over the next three years and in particular in advance of the SCCC. RISK PROFILE REPORT 20 RISK: Failure to implement Welsh Community Care Information 5 2 System (WCCIS) IMPACT: Reduced ability to support integration between Health Since 4 1 July and Social Care ACTION: Implementation dates are yet to be agreed however, 3 Executive and Board sign off of deployment order to be agreed, based on risk mitigation and National schedule. 2 OWNER: Director of Planning and Performance OVERSIGHT: Information Governance Committee Impact Likelihood 20 Since Oct 2017 RISK: Failure to recruit and retain appropriately skilled staff to deliver high quality care IMPACT: Negative impact on patient care and service delivery due to lack of skilled workforce, low staff morale, increased sickness. ACTION: Plans in place to maximise recruitment in all identified areas to minimise risk OWNER: Director of Workforce and OD and Director of Nursing OVERSIGHT: Finance and Performance Committee Tab 3.5 Risk Dashboard 3.5

135 Public Board Meeting - 24th Janury /01/18 Corporate Risk Dashboard Report as at December Since March 2017 RISK: Inadequate levels of capital funding for estate requirements IMPACT: Health Board will be unable to meet the levels of refurbishment required for Health Board to meet its plans ACTION: Detailed capital programme that is regularly reprioritised by the Executive Team. Opportunities maximised with regular dialogue with Welsh Government. OWNER: Director of Planning and Performance OVERSIGHT: Finance and Performance Committee Tab 3.5 Risk Dashboard of 145

136 Tab 4.2 Clinical Futures Programme Update Agenda Item: 4.2 Clinical Futures Delivery Programme Update Purpose of the Report: To provide an update on the Clinical Futures programme and provide assurance on delivery. 4.2 Recommendation The Board is asked to: To note the progress the amber status. Advise if any further assurance is required at this stage. Consider the decision making points and provide feedback. The Board is asked to: Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance Note the Report for Information Only Executive Sponsor: Nicola Prygodzicz, Director of Planning and Performance Report Author: Corrina Casey, Interim Programme Lead Date of the Report: 4 January 2018 Supplementary Papers Attached: None 1. Background Reports in September and November 2017 outlined programme objectives, governance and change requests as per the change control process. This report provides an update to the Board for assurance. 2. Current Progress Recent progress includes: x Divisional structures enhanced across Unscheduled Care, Scheduled Care and Family and Therapies to support Clinical Futures work and agreed plans for 2018 to refresh their service models and implementation plans. Initial service models have been received for Emergency Department and Acute Medical Take, in addition to the four models noted in November 2017 report. The Hospital at Night proposal was developed, but further work is outstanding to both current and future model of 145 Public Board Meeting - 24th Janury /01/18

137 Tab 4.2 Clinical Futures Programme Update Agenda Item: 4.2 A refresh session was held for finance and workforce Business Partners on the Grange University Hospital (GUH) Business Case and all involved have been encouraged to take a lead to ensure Divisions align with their Integrated Medium Term Plan (IMTP). Due to increasing volume of change requests further control conditions and criteria have been added to the process for services to request building and service model changes, taking on board the current refresh work. A survey to assess understanding and engagement in the programme was completed in November. Over 800 staff took part with a good mix of professions responding, the exception being Facilities and Estates colleagues, most likely due to computer access (a paper version was made available). Awareness of the programme and its intentions were good, more work is required to engage clinical staff. An event took place in December with 130 colleagues, tailored for clinicians. Therapies, Emergency Department, Acute Medical Take, Level 1 Primary and Community Services, Child Health service redesign work was shared with question sheets to capture feedback. Over 250 staff attended separate events to discuss the programme and over 40 people signed up to be change agents. Organisation capacity and demand modelling Phase 1 has been completed by ABCi, their approach has been very well received. This reviewed and tested the original business case modelling, provides insight on the work required to achieve some of the business case assumptions, added population modelling and identified the scale of transformation required for GUH opening. Phase 2 will incorporate scenario modelling Assessment The programme remains at Amber overall. The Amber status is defined by Most deadlines are being met. Resource is affecting progress and/or ability to provide assurance in several areas. This is partially mitigated by the Health Board supporting the appointment of mission critical resources, most of whom will be in place by end of February The Delivery Board are considering interim resource solutions to address clinical design areas of risk until the position with additional external funding and/or the funding of an optimum or contingency team from 2018/19 IMTP is clear. 2 Public Board Meeting - 24th Janury /01/ of 145

138 Tab 4.2 Clinical Futures Programme Update Agenda Item: 4.2 Oct 2017 Nov 2017 Dec Service Re-Design Communication and Engagement Strategic Capital and Estates (GUH project tracking green for all 3 months) Workforce and Organisation Design Supporting Infrastructure Information Technology Programme Risks escalated to the Delivery Board included: The impact of not commissioning advanced practitioners in line with critical path, Potential impact of the Grange University Hospital (GUH) building to Health Board s 2018 cash flow, Impact of not successfully addressing extent of the cultural change required and a lack of detailed milestones in some projects, Each risk is owned by an Executive Director and has a mitigation plan in place to address or reduce the risk. 4. Timeline and Key Decision Points A high level timeline is shown in Appendix 2. Work will be undertaken in March 2018 to further define the critical path and to show the current workstream plans more holistically for areas such as engagement. At this stage known decision points for the Board are: Consideration of significant building or service changes outside of the GUH full business case or consultation as and when they arise of 145 Public Board Meeting - 24th Janury /01/18

139 Tab 4.2 Clinical Futures Programme Update Agenda Item: 4.2 A review of the service redesign refresh in January Board decision may be required if there is significant variance to original model and/or financial impact. Bi-monthly assurance review through current reporting to assess if any Board action is required. Critical risks, their associated mitigation plans and/or un-mitigated critical path slippage will be escalated if they materialise. An agreement to the process for go-no/go for GUH handover and opening; endorsement of the GUH commissioning plan. Any decision in line with the current scheme of delegation and any requests to adjust the scheme of delegation for programme efficiency purposes Conclusion The Clinical Futures programme continues to make progress, with an Amber status. Risks are emerging but each currently has a robust mitigation plan in place. 6. Recommendation The Board is asked: To note the progress made over the past two months and the amber status. Advise if any further assurance or interventions are required at this stage. 4 Public Board Meeting - 24th Janury /01/ of 145

140 Tab 4.2 Clinical Futures Programme Update Agenda Item: 4.2 Appendix 1 - Red, Amber Green Definition RAG Definition 4.2 Red Amber Green No or limited progress being made At high risk of delivery to time/cost May require board level escalation Take action Some progress being made, delivery to date or to plan in most but not all areas Some risks with mitigation plans Monitor or take some action On time, on plan, Mitigations for risk No action required of 145 Public Board Meeting - 24th Janury /01/18

141 Appendix 2 High Level Draft Programme Timeline Agenda Item: 4.2 Tab 4.2 Clinical Futures Programme Update Public Board Meeting - 24th Janury /01/ of