Velindre NHS Trust DELIVERING EXCELLENCE: OUR THREE YEAR PLAN 2014/ /17

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1 Velindre NHS Trust DELIVERING EXCELLENCE: OUR THREE YEAR PLAN 2014/ /17 FINAL DOCUMENT 14 March

2 Contents Page Introduction How to use the plan 1 Engaging with our commissioners 5 Our role in public health 5 Where are we now The services we provide 7 Understanding our strengths, weakness, opportunities 15 and threats Our vision for the future Our vision and goals 17 Our strategic objectives 18 Towards 2017: achieving excellence National strategic direction and policy 19 Key issues on the horizon 25 The Planning Process 32 Improving the quality of Cancer Services Where do we want to be in Forecast demand for our services 36 Our priorities 37 Radiotherapy: our performance and quality ambitions 38 Our plan of action for radiotherapy 40 Chemotherapy: our performance and quality ambitions 50 Our plan of action 53 Improving quality, safety and our staff: our performance 59 ambitions Our plan of action 62 Research and development: our plan of action 72 Improving the quality of Blood and Transplant Services Where do we want to be in Benchmarking our services 77 Forecast demand for our services 81 Our priorities 85 Our performance and quality ambitions 86 Our plan of action 88 Developing a culture of high quality and continuous improvement Supporting our staff to excel 110 Our approach to organisational development 119 Our approach to quality improvement 124 2

3 Page Enabling Transformation to happen: improving the infrastructure Information, communication and technology plan 130 Capital developments and resources plan 145 Spending our resources effectively Our financial strategy and plans 152 Managing the delivery of our plan Commissioning arrangements 161 Integrated performance, risk and assurance framework 161 Performance Management and Quality Improvement System 163 Governance arrangements 164 Measuring our success 167 Risks to delivery Risk register 170 3

4 Introduction Patients, donors, carers and their families are at the centre of everything we do and their needs can only be met if we are able to create an environment which supports our staff in achieving their potential. We are therefore delighted to present Delivering Excellence: 2014/ /17 which sets out our plan for the next three years. It is intended to tell a clear and uncomplicated story about our priorities, the actions we wish to take and the improvements and benefits we expect to see for patients, donors, carers, families, our staff and our partners. The foundation for this plan is our five year framework, Delivering Quality, Care and Excellence which set out a clear vision for the Trust and a set of aims focused on improving the quality and outcomes of our services for those people who use them and the environment and job satisfaction for the staff who provide them. We have used this, together with a range of national policy and service standards, to develop a clear set of actions for the next three years. It is important to recognise at this point that the three-year plan will constantly change during the period as a result of a range of factors, some of which we know about and some which will emerge. Therefore, this plan is intended to provide a direction of travel for the Trust which will evolve as we work through its implementation. How to use the plan Our aim is to make this plan clear and easy to understand. In order to achieve this we have set out the plan in the following way: Section 1: Where are we now: we set out the current range of services we provide and the demand on these services from patients, donors and families/carers. Section 2: Our vision and goals: we set out our vision for the Trust and our strategic objectives up to Section 3: Towards 201; achieving excellence: we set out the big challenges and opportunities we have identified over the next three years. Section 4: Improving the quality of Cancer Services: our priorities and action plan: we set out our vision of cancer services by 2017; our priorities, performance expectations and the key actions we will take to achieve them. Section 5: Improving the quality of the Blood and Transplantation Services: our priorities and action plan: we set out our vision for blood and transplantation services by 2016, our priorities and performance expectations, and the key actions we will take to achieve them. 4

5 Section 6: Developing a culture of high quality and continuous improvement: we set out our organisational development and quality improvement plans which will enable us to put quality at the heart of everything we do. Section 7: Enabling Transformation to happen: improving the infrastructure: we set out our plans for improving the infrastructure and environment within the organisation. Section 8: Spending our resources effectively: we set out our financial plans which will support the delivery of the service priorities and performance expectations. Section 9: Managing the delivery of our plan: we set out the arrangements we have in place to support us in delivering our plan. Section 10: Risks to Delivery: we set out the main risks we have identified in delivering our plans and the actions we are taking to effectively manage them. Engaging with our Commissioners As one of three NHS Trusts within Wales we provide services to the population of Wales on behalf of the Local Health Boards. The commissioning process in Wales is being developed through a range of forums and activities which will take some time to come to fruition. All Local Health Boards and Welsh Health Specialised Services Committee (WHSSC) received a copy of our draft plan in November 2013 to enable feedback and further discussion in advance of the finalisation of the plan. We received a number of comments from Local Health Boards and these are reflected in the plan. Looking to the future, we will continue to work with the Local Health Boards, WHSSC and the Welsh Government to further strengthen the planning and commissioning arrangements to ensure that the services we deliver. Our Role in Public Health We, together with all public services in Wales, have a vital role to play in improving public health in Wales. We are in an excellent position as we have a very talented group of staff, a very strong reputation and recognisable brand, and provide a range of services which allows us to come into contact with a wide range of patients, donors, families and carers at different stages in their lives. We are extremely excited by the potential that this offers us and believe that we could make a significant and sustained contribution to public health across the whole of Wales 5

6 and a real difference. In the first instance, we are keen to identify what our particular role is within the wider system and develop a clear understanding with our partners about the contribution we could make. This will allow us to develop a clear plan of action and ensure our staff have the appropriate skills and knowledge to enable them to make a difference. Importantly, it will ensure that we are able to contribute effectively and in an integrated manner. We will take this issue forward as part of our discussions with our commissioners and partners. 6

7 Section 1: Where are we now? The services we provide We provide a number of services within the Trust which are described below. Velindre Cancer Centre This is a specialist treatment, teaching, research and development centre for non-surgical oncology. It treats patients with chemotherapy, Systemic Anti-Cancer Treatments (SACTs), radiotherapy and related treatments, together with caring for patients with specialist palliative care needs. Specialist teams provide care using a well established network multi-disciplinary team (MDT) model of service for oncology and palliative care, working closely with local partners and ensuring services are offered in appropriate locations in line with best practice standards of care. Whilst radiotherapy services are currently centralised at Velindre Hospital, chemotherapy/sact and Outpatients services also run on an outreach basis with services delivered in facilities around South East Wales, including District General Hospitals. The aim is to improve and extend life, with quality of life at the forefront of all treatment and care. The Welsh Blood Service This service plays a fundamental role in the delivery of healthcare in Wales. It works to ensure that the donor s gift of blood is transformed into safe and effective blood components which allow NHS Wales to improve the quality of life and save the lives of many thousands of people in Wales every year. The Welsh Blood Service: recruits blood and stem cell donors from the public in south, mid and west Wales and through voluntary donations encourages them to continue to support the provision of a wide range of specialist clinical services to NHS Wales. manufactures those donations into safe blood components. provides blood and stem cell components to hospitals, where they will be transfused to patients. supports patient care in a range of clinical specialities, for example in the selection and provision of blood components for patients with specific needs, and in the selection of compatible stem cells and kidneys for transplant patients. Provides professional support for both UK and International laboratories as part of the UK National External Quality Assessment Scheme for Histocompatibility and Immunogenetics. 7

8 Hosted Organisations The Trust hosts a number of organisations on behalf of Welsh Government and NHS Wales: NHS Wales Informatics Service (NWIS) NWIS is responsible for both the strategic development of Information Communications Technology (ICT) and the delivery of operational ICT services and information management. NWIS has a national remit to support NHS Wales, make better use of scarce skills and resources, and facilitate a consistent approach to health informatics and the implementation of common national systems. Shared Services The NHS Wales Shared Services Partnership (NWSSP) is an organisation owned and directed by NHS Wales. It was established in 2011 and supports NHS Wales through the provision of a comprehensive range of high quality, customer focused support functions and services. The range of services include E-Business, Employment, Facilities, Legal and Risk, Primary Care, Procurement, Welsh Risk Pool and Workforce, Education and Development NISCHR Clinical Research Centre (NISCHR CRC) The National Institute for Social Care and Health Research Clinical Research Centre (NISCHR CRC) was established in 2010 and brings together all-wales research networks in health and social care and cancer (the former Clinical Research Collaboration Cymru and the Wales Cancer Trials Network, now Wales Cancer Research Network). National Collaborating Centre for Cancer (NCC-C) The NCC-C was established in April The centre is funded and commissioned by the National Institute for Health and Clinical Excellence (NICE) to develop evidence-based clinical guidelines for the NHS in England, Wales and Northern Ireland on treating and caring for people with cancer. Velindre NHS Trust is directly involved in the governance of this UKwide organisation for improving the care of patients with cancer. Cancer National Specialist Advisory Group (CNSAG) CNSAG is an all-wales NHS organisation based in Cardiff. It works with the Welsh Government and the Cancer Networks to ensure delivery of high quality, up-to-date care for cancer patients and their carers. In collaboration with the All Wales Cancer Steering Groups, it provides expert clinical advice to the Welsh Government regarding the strategic development of cancer services in Wales. It also supports the development and work of the Cancer Networks in Wales. 8

9 Demand for our Services Cancer The incidence of cancer is increasing in Wales by approximately 1.5% per year. In real terms, we expect 1 in 3 people to be diagnosed with cancer before the age of 75 and around 40% of the population of Wales to be diagnosed with cancer during their lifetime. Due to improvements in outcomes people are living with and beyond cancer (survivorship). Currently 120,000 people in Wales are living with or after cancer (approximately 4% of the population) and by 2030 it is forecast this figure will almost double. The demand and complexity of radiotherapy treatment is rising at a significant pace and is often not accounted for in future service planning. The pace of clinical and technological change and innovation in cancer services is rapid and this can often lead to misunderstanding when trying to plan services. Traditionally, current and future referrals and activity levels are used to assess whether a service has sufficient capacity and capability to achieve the required standards and outcomes. However, whilst important this does not provide a comprehensive picture with regard to cancer services. With regard to radiotherapy services a better currency is the time taken to provide the service. Over the past decade there has been a shift from conventional to technical radiotherapy. This will continue over the following decades and represents a step-change in the way that radiotherapy is planned and delivered. For example, in 2013 radiotherapy is mainly 3D, computer-aided and digital. It is vastly more sophisticated and complex than 10 years ago. The majority of radiotherapy planning is done using imaging information from a 3D CT scanner. The oncologist, using computer treatment planning software, manually contours the tumour and the treatment volumes on the planning CT scans, a process that may take 3 hours for a particularly complex case compared to 15 minutes a decade ago. A physicist may require a day to produce an acceptable plan. Treatment itself commonly involves multiple bespoke radiation beams and requires rigorous quality assurance. This can significantly extend the standard 15 minute treatment delivery slot. The increase in complexity and related human resource requirements are particularly noticeable when radiotherapy departments start to use IMRT routinely. It is probable that this will be the biggest service change over the next 5 years. Other developments, such as those related to IGRT, will be no less complex but allowing for the usual learning curves, are likely to be introduced more incrementally than will be the case with IMRT. It is probable that some of the time consuming work involved in planning complex radiotherapy will become more automated over the next few years. An example of this is the increasing sophistication of automatic segmentation software which can, to a variable extent, automatically contour body organs in a planning CT scan. This is currently a manual procedure which can take hours per case. To date, the automatic segmentation systems on the market do not meet the aspiration of being fully automatic and operators are still required to review and edit contours generated by these systems. 9

10 The complexity of radiotherapy treatment will continue to increase and hence the time taken to image, plan and verify. There are 3 components to this complexity: (i). target volume definition: this will increasingly involve co-registering of diagnostic imaging such as MRI and PET-CT and multi-disciplinary input into RT radiotherapy planning from radiology. (ii). dosimetric treatment planning: this is increasingly using computer software to sculpt radiation delivery to treat the target volume and spare normal tissues at risk. This may allow higher dose delivery to the target and improve cure rates or reduce toxicities from radiotherapy by sparing normal tissues. Planning may also take into account temporal changes in shape or movement of the target volume in the form of 4D CT planning, which requires more extensive imaging procedures to record and account for motion effects. (iii). Treatment set up, verification and radiotherapy delivery: this will be affected by the complexity of beam arrangements, new technology to accurately image during treatment what is actually being treated and adapting the treatment delivery to changes in target volume shape or position either by resetting fixed treatment fields, tracking in real time or adapting to changes of tumour position or shape identified by repeated imaging during treatment. The increasing complexity of radiotherapy treatment delivery has resulted in a requirement to increase the routine appointment slot duration for radiotherapy attendances. IMRT planning has also had an impact on the demand for medical physics planners. Audits have demonstrated that a conventional conformal plan would take approximately 3.5 hours to produce. The IMRT planning process was recently mapped and demonstrated a time requirement of up to 11 hours to produce and check an IMRT plan. This is reflected in appointment times as in 2007/08 over 80% of referrals were allocated a 10 minute slot. By 2012/13 this had reduced to less than 22% of attendances. When predicting the required daily LINAC machine time for radiotherapy in the future the known changes to the service have been considered and have been included as additional hours per working day. The impact of changes to be implemented in the coming three years is relatively well understood and has formed the basis of the modelling. 10

11 Fig. 1 Current and ppredicted hours of LINAC daily machine time required up to 2025 Initial forecasts suggest a 48% increase in LINAC machine time between 2013/2014 and 2024/2025, which equates to approximately 35 hours per day of LINAC machine time. It is expected that the LINAC machine time predictions set out in Fig. 1 will be understated as new and increasingly complex technology is introduced into the service. Fig. 2 Current and predicted referrals and LINAC machine time required to treat them by 2025 Whilst a 1.5% annual increase does not initially seem significant, it represents a major challenge when converted into LINAC machine time hours required to treat patients. Fig. 2 illustrates this as whilst the predicted number of radiotherapy referrals increases steadily over the next 10 years, the amount of daily LINAC machine time required to meet the increase in referrals rises significantly as a result of the increase in complexity of treatments. It is clear that the improvements to planning and treatment regimes will lead to significant increases in the amount of time it takes to treat each patient with more sophisticated 11

12 clinical and technological procedures. This should be partially offset by a reduction in the number of episodes of treatment that patients receive, although the expected gains have not yet been fully evident in SBRT and IMRT. This additional element of complexity is often not understood sufficiently when planning service levels and is expected to grow exponentially. Chemotherapy attendances Curent and predicted attendances for SACT/Supportive care / / / / / / / / / / / / / / / / /25 Fig. 3 Actual and predicted referrals and SACT/Supportive care up to 2025 The picture is similar for chemotherapy treatment with a steady increase in referrals over the next decade. However, in real terms this will require an additional increase in activity of 16%. Blood and Transplantation Services The demand for red blood cells has fallen consistently over the last decade for a number of reasons. These include improved clinical practice in theatres, more effective stock management and more effective usage and reduced levels of waste. This is in contrast to the demand for platelets which has increased steadily over the past decade as a result of higher standards relating to the quality of blood products. 12

13 Red Blood Cells Issued RBC Demand /99 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 Fig.4. Red Blood Cells (RBC) issued to customer hospitals Pools Issued Apheresis Issued Total Issued Fig.5 Platelets issued to customer hospitals / / / / /09 Deceased kidney donor work-ups Live kidney donor work-ups Haemopoietic stem cell recipient/donor testing Fig.6 Stem cell and Transplant Immunology Services 13

14 The increase in testing for kidney transplantation has risen as a result of UK initiatives to decrease waiting lists. As such, this leads to improved quality outcomes for patients as well as being more a cost effective treatment. There has been a considerable drive to increase liver transplant donors in the last few years as these are associated with enhanced outcomes for patients. Stem cell provision has also increased as a result of an increase in demand for stem cell transplants on a global basis. In particular, technological advancements have enabled this to become a more viable option for older patients. 40 Welsh Bone Marrow Donor Registry (WBMDR) Number of HSC Collections UK International Fig. 7 Welsh Bone Marrow Registry There has been a global increase in demand for transplants and due to the availability of high resolution typing of WBMDR donors this enables faster identification of suitable matched donors. 14

15 Understanding our services We have undertaken a SWOT (strengths, weaknesses, opportunities and threats) analysis of our two main services to inform the development of our strategic plans. These are set out below. Cancer Services High quality of care Strengths Very good reputation High / positive brand recognition Committed clinicians, staff and volunteers Strong patient facing culture Very high patient experience and satisfaction ratings International reputation for some areas of research and development Opportunities Development of new treatments and technologies in Wales Ability to repatriate patients receiving treatment in England/other countries back into Wales as wider range of services and treatments are offered Development of a new cancer campus in South East Wales Increase fundraising activities to support further developments in treatment and technology Further development of research and development activities e.g. Phase 1 clinical trials Develop strategic relationships with other tertiary cancer service providers to share learning Weaknesses Hospital is 60 years old and the age of the estate impacts on the quality of care and patient experience Increases in referral and demand may outstrip capacity Lack of physical space to meet need Challenge to keep pace with advances due to limited resources Limited space available to progress research and development agenda Increases in referrals and demand result in significant pressures on clinical workforce No established capital programme for replacement of essential equipment and technology e.g. LINACS Partnerships with Local Health Boards still in development stage Threats Further reduction in capital resources from Government Reduced funding from Local Health Boards Inability to keep pace with advances in treatment and technology which could impact on patient care and also the recruitment and retention of staff Patient satisfaction and experience ratings fall as a result of the poor environment 15

16 Blood and Transplant Services High quality of care Very good reputation Strengths High / positive brand recognition Committed clinicians, staff and volunteers Strong patient, donor facing culture High patient, donor experience and satisfaction ratings International reputation for some areas of research and development Opportunities Development of new treatments and technologies in Wales Provision of all-wales service by acquiring North Wales services from 2015/2016 Develop lean culture and ways of working to ensure effective use of resources Increasing attraction and retention of donors reduces the amounts of blood imported Increase research and development activities to improve quality of service, reputation and generate additional income Improved marketing and communications to increase donor attraction and retention Development of recruitment strategy for bone marrow donors and creation of single point of contact within the UK for Transplant Centres Development of strategic relationship by joining the National Marrow Donor Programme (NMDP) as a donor centre Potential to extend services into the wider public health agenda on behalf of Local Health Boards. Weaknesses Transformation programme encountering some difficulties with the up-skilling of staff Difficulties in retaining existing donors may result in under-supply; similar to the picture across the United Kingdom Limited resources to actively market services Lack of capital resources Extended timeframes for implementing key technology and information systems Partnerships with Local Health Boards not sufficiently mature or effective Lack of national blood stock system Threats Inability to fully introduce a modern service model Donors do not commit to a modern service model i.e. planned appointments Cost of supply increases and results in significant financial risk Reduced funding from Local Health Boards Reduced capital resources from Government Inability to keep pace with advances in treatment and technology due to resource constraints Patient, donor satisfaction and experience may reduce as a result of the changes to service provision Increasing regulation may have additional cost impacts on the service Collaborative work with NHSBT needs to be agreed to support development of plan to uplift short fall in collection against demand in north Wales pre-transition. Failure to achieve this will restrict WBS ability to meet clinical demand at go- live. 16

17 Section 2: Our vision and goals We have developed an uncomplicated vision and set of goals to guide our development. Our Vision - - high quality outcomes. Velindre NHS Trust will be recognised locally, nationally and internationally as a renowned organisation of excellence for patient and donor care, education and research. Our Goals High Quality Outcomes Improved well being and quality of life for our patients and donors Excellent care for our patients, donors, families and carers World class research and development Organisational excellence 17

18 Our strategic objectives In order to achieve our vision we have identified a small set of objectives. Equitable and timely services: providing patients and donors with access to services according to their clinical needs in a fair way Safe and reliable services: prevent all avoidable harm to patients and donors Providing evidence based care and research which is clinically effective: identifying and using the most effective treatment, drugs and technology to get the best outcome EXCELLENCE First class patient /donor experience: providing the care to patients and donors that we would want for our family and friends Supporting our staff to excel: providing our staff with the support, encouragement and environment to achieve their potential Spending every pound well: ensuring everything we do adds value for patients, donors and partners 18

19 Section 3: Towards 2017, achieving excellence National Strategic Direction and Policy The focus and direction of the Trusts three year plan is determined by a range of drivers which bring together national policy, Local Health Boards local needs assessment (in their capacity as commissioners of our services) and the need to comply with statutory requirements. National Policy Drivers There are a number of important national strategies and policies which guide the development and delivery of the services we provide. Together for Health was launched in November 2011 and sets out the Government s aspirations for a high quality, safe, effective and person-centred health system. Its aims are for: Health to be better for everyone meaning that more children will have a good start in life and more people will enjoy a long and healthy life. Access and patient experience to be better meaning that people will be able to access primary care more easily, will have more services delivered locally (e.g. through pharmacies) and more services will be available 24 hours a day, 365 days a year. In addition, more information and advice will be available by telephone and on-line. Better service safety and quality will improve health outcomes meaning that we can safely sustain a network of care, with partners, which assures high quality care and is resilient to manage future need. This network will be able to meet patients justified expectations in terms of safety, quality, access, communication and respect leading to improved health outcomes for people. To achieve this requires sustained and long term change to account for the advances in medicine, new technologies and a population that is ageing and living much longer. This means a reconfigured health system fit for today and future years that is built on prevention, self-management and home-based services, recognising the important role carers play in helping maintain independence at home integrated health and social care centres, partnerships and teams, hospital clusters, networks and regionally based services, planned specialisation and consolidation of care into centres of excellence. These are supported by a range of cross-cutting policies which are set out in table 1. 19

20 Table 1 Strategic drivers within Wales Policy Document Working Differently, Working Together Safe Care, Compassionate Care Together for Mental Health - A Strategy for Mental Health and Wellbeing in Wales Rural Health Plan More Than Just Words the Welsh Government s strategic framework for Welsh language services Our Healthy Futures: a range of Health Improvement documents Direction and objectives This document focuses on the vital role that all staff play in delivering safe and effective care for the people of Wales. It recognises that the NHS in Wales is working within a changing environment in challenging times. It is therefore important that staff are supported by the best in employment practices. This framework will support the development of the right staffing model in order to continue to transform the way we deliver healthcare. This governance framework builds on previous work set out by the WG and describes the assurance systems which should be in place to ensure organisations have a robust, transparent approach to quality care. The strategy aims to improve the lives of people using mental health services, their carers and their families. At the heart of the Strategy is the Mental Health (Wales) Measure 2010, which places legal duties on Health Boards, Trusts and Local Authorities to improve support for people with mental ill-health. The strategy is structured around six key themes: promoting mental wellbeing, partnership with the public, delivering a welldesigned, integrated network of care, addressing the factors which affect mental wellbeing and action planning. The plan aims to ensure that the future health needs of rural communities are met in ways which reflect the particular conditions and characteristics of rural Wales. This document provides a clear framework for the continued development of the Welsh Language and the provision of all services in the language of choice. This strategy sets out a clear direction and programme for improving public health in Wales. 20

21 The additional range of strategies and documents also contribute to the strategic direction and plans of the organisation (this is not an exhaustive list): Sustainable Development Charter One Wales: One Planet Doing Well, Doing Better: Standards for Health Services in Wales Delivery Plan for the Critically Ill 2013 The Francis Report National Dementia Vision for Wales Lives / 1000 Lives Plus The NHS Wales Quality Delivery Plan Government priorities and health targets The Welsh Government also has a range of national Tier 1 targets which the Trust is required to meet. Cancer Policy Drivers Cancer is one of the two biggest causes of premature death in Wales. With our ageing population the demand for cancer care is increasing. For this reason tackling cancer is one of the Welsh Government s top priorities. In 1995, a report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales (known as the Calman-Hine Report) recommended a restructure of services to create a network of care in England and Wales to enable a patient, wherever he or she lives to be sure that the treatment and care received is of a uniformly high standard. Fundamental to this was the development of a structure of cancer centres in a hub and spoke arrangement with smaller cancer units. The application of these principles in Wales was set out in the Cameron Report, 'Cancer Services in Wales' which laid down the foundation for the development of cancer services in Wales, with services based around three cancer centres. The development of the National Cancer Standards (2005) helped to define the core aspects of the service that should be provided for cancer patients in Wales. These National Cancer Standards take account of the evidence-based Improving Outcomes Guidance series published by the National Institute of Health and Clinical Excellence (NICE). Designed to Tackle Cancer in Wales ( ) published by the Welsh Government continued the development of a strategic framework for tackling cancer with the emphasis on action based around four themes: (i) more prevention; (ii) early detection; (iii) improved access; and, (iv) better services. The current strategy, Together for Health: Cancer Delivery Plan was launched in 2012 and sets out a clear vision for cancer services in Wales: 21

22 People of all ages to have a minimised risk of developing cancer and, where it does occur, an excellent chance of surviving, wherever they live in Wales. Wales to have cancer incidence, mortality and survival rates comparable with the best in Europe. The Delivery Plan sets out the strategic themes and actions required to improve outcomes in the following key areas: Preventing cancer: people live a healthy lifestyle, make healthy choices and minimise risk of cancer. Detecting cancer quickly: cancer is detected quickly where it does occur or recur. Delivering fast, effective treatment and care: people receive fast, effective treatment and care so they have the best chance of cure. Meeting People s Needs: people are placed at the heart of cancer care with their individual needs identified and met so they feel well supported and informed, able to manage the effects of cancer. Caring at the End of Life: people approaching the end of life feel well cared for and pain and symptom free. Improving Information: providing improved analysis and information which is available at the right time to the right person. Targeting research: to support improvements in cancer treatment and care. The Trust is working with Local Health Boards and a wide range of partners to implement this plan. Welsh Blood Service Policy Drivers The Welsh Blood Service is charged by Welsh Government to be the supplier of blood components for customer hospitals across NHS Wales. This means it must ensure that supplies are sufficient to meet demand in compliance with relevant regulatory and statutory requirements. Regulation and compliance in healthcare continues to develop both in terms of stringency and increased frequency of change. The introduction of the EU Blood Directive was transposed into UK law in 2005 as the Blood Safety and Quality Regulations (BSQR). This has resulted in a phased shift in the extent and stringency of achieving regulatory compliance. As a result, all UK Blood Establishments became subject to regular inspection against the BSQR by the Medicines and Healthcare products Regulatory Agency (MHRA), on a minimum of 2 yearly cycles to ensure regulatory compliance. The diagnostic services provided by the WBS are also subject to a variety of regulatory authorities/organisations, including the Human Tissue Authority, Clinical Pathology Accreditation UK Ltd and the European Federation for Immunogenetics. These developments have meant that the standards of premises in which blood component collection and manufacturing take place and the quality systems and resources required to support this activity and maintain its Blood Establishment License have significantly increased. Furthermore the emergence of new infectious agents that can be transmitted by 22

23 blood and new technologies that improve blood safety has led to the need to introduce new tests and technology to keep the blood supply safe. Not surprisingly, this continually drives up the cost of blood and related services whilst driving down operational flexibility. The Joint UK Blood Transfusion Services and National Institute of Biological Standards and Control Professional Advisory Committee (JPAC) prepare detailed service guidelines, known as the Red Book for the UK Blood Transfusion Services and act in concert through the UK [blood services] forum, a body which co-ordinates UK wide inter-service activity. Further advice for the UK Blood Services may be given by external bodies such as the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) who in turn provide expert advice and recommendations to the four UK Health Departments; SaBTO also formally considers cost-effectiveness of transfusion strategies. Recent recommendations, which may become mandatory requirements by the Health Departments, include the need for prion filtration, the restricted use of UK plasma and the preferred use of pooled platelets. Non-mandatory guidelines and recommendations also have an impact on the Welsh Blood Service. Perhaps the most visible are those contained in the Health Service Circulars that lay down clear guidance for hospital laboratories on the appropriate use of blood (Better Blood Transfusion). The Welsh Blood Service has been very proactive in supporting hospitals and this support will continue to be expected. Other examples include recommendations from the Serious Hazards of Transfusion (SHOT) team, the National External Quality Assurance (NEQAS) Steering Groups and the British Committee for Standardisation in Haematology (BSCH) all of which influence hospital and blood service practice. Professional bodies such as the Institute for Biomedical Science (IBMS) and British Blood Transfusion Society (BBTS) are also influential in transfusion practice. Other professional bodies e.g. those for nursing and obstetrics produce guidelines that affect the work of the WBS. Summary The strategic and policy framework in Wales, together with the various clinical and professional standards and guidance have a number of common principles at the heart of them, which the Trust has at the centre of its thinking. These are summarised as: Putting citizens and patients at the centre of service design and delivery; Providing services of the highest quality which meet the needs of individuals consistently; Improving the quality of services; Delivering outcomes which are comparable with the best elsewhere; Reducing all avoidable waste, harm and variation; Providing care at home or within the local community wherever and whenever possible; Developing a system which is based upon the principle and practice of co-production; Uses resources in a sustainable way; Treating people individually with dignity and respect; 23

24 Ensuring that every Welsh pound is spent efficiently and effectively; and Providing a first class experience for everyone who uses services. 24

25 KEY ISSUES ON THE HORIZON There are a number of challenges and opportunities which have been at the forefront of our thinking during the development of the plan. Generic Issues Our population is growing: The Welsh Government have predicted that the population of Wales will increase by 5% to 3.17 million by 2020 and by 12% to 3.37 million by This will increase the demand for services across the NHS (National Population Projections for Wales 2010) Our population is ageing: we are facing an increase in the number of older people across Wales. This is illustrated in Fig. 8 which shows that the number of people in Wales aged 65 and over is projected to increase by around 365,000, approximately 55%, between 2010 and This will place an increasing demand on our services given the link between age and the incidence of cancer and the need for blood services. Fig. 8 Population aged over 65 projections Funding is decreasing in real terms: the funding position within the NHS in Wales is extremely challenging with the medium term outlook likely to see little or no growth in cash terms. This presents significant pressure for all NHS organisations given the increasing costs of providing health care against ever increasing demand for services, rising costs of medicines and technology as a result of innovation and advances in clinical practice and unavoidable cost increases such as pay inflation. We need to keep pace with clinical advances and technology: the main services we provide are non-surgical oncology, blood donation and support for transplantation, and these are largely dependent on cutting clinical services and technology. The pace of technological advancement is extremely rapid and our ability to keep pace is driven by the availability of 25

26 capital resources, which are significantly constrained within Wales. We need to overcome this to achieve our ambitions. We need to continuously improve the quality of care, patient and donor experience: the public quite rightly expect us to continuously improve the quality of services they receive and their experience of it. This is at forefront of our thinking and has been accentuated by the unacceptable themes identified within the Francis Review into Mid Staffordshire NHS Foundation Trust. We currently provide high quality services but fully believe that they can always be improved. We need to continue to reduce inequalities in health: whilst we do not have a statutory responsibility for improving population health we believe we have an integral role to play in reducing inequalities in health within South East Wales. There is significant variation in the life expectancy for people in different communities in Wales, many of whom receive our services. The causes of this are complex and related to many factors including lifestyle, socieconomic factors (such as unemployment and poverty) and access to services (the Inverse Care Law which identifies the fact that those who least need services access them more than those with the greatest need). We have the opportunity to reverse this unacceptable trend. We need to continue to improve the safety and outcomes of the care we provide: we are proud of the quality of care we provide and the patient outcomes we achieve. We, like all ambitious organisations, are focused on continually improving the quality of services we provide and the outcomes they produce. There are a number of areas where we believe further improvements can be made regarding improved safety and enhanced clinical outcomes to enable us to be an organisation that is identified around the United Kingdom and the world as being synonymous with excellence. Specific to Cancer Services Incidence of cancer is increasing: more people in Wales are being diagnosed with cancer than ever before. The incidence of cancer is increasing annually by approximately 1.5% in Wales with the most commonly diagnosed cancers (breast, lung, bowel and prostrate) accounting for over half of all new cases. This is particularly relevant given the relationship between an ageing population and the increased likelihood of having cancer. This presents a challenge for services as more patients require treatment and ongoing care than ever before. 26

27 Fig. 9 Average Number of New Cases per Year (All Cancers Excluding Non-Melanoma Skin Cancer) in the UK from and Age-Specific Incidence Rates per 100,000 Population The relationship between deprivation and cancer incidence for the South East Wales population that the Velindre Cancer Centre serves: The Welsh Cancer Intelligence and Surveillance Unit report, Cancer Incidence, Mortality and Survival by Deprivation in Wales, highlights the relationship between cancer incidence and relative areas of deprivation and affluence. There is a high concentration of deprived areas within the Cancer Centres catchment population of South-East Wales as illustrated in Fig. 10. This disparity is further exemplified by the fact that cancer incidence in the most deprived areas is 21% higher for men and 14% higher for women than reported for men and women from affluent areas. Treatments are becoming more complex and taking more time to plan and administer: research and development is supporting the advancement of cancer care at a rate unsurpassed. This is enabling more sophisticated treatments to be provided to patients which have improved clinical effectiveness and survival rates. These advanced treatments require greater amounts of time to plan, prepare and administer and this causes pressure as there are more patients requiring treatment which often take longer to provide. We therefore have to find sustainable ways to ensure that patients are still able to access care at the right time. 27

28 Fig. 10 Deprivation in Wales 1 Affluent (376) 2 Quintile 2 (378) 3 Quintile 3 (373) 4 Quintile 4 (377) 5 Deprived (392) Survivorship has increased and the proportion of the population living with cancer in remission or with managed relapses will continue to rise: the increasing effectiveness of cancer treatment has seen a significant increase in the number of patients surviving the disease. At the end of 2009, almost 85,000 people were living after a prior diagnosis of cancer during the previous 15 years (just under 3% of the population). Macmillan have forecast that this figure is set to double to about 7% of the population by For many people cancer is now considered to be a chronic condition which requires a new approach to supporting people living with the disease. We therefore need to continue to develop services and support mechanisms which enable people to effectively manage their condition and live happy and fulfilled lives. Developing a cancer campus in South East Wales: the increasing demand for services, the ageing condition of the cancer centre, the lack of physical space to treat people, and the need to keep pace with advances in treatment and technology have made the development of a new facility a high priority for the Trust. We want to develop a set of services which are fit for the 21 st Century and support them with a world class cancer campus which brings together the best possible patient care and environment with the voluntary sector, and 28

29 leading edge research and development with academia. This will provide the basis for excellence and be future proofed for decades to come. The current patient environment is poor and does not provide a high quality experience for patients, families and carers. The Velindre Cancer Centre was built in 1956 and has been extensively developed in an incremental fashion. The hospital is widely acknowledged as having a Velindre Way which is embodied by a culture where patients are at the centre of everything, the environment is a compassionate and caring one and where staff consistently go the extra mile to meet the needs of patients, families and carers. Notwithstanding this, there are large parts of the hospital which do not comply with statutory requirements such as Health Building Notes. The site also presents a significant challenge with regard to energy and environmental management with the building design constraining the potential gains that could be made. Of greater importance is the impact the environment has on patients and the service they receive. In general, the hospital is not fit-for-purpose to provide cancer services for a population of 1.5 million people in the 21 st century. This is illustrated in a number of ways: Physical Two out of the three inpatient wards are well below the required standard for modern healthcare; Space is cramped with the majority of inpatients having insufficient space; The majority of circulation routes are too narrow for the volume of traffic and patients and staff/families have to stand tight to the wall in the main corridor if a trolley or wheelchair is passing as there is insufficient room for two-way traffic; The outpatients department is too small to cope with current demand and in desperate need of modernisation; Patients, staff and services have to cover too much distance due to the poor adjacencies that have resulted from piecemeal design e.g. the pharmacy is at the furthest point away from the outpatients department; The hot and cold water infrastructure is insufficient to support the showers and washing facilities on the First Floor inpatient wards due to the incremental development of the building. The existing working environment often causes staff to make compromises as they deliver care. For example, using smaller hoists in patient rooms due to the limited space. Patients and families The facilities do not always provide patients with their basic and fundamental needs. For example, there are frequent occasions when inpatients on the First Floor ward 29

30 are unable to have a shower as the pressure is insufficient to get water to the showers and as it cannot be controlled safely; it is either very hot or very cold. The dignity of patients is compromised due to the lack of space and privacy for inpatients. For example, there is little space between beds on the First Floor. There is a similar picture for outpatients where the design of the consulting rooms does not allow for total privacy. The majority of the inpatient, outpatient and therapies environments are not synonymous with a cancer centre which supports well-being and healing. There is insufficient car parking available for patients and their families and they often have to spend too long waiting for a space or finding a car parking space outside the hospital in a built up and busy residential area. While quality of the service provided to patients is rated very highly, we fully recognise that the environment that it is provided in is not fit-for-purpose and does not provide patients, their families or our staff with the experience they deserve. This particular issue is perhaps the biggest risk to the reputation of the Velindre Cancer and will reduce our ability develop our reputation nationally and internationally and provide the highest quality patient care to which we aspire. Specific to Blood and Transplantation Services The donor pool is shrinking: an ageing population means today s donors are tomorrow s recipients and the potential pool of donors is shrinking, creating an inverse relationship between supply and demand. Life is getting busier and time is precious and more and more people are travelling further to exotic destinations that may exclude them from blood donation. Keeping pace with a social media and communications: reliance on conventional communication channels will not suffice if we are to attract and retain the donor base of the future. Smart phone technology and social media platforms have revolutionised the way in which we interact on both a personal and business level. Our ability to provide modern donor interfaces that utilise up-to-date technology is vital if we are to future proof the service. Supporting the fluctuating demand for blood: differences between the population blood group profile and demand patterns necessitate ever more sophisticated donor marketing tools. The ability to successfully employ blood group targeted communications and collection programmes represents a significant challenge for the Welsh Blood Service in achieving effective donor relationship and supply chain management. Retaining a sufficient and loyal donor panel with the optimum spread of blood groups by improving the donor experience: we have the opportunity to personalise the donor service in order to make it a more enjoyable and attractive experience. Reducing waste: we are in an environment where donor attraction and retention is more challenging than it has ever been. We need to do all we can to reduce any waste within the 30

31 service and ensure that all the blood and bone marrow we do collect is used as effectively and efficiently as possible. Meeting increasingly stringent blood selection guidelines and regulatory requirements. The requirements for blood services increase annually, which we fully support. We therefore need to ensure that we are an organisation that is at the forefront of driving continuous improvement and quality of service. 31

32 The Planning Process Translating Strategic Direction and Policy into Action within Velindre NHS Trust We are committed to developing an integrated strategic and service planning approach which is clinically led. In support of this we have introduced a clear planning framework based upon the best practice identified by Welsh Government which is set out below. Fig. 11 Welsh Government Planning Cycle We have slightly amended this as an LHB commissioned service, and use Stage 1 (understand your population/healthcare environment) in two distinct elements: 32

33 1. understand LHB commissioners intentions and requirements for blood and cancer services at the respective population level; and 2. take a clinical and professional view in respect of the required advances in each of the services. The Trusts planning and assurance processes are set out below. Trust Board Sets strategic direction and goals Planning and Performance Committee Provides assurance to the Board on planning and performance issues Other Trust Committees e.g. Quality and Safety Provides assurance to the Board on a range of specific/cross-cutting issues Trust Planning Group - Clinical representation - Functional representation e.g. human resources, information communication and technology Velindre Cancer Centre Senior Management Team Co-ordinate the VCC planning process Welsh Blood Service Senior Management Team Co-ordinate the WBS planning process Site specific clinical groups for each cancer site Clinical leadership of the planning process WBS Service specific clinical groups Clinical leadership of the planning process Fig. 12 Trust Planning Framework 33

34 Section 4: Improving the quality of Cancer Services: Priorities and Action Plan

35 Where do we want to be in 2017: our vision of excellence Provide leading cancer care: - we want to be in the top five cancer centres in the UK as determined by key quality measures. - we want to be recognised internationally as a centre of excellence for non-surgical care; - we want to be the hospital of choice for patients requiring specialist non-surgical cancer care in Wales. - we want to be recognised as a leader of research and development in the United Kingdom with a strong international reputation and to develop a programme of activities to be considered world class. Delivering the Velindre experience - we want patients, families and carers to continue to feel the warmth and compassion within the care we provide. - we want to attract and retain the best staff who share our values and ethos. - we want our staff to continue to work as teams and provide services which are designed and delivered around individual patient need. - we want to continue to work with Third Sector to develop a range of new services. Meeting the needs of patients - we want to ensure all patients have the right level of access to non-surgical oncology care, enabling patients to receive the best treatment in specialist areas. - we want to provide treatments using cutting edge technology. - we want to provide our services at home or as close to home as possible by giving patients greater flexibility and choice regarding their treatment and any follow-up care; - we want to have achieved the relevant approvals and be well on the way to developing a new cancer campus which has the latest clinical services, treatments and technology necessary to be a leader in cancer care. - we want to work with the Maggie s to provide a Maggie s centre on the new cancer campus which provides holistic support to patients through their journey. Outcomes comparable with the best elsewhere - we want to have clinical outcomes that are outstanding and compare with the best in the world. This will see continued improvement in survival rates so that more patients diagnosed with cancer survive for five years or greater. - we want to develop better information systems to measure our clinical outcomes and share information with our partners and patients. - we want to prevent and eliminate all avoidable harm to patients. 35

36 Forecast Demand for Services Fig. 13 Forecast radiotherapy referrals and LINAC machine time required to treat them Curent and predicted attendances for SACT/Supportive care / / / / / / / / / / / / / / / / /25 Fig. 14 Forecast chemotherapy attendances Note: there are two different unites used to determine future projections (i) referrals: the number of patients referred to the service (ii) LINAC machine time: the total number of hours of treatment that will be required for each patient referred. This approach is used as the complexity of treatment has increased significantly over recent years. This has an exponential affect ion the service i.e. a small increase in referrals has a significant impact upon the capacity of the service due to the sharp growth in the amount of time required to treat each patient today compared with previous years. 36

37 Our Priorities for the Future. By 2017, our cancer service will... Equitable and timely services achieve all national waiting times targets and seek to achieve waits less than the targets work with Local Health Boards to assess the need to increase access to radiotherapy for patients with cancer within our resident population Increase the provision of IMRT/IGRT/SBRT/SRS to patients in South Wales reduce outpatient waiting times within the centre increase the number of patients receiving chemotherapy in outreach and homecare settings Providing evidence based care and research which is clinically effective improve performance against deaths within 30-days for patients receiving chemotherapy improve performance against deaths within 90-days for patients receiving radical radiotherapy increase the number of clinical trials and the number of patients accessing them increase the number of patients recruited to Phase 1 clinical trials provide care in line with NICE guidelines and NICE/AWMSG appraisals Supporting our staff to excel support staff to receive all required statutory and mandatory training ensure all staff have a PADR support attendance at work improve staff work/life balance develop a flexible workforce which can respond to changing clinical needs develop capacity, capability and leadership to deliver strategic change develop talent management and succession planning within the service continue to work in partnership with staff and their representatives continue to embed a learning culture within the service encourage all staff to be trained in service improvement techniques (IQT) 37 Safe and reliable services reduce healthcare associated infections to zero (MRSA, MSSA and C.Difficile) reduce hospital acquired inpatient pressure ulcers to zero reduce the number of patients discharged with a deep vein thromboembolism (DVT) to zero improve the management of septicaemia prevent patient harm reduce medication errors reduce treatment errors comply with all national, professional and clinical requirements and environmental agency, Health and Safety and other regulatory bodies First class patient experience increase the number of patients able to access their preferred place of care increase the number of patients able to access their preferred place of death respond to all complaints within 20 days have made significant progress in developing a world class cancer campus modernise out patients services to reduce on the day waits Spending every pound well Improve levels of efficiency and productivity Improve quality and reduce waste reduce energy consumption and associated costs seek to develop high quality services in new and innovative ways Increase income generation from research and development continue to participate in strategic joint procurement opportunities with UK health organisations

38 Our performance and quality ambitions by 2017 Dimension Equitable and timely access to services Safe and reliable services Providing evidence based care and research which is clinically effective First class patient experience Ambition - 98% patients commencing radical radiotherapy within 28 days - 98% patients commencing palliative radiotherapy within 14 days - 100% patients commencing emergency radiotherapy within 2 days - 98% of patients commencing non-emergency chemotherapy within 21 days - 98% of patients commencing emergency chemotherapy within 5 days - 35% of patients treated with radical radiotherapy receiving intensity modulated radiotherapy patients receiving SBRT/SRS including patients in clinical trials - 90% patients waiting 20 minutes or less when they attend the cancer centre - increase the number of patients receiving outreach chemotherapy to 45% - Work with LHBs to increase access to radiotherapy - 0 cases of MRSA - 0 cases of MSSA - 0 cases of C.Difficile - 0 cases of hospital acquired pressure ulcers - 0 cases of Hospital Acquired Thrombosis - 100% compliance with sepsis 6 bundle - Reduce the rate of patient harm - Reduce medication errors - Reduce treatment errors - 0 major non compliance in respect of external regulators - Accreditation retention (MHRA etc) - Maintain compliance with Health and Safety and Environmental Agency regulations - Improve performance against deaths within 30 days of chemotherapy - Improve performance against deaths within 90 days of radical radiotherapy - Increase in number of clinical trials open and number of patients recruited - Increase the number of patients recruited for Phase 1 trials - 100% patients satisfied - 100% of staff who would recommend Velindre to friends and family needing care - Increase the number of patients able to access their preferred place of care - Increase the number of patients dying in their preferred place 38

39 Supporting our staff to excel - 100% of statutory training delivered - 100% of staff to receive PADR - Sickness absence rate of 3.5% or less - 25% of staff trained to Silver level of IQT 39

40 Cancer Services Plan for 2013/ /2017 Radiotherapy Quality and Performance Ambitions over the next 3 years Strategic Theme Objective Key Actions Baseline 2012/ / / / /17 Equitable and timely access to services 98% of patients commencing radical radiotherapy on 28 day pathway 98% of patients commencing palliative radiotherapy within 14 days 100% of patients commencing emergency radiotherapy within 2 days Increase radiotherapy access to the appropriate rate for patients with 94% 98% 98% 98% 98% minimum, to be reassessed 94% 98% 98% 98% 98% minimum, to be reassessed 99.5% 100% 100% 100% 100% 37% assumed from RCR Establish realistic performance ambitions with LHBs and develop implementation plan, if required, to increase access to radiotherapy for population of South East Wales 40

41 cancer within our resident population Increase provision of IMRT to 35% of radical plans Develop use of IGRT techniques across tumour sites Repatriate activity from England and increase the provision of Stereotactic Body Radiotherapy and Stereotactic Radio surgery to 300 patients per annum by 2017 Safe and reliable services 15% 24% 35% 35% by October 2015 Reassess target figure Development of CBCT 24 (12 NSCLC, 12 palliative neurology) Review IGRT plan to establish baseline clinical need for different imaging techniques by tumour site 36 (18 NSCLC, 18 palliative neurology) Increase provision over baseline for appropriate sites, in line with IGRT plans Develop online imaging provision 50 (20 NSCLC, 20 palliative neurology, 10 others) Implementation of full year effect of business case = 220 patients Identify new target e.g. 50% of radical treatments delivered by inverse planned IMRT) 300 patients per annum Reduce treatment incidents and errors Establish baseline and continue to collect incident data Establish realistic performance ambitions and benchmark with national figures where possible 41

42 First class patient experience Evaluate current waiting times targets based on clinical need with a view to establishing reduced waiting times for radical specific patient groups including lung and radical neurology patients. Reassess general targets and establish whether JCCO guidelines are still appropriate Implementation of RCR guidance on management of interruptions for category 2 patients As per Joint Council for Clinical Oncology (JCCO) guidelines 14 day pathway for selected H&N cases With Service Improvement team develop new pathways for selected lung and neuro cases Agree new waiting times targets < 5 days < 5 days < 2 days for pilot site Consolidate new pathways Implement new targets < 2 days for all category 2 patients depending on available resources < 2 days for all category 2 patients 42

43 How will we achieve it Radiotherapy Objective Key Actions 2013/ / / /17 Equitable and timely access to services 98% of patients commencing radical radiotherapy within 28 days 98% of patients commencing palliative radiotherapy within 14 days 100% of patients commencing emergency radiotherapy within 2 days Explore service delivery model to ensure optimum use of resources Review servicing provision to minimise interruption for patients Identify operational service efficiencies and implement Develop radiotherapy strategy Calculate requirement for additional equipment Develop business case for additional LINAC /equipment Secure approval /funding for additional equipment Develop LINAC/equipment implementation plan and begin implementation Develop long term site expansion programme including interim plans for waiting times compliance Recruit additional staff Site expansion plans to include bunker solution for LA6 replacement Further implementation of Linac /equipment plan Site expansion plans Further implementation of Linac /equipment plan including replacement of LA6 Undertake pathway analysis to maximise staff potential in developed and enhanced roles Ensure most appropriate servicing model, balancing service needs and financial considerations Increase radiotherapy access to the appropriate rate for patients with Establish actual baseline for radiotherapy access utilising Malthus programme Undertake analysis of each Site Specific Team (SST) Identify areas of variation Collaborate with LHBs and other cancer centres via COSC to establish an All Wales position for access rates Access Malthus Cymru Identify areas of low access across Implement plan (if funded) Develop business case to improve access Secure any additional Rerun Malthus to ensure figures continue to be accurate in light of changing practice Either maintain current 43

44 cancer within our resident population Develop a strategic plan for radiotherapy services Evaluate current waiting times targets/ JCCO targets and establish (i). reduced waiting times for tumour sites where there is a clinical benefit e.g. radical lung, radical neuro patients (ii). whether guidelines are still appropriate for all tumour sites and for both radical and palliative patients Baseline information and evidence gathering Visit Clatterbridge and other centres for benchmarking/ learning Consolidate new 14 day H&N pathway Discuss with SST leads re appropriate pathway for other SST (such as lung/neurology) SE Wales, South Wales and all Wales and develop plans for resolution with networks, LHBs and COSC Engage patients/lhbs/whssc Develop SACT strategy Consult and secure support/funding Commence implementation Work with relevant SSTs and staff groups to develop new radical pathways for lung and neurology cases Discuss options for new waiting times standards based on clinical need Develop proposed new waiting times standards and engage with COSC/networks/Welsh Govt/LHBs Discuss any funding requirements with LHB/WHSSC Secure funding funding required Full implementation of strategy Further development implementation of next phase of strategy Roll out new pathways at VCC Implement new standards Influence colleagues in other centres to adopt new standards rates or investigate ways to deliver new rates Ensure equity Embed ongoing strategic development plans for radiotherapy into practice Re-evaluate waiting times targets in light of changing clinical practice and clinical trials results 44

45 Objective Key Actions 2013/ / / /17 Providing evidence based care and research Increase provision of IGRT and adaptive radiotherapy techniques across tumour sites Increase provision of IMRT to 35% of radical plans Increase the provision of Stereotactic Body Radiotherapy and Stereotactic Radio surgery to 300 patients per annum by 2017 Develop strategic plan for the implementation Evaluate CBCT requirements for prostate cancer patients Establish baseline clinical need for different imaging techniques by tumour site Review the need for H&N ART Develop online imaging for bladder cancer patients in line with HYBRID protocol Implement year 3 of IMRT BC Commence project for implementation of SRS/SBRT service Develop scope of SBRT liver project Recruit additional staff required (from CF) Undertake strategic review of radiotherapy services Continue to implement IMRT/IGRT as per RDG approved Review IGRT plan in light of increased demand for online imaging Evaluate online imaging requirements including resources Develop business case for additional resources required e.g. fiducial marker service) if appropriate Secure commissioner support and funding for service development Implement year 4/5 of IMRT BC Agree final position for IMRT Implement SBRT lung and SRS/SRT as per stereotactic Business Case Work with WHSCC to establish funding stream implementation Implement SBRT liver pilot project Prioritise clinical trials involving SBRT Ensure representation from VCC at all key SBRT/SRSD national meetings Identify priorities for adaptive radiotherapy Develop adaptive pathways including review of resources required Develop online imaging provision Implement in phased approach Explore ways in which to implement final position if different from IMRT business case Increase SBRT/SRS provision to 220 patients (first full year numbers) to be confirmed by the clinical implementation group Ensure 4D adaptive radiotherapy available for all patients who would benefit Attain new target figure (?50% of radical treatments delivered by inverse planned IMRT) Fully implement BC Reassess total in light of changing clinical practice and available clinical trials Develop an annual plan through Multi-Disciplinary working and with RDG approval to include IMRT, IGRT, SBRT and SRS/SRT Multi-Disciplinary working groups to engage the relevant SSTs to ensure updated and accurate plan reflecting service changes and clinical requirements 45

46 of advanced radiotherapy techniques Implement Image Guided Brachytherapy for the appropriate gynae cancer patients by 2016 Implement HDR brachytherapy for prostate cancer patients Assess clinical need for contact radiotherapy for lower GI patients MDT development plans Explore potential improvements to current pathway Development business case and secure funding for Levels 2-4 Commence implementation of level 3 service Commission HDR Brachytherapy equipment Establish baseline clinical need and service ambition Establish project group to identify scope of need and resources required Identify resource implications Agree sole treatment/boost/ both and prioritise Develop understanding of clinical case/need for development Collate development requirements supra regional for metastatic prostate ca, colorectal multidisciplinary forum Implement level 4 service Develop business case and identify/secure revenue funding as required Develop pathway for prostate cancer boost treatment Implement for pilot group Develop clear clinical direction Develop business case and engage with LHBs/WHSSC to secure support/ funding if approved Work with network and other stakeholders to develop MDT development plan Increase provision in line with clinical need and available funding Implement HDR for all appropriate prostate cancer patients Implement service / contact radiotherapy plan if approved to progress Identify priorities and adopt phased approach Implement first phase Action to be removed if plans have been fully implemented Action to be removed if plans have been fully implemented Action to be removed if plans have been fully implemented Action to be removed if plans have been fully implemented Analysis of management of N/A Review current management of patients who experience interruptions and compare Fully implement plan in accordance Action to be removed if plans have been 46

47 interruptions to treatment for all categories of patients in line with RCR guidance to guidance Assess practicalities and resource implications of implementing guidelines Develop plan to introduce for pilot site Develop implementation plan for other sites, as required with RCR guidance fully implemented Objective Key Actions 2013/ / / /17 Safe and reliable services Reduce treatment incidents and errors Implement Organ Motion Management (OMM) for appropriate patient groups Establish baseline of treatment incidents/errors Trend analysis undertaken and actions from investigation followed up Establish service improvement programme Develop systems to review incident and error rates Increase number of staff able to investigate incidents Establish scope, timelines and targets for OMM techniques for appropriate SSTs Agree clinical priorities giving consideration to respiratory motion management for breast and lung ca patients and OMM for liver, gynae & prostate ca patients Develop scope of need and resources required Introduce OMM based on clinical priorities and available resources Benchmark current practice, targets and levels nationally where possible Establish performance ambitions Implement service improvement actions identified Identify resources for OMM based on clinical priorities Implement OMM where resources are available for selected patients Develop OMM capabilities Develop business case to secure support/funding for wider range of OMM application Evaluation and agree further action Fully implement all OMM techniques in accordance with agreed clinical priorities and available funding Review system for reporting and investigating incidents with a view to ensure it is still fit for purpose Review OMM practices to ensure they result in the expected benefit for patients Ensure all patients who would benefit from OMM access the appropriate technique/equipme nt 47

48 Increase provision of advanced in vivo dosimetric (IVD) verification IVD on 2 Linacs Assessment and development of business case to determine way forward for advanced verification through IVD or portal dosimetry Evaluate technology options for diode and portal dosimetry verification Identification of required equipment and resources Obtain support/approval from LHBs/stakeholders Implement according to resource provision Fully implement advanced verification Ensure that all new and replacement equipment BC considers IVD needs Introduce functional imaging in radiotherapy planning Develop understanding of need Collaborate with PETIC on future development plan Set up MD working group including PETIC to establish the way forward Incorporate functional imaging into radiotherapy planning protocols across VCC Develop BC and secure support/funding Begin implementation for specific tumour sites Review progress against the agreed plan Complete roll out of functional imaging plan Objective Key Actions 2013/ / / /17 First class patient experience Improve on the day waiting times for patients attending the radiotherapy department Introduce Holistic Needs Assessment (HNA)for all patients undergoing radiotherapy Establish baseline data for patients waiting in the radiotherapy department Determine service improvement plan Implement plan possibly pilot group if appropriate Audit on the day waits in radiotherapy to ensure average is less than 20 minutes Work to understand outliers and what can be done to improve these cases Pilot study in collaboration with Macmillan Analyse pilot and establish need for roll out Develop business case and engage with Welsh Govt/LHBs/ stakeholders to secure ongoing support/funding Roll out HNA use for appropriate patients in accordance with funding Ensure waiting times are routinely monitored and maintained Complete roll out of HNA Review benefits of HNA 48

49 Develop improved working relationships with HBs to better understand and support referral pathway problems Develop a world class cancer campus Develop links with HBs Identify key individuals and groups within HBs and across network Support and aid improvement of referral pathways to ensure patients are referred in the most timely and efficient manner Secure support for cancer campus Identify and purchase land Undertake feasibility study Develop and submit Strategic Outline Programme Develop Strategic Outline Case Develop Full Business Case (subject to approval of SOC) Potential enabling works Review current practice to ensure still fit for purpose Further building works Recruit staff Ensure staff development continues in line with future needs 49

50 Systemic anti-cancer treatments Quality and Performance Ambitions over the next 3 years Strategic Objective Theme Baseline 2012/2013 Equitable and timely access to services Performance Ambitions 2013/ / / /17 98% of patients commencing emergency chemotherapy within 5 days 98% of patients commencing non-emergency chemotherapy within 21 days Increase provision of chemotherapy to patients in an outreach setting Safe and reliable services Reduce medication errors 93% 98% 98% 98% 98% 93% 95.5% 98% 98% 98% 32% 40% 45% To be confirmed following development of chemo strategy To be confirmed following development of chemotherapy strategy No baseline Establish realistic performance ambitions Achieve agreed targets 50

51 Reduce the post 30 days mortality rate for patients receiving chemotherapy and benchmark against NICE/other organisations First class patient experience 2.5% <2% <2% Reduce on-theday waits in chemotherapy areas No baseline Establish realistic performance ambitions and develop plans to achieve the target Achieve agreed targets Further develop Non medical prescribers ensuring that patients receive the most efficient and effective service delivered by appropriate clinical professional Improve patient education and information 24 qualified NMPs in a variety of different roles N/A Establish realistic performance ambitions Review methods of patient education to establish most appropriate Achieve agreed targets Achieve agreed targets 51

52 methods and then establish current practice in each tumour site and venue 52

53 How will we achieve it Systemic anti-cancer treatments Objective Key Actions 2013/ / / /17 Equitable and timely access to services 98% of patients commencing emergency chemotherapy within 5 days 98% of patients commencing non-emergency chemotherapy within 21 days Ensure ongoing access to NICE & AWMSG approved drugs Develop strategic plan for SACT services Link with outreach project to ensure that access is not adversely affected by the increase in demand for services Embed the 36 hour rule into service Continue to incorporate service improvements into SACT pathway Continue to ensure all NICE/AWMSG approved new drugs are available to our catchment population Baseline information and evidence gathering Visit Clatterbridge and other centres for benchmarking/ learning Ensure that the chemotherapy services review develops plans to manage the demand Once service improvements embedded at VCC, roll out to outreach settings in a controlled way Engage with WG and LHBs to ensure ongoing equitable access for all approved drugs If appropriate develop business case for funding for new NICE/AWMSG approved drugs Engage patients/ LHBs/WHSSC Develop SACT strategy Consult and secure support/funding Commence implementation Work with SSTs to improve and achieve appropriate medical availability across all SACT pathways Extend engagement to include all other drugs Full implementation of strategy Ensure that ability to comply with targets is embedded into clinical practice Ensure ability to comply with standards is embedded into clinical practice Review SACT strategy and update to reflect changing clinical practice 53

54 Increase patients receiving outreach chemotherapy to target in line with the 25 minute travel time target Increase provision of homecare services Review optimum venue for administration of blood transfusions (BTs) Review outreach services in order to inform and develop appropriate targets Develop a sustainable plan to move services Analyse implications of WG policy direction Review current contracts for homecare provision Engage with appropriate stakeholders to establish optimum configuration Undertake a review of current venues (centre and outreach) Establish pathway for current practice Agree optimum configuration of transfusions undertaken between centre and outreach Work towards agreed targets with LHBs Develop/agree service model with LHBs and secure required funding Develop implementation plan Engage with LHBs to agree a way forward for the administration of BTs to ensure the best service for patients Develop SLAs to allow implementation in outreach clinics Review of services to ensure correct balance between centre and outreach Implement plan Repatriate patients to host LHB as per agreed plan Review progress and sustainability to ensure safety and patient satisfaction Ensure appropriate balance is maintained Review provision of homecare in light of changing patient needs and clinical practice Action to be removed if plans have been fully implemented 54

55 Objective Key Actions 2013/ / / /17 Safe and reliable services Establish an e prescribing system which allows transfer of patient care across organisational boundaries and implement an e prescribing solution for solid tumours at VCC Engage in network wide chemo project Implement the Welsh Clinical Portal to include Medicines Transcribing and electronic Discharge within VCC Complete review of current e- prescribing processes Establish if there is a need for a BC to support a single e- prescribing system across South Wales Configure and test third party solution Schedule a pilot at VCC Development of agreed standards for chemotherapy across the network Identify scope of project with key personnel including IT Liaise with colleagues at NWIS to agree an implementation date Identify dependencies and schedule accordingly Implementation of the solution into the VCC live environment Roll out solution across the network in agreement with stakeholders Engage with external partners to ensure that the system will enable patients to receive their anti cancer treatments closer to their homes, across LHB boundaries where necessary Rationalise services to ensure joined up care for patients within and out with our catchment area Work with HBs/WG to ensure that VCC is able to implement the new standards Undertake process mapping exercise to establish workflow Engage with stakeholders at VCC to ensure seamless roll out Determine actions required to implement plan Implement plan such that MTeD is utilised for 100% of patients discharged Ensure standards are embedded into clinical practice Action to be removed if plans have been fully implemented 55

56 Reduce medication errors Establish baseline of medication errors Trend analysis undertaken and actions from investigation followed up Establish service improvement programme Develop systems to review incident and error rates Increase number of staff able to investigate incidents Benchmark current practice, targets and levels nationally where possible Establish performance ambitions to include medicines reconciliation within 24 hours, reduction in omitted or delayed pharmacy doses and dispensing errors Implement service improvement actions identified Evaluation and agree further action Achieve agreed targets Objective Key Actions 2013/ / / /17 First class patient experience Reduce on-the-day waits in chemotherapy areas Gather baseline data wait times for each area Trend analysis undertaken and actions from investigation followed up Engage with patients to gain views on standards / areas for improvements Establish service improvement programme Establish waiting times internal standard Develop and implement service improvement plan Assess effectiveness of improvements Ensure waiting times are routinely monitored and maintained 56

57 Further develop Non medical prescribers ensuring that patients receive the most efficient and effective service and maximising skill set of different clinical professions Assess and provide appropriate patient education Identify resources required to undertake a project to review current service, optimum numbers and configuration of NMPs Ensure project scope includes future needs and sustainability Review group education sessions for capecitabine and other general chemotherapy education groups Undertake scoping exercise to establish gaps in current service and next steps Address the gaps in service where there is no or low NMP cover Identify forecasted increase in demand and reflect this in the new NMP configuration Identify sources of funding to implement findings of the review Ensure that all NMPs have appropriate job planning to address areas of need Review provision of NMPs to ensure best outcomes for patients Agree a preferred model of provision with patients and staff Ensure phone service for concordance included in revised model Identify additional resource requirement and secure funding Develop implementation plan Implement model Review and evaluate practice to ensure patients receive and understand their instructions Review clinical workforce for prescribing/delivery of chemotherapy/sact Undertake pathway analysis to ensure optimum roles across the SACT pathway Agree optimum model for clinical staff Develop additional/ appropriate roles and role development Work with senior management to ensure all opportunities for role Ongoing review to ensure best clinical model for patients 57

58 Review workforce in terms of skill mix redesign and improved skill mix are realised Indentify resource implications and secure funding Implement improvements Evaluation of improvements 58

59 Improving quality, safety and our staff Quality and Performance Ambitions over the next 3 years Strategic Theme Objective Key Actions Baseline 2012/ / / / /17 Equitable and timely access to services Safe and reliable services Secure ongoing funding for at risk posts e.g. CNS Multiple posts across VCC being funded by non establishment means Identify the posts at risk and establish the loss to service if funding ceases Ensure all essential posts at VCC have secure funding Reduce healthcare associated infections to zero Reduce Velindre acquired pressure ulcers to zero Reduce the number of patients discharged with hospital acquired thrombosis Reduce incidents of patients with septicaemia to zero C diff full year actual = 12 MRSA full year actual = 0 MSSA actual = 7 C diff target = 10 MRSA = 0 MSSA target = 0 C.diff = 0 MRSA = 0 MSSA target = 0 C.diff = 0 MRSA = 0 MSSA = Not available Not available C.diff = 0 MRSA = 0 MSSA = 0 59

60 Undertake mortality review of all deaths at VCC First class patient experience 100% 100% 100% 100% 100% Increase the number of patients that die in their preferred place Increase the number of patients who access their preferred place of care Increase patient satisfaction Reduce on the day waiting times within the centre to less than 20 minutes or as appropriate dependent on service Supporting our staff to excel Baseline not available Baseline not available Establish realistic performance ambitions Establish realistic performance ambitions Achieve agreed target Achieve agreed target 95% 100% in key areas 100% in key areas 100% in key areas N/A Establish realistic 20 minutes in pilot To be performance ambitions area confirmed following results of pilot 100% <20 minutes Increase the % of staff who would recommend Velindre to friends and family needing care N/K 65% 70% 75% 80% 60

61 Support staff to receive all required statutory and mandatory training: 95% statutory training 95% mandatory training Ensure all staff have a PADR To be confirmed when ESR data is robust Establish realistic performance ambitions 30% 50% 70% 90% 100% 95% Reduce sickness absence levels to improve staff attendance: - sickness absence rate of 3.5% or less Develop capacity, capability and leadership to deliver strategic change Develop talent management and succession planning within the service 4.01% 3.5% 3.4% 3.3% N/A N/A Roll out IQT Training initiative: Bronze Level Staff Silver Level Managers N/A Review Pilot outcomes of VCC talent management initiative Review PADR arrangements dependent on Pilot outcomes Roll out IQT Training initiative: Bronze Level Staff Silver Level Managers Consider full roll out of revised PADR dependent on Pilot outcomes 3.3% Roll out IQT Training initiative: Bronze Level Staff Silver Level Managers Consider full roll out of revised PADR dependent on Pilot outcomes 61

62 How will we achieve it Improving quality, safety and our staff Objective Key Actions 2013/ / / /17 Equitable and timely access to services Secure ongoing funding for at risk posts e.g. CNSs Establish number of at risk posts Confirm posts are essential to ongoing patient care Engage with LHBs to ensure that essential roles are appropriately funded in order to continue the Trust s standards of care Establish ongoing secure funding for all essential roles within the Cancer Centre Establish ongoing secure funding for all essential roles within the Cancer Centre Objective Key Actions 2013/ / / /17 Safe and reliable services Reduced healthcare associated infections to zero (MRSA, MSSA and C.Difficile) Continue with education and awareness programmes Focus on increasing compliance with hand hygiene bundle Work with colleagues throughout VCC to establish further mechanisms for preventing C diff including improving hand hygiene compliance Review prescribing of antibiotics to minimise the risk of C. diff Routinely screen all patients admitted to VCC for MRSA Develop pathway to ensure that screening is undertaken and acted upon where appropriate Continue to monitor 62

63 Development of the Acute Oncology Service across SE Wales Reduce Velindre acquired pressure ulcers to zero (national target) Reduce the number of patients discharged with HAT Reduce the rate of patient safety incidents VCC establish AOS hub Evaluate pilot Provide support for development of AB spoke Continue to utilise care bundles / audit use of care bundles Develop wider information/ awareness across the hospital Undertake RCA of patients diagnosed with HAT Implement best practice across wards Define terms and targets for this measure across the different services Ensure accurate and complete data collection is possible Based on outcomes of the Aneurin Bevan pilot, engage with the network to agree next steps for further spoke services Develop business case and secure support/funding from LHBs/stakeholders Support other Health Boards to develop AOS for their populations, linking to unscheduled core agenda as appropriate Work with colleagues across region to shared/learn from best practice in preventing pressure ulcers Support development of further spoke services if funded Ensure that plan encompasses VCC catchment population such that AOS are equally available Work with primary care providers through the HBs to identify at risk cancer patients to support the reduction of pressure ulcers experienced at home Audit practice to ensure that: 100% of patients who have risk assessment completed 100% of patients considered high risk who have had appropriate thromboprophylaxis prescribed Work across the Division to improve the incident rate through RCA, analysis of trends and shared learning Benchmark with similar organisations where possible to ensure robust targets are in place Action to be removed if plans have been fully implemented Continue to monitor Continue to monitor Achieve targets Continue to improve rates 63

64 Improve management of septicaemia by achieving 100% compliance with the response to the bundle for sepsis Audit of NEWS and sepsis bundle Enhance clinical leadership / focus on sepsis Continued focus / audit of CAUTI insertion and maintenance bundles Continue to publicise/champion the sepsis care bundle Improve communication with LHBs for patients with sepsis Audit compliance with bundles Explore benchmarking with other LHBs etc Continue to identify, share and implement best practice from around the world Conclude work on bed criteria with possibility of introducing step-up beds to support patients with sepsis on-site Continued focus / audit of CAUTI insertion and maintenance bundles Audit compliance with bundles Assess if further action is required as a result of the audit Evaluation of progress Objective Key Actions 2013/ / / /17 First class patient experience Increase the number of patients who can access their preferred place of care Establish baseline within the end of life priorities Work with partners to establish appropriate data capture for all patients Engage with patients /families/carers Develop plan with LHBs/third sector to ensure that the plan is integrated and that patients discharged from VCC to their preferred place of care are referred to specialist palliative care in that setting if appropriate and needed Finalise plan and resourcing Implement plan Evaluation and review Increase the number of patients that die in their preferred place Establish baseline within the end of life priorities Work with partners to establish appropriate data capture for all patients Engage with patients /families and carers Develop plan with LHBs/third sector such that patients with Welsh integrated care priorities at the end of life documentation Evaluation and review Investigate areas of non compliance to ensure all Continue to monitor and achieve targets 64

65 Ensure that 100% of palliative care patients have an POS-S or equivalent assessment within 24 hours of referral Improve support for patient s carers and their families To implement the Trust s action plan for Together for Mental Health and ensure patients and staff receive the care/support they require to ensure mental well being Establish a baseline of current assessment Develop a plan to ensure that the palliative care team are available to undertake the assessments Develop and implement Carer s strategy, including processes for identification of carers and training for them Develop carer s information pack Develop and implement Carer s awareness Training Trust will aim for Platinum award for corporate health standard Embed the excellent work undertaken by the Dementia and cognitive impairment nurse across the Division, including picture menus, environmental improvements Continue to offer complementary therapies to patients, carers and staff E-hna pilot to become embedded in place can access their preferred place of death Finalise plan and resourcing Implement plan Implement plan to ensure that all patients have a POS-S assessment Introduce monitoring/audit of POS-S Increase the number of staff who attend Carer s awareness training Establish a new post to support the supportive care team in the provision of services and support to meet the needs of carers Roll out the carer s information pack Continue work, led by the clinical psychologist, on the project re holistic needs assessments for patients; rolling out to other cancer sites where possible Develop pathways for inpatients who have a co-morbid drug and /or alcohol problem stakeholder organisations meet the requirement Re-audit practice to ensure compliance Establish plan for remedial action if areas of audit show non compliance Review the action plan and update to reflect changing priorities to meet the requirements/ne eds against this strategy Continue to monitor and achieve targets Continue to monitor and achieve targets Achieve actions contained within revised plan 65

66 Increase patient satisfaction Ensure that people living with and beyond cancer have a personalised assessment, information and care plan and are empowered to manage their condition Reduce on the day waiting times within the centre to less than 20 minutes Stratify follow up for breast cancer patients Develop and introduce routine patient satisfaction recording as follow up of national pilot Explore with patients, carers and patient representatives the causes of any dissatisfaction experienced at VCC Utilise lessons learned from concerns procedure to support satisfaction scores Identify key areas for Cancer Centre Develop appropriate improvement plans / secure resources and implement improvements Re-audit to ensure patient satisfaction is attained/ maintained Continue to work towards patients who are better informed and prepared for the long term effects of living with and beyond cancer Raise patient and public awareness of available programmes and support Work with internal and external colleagues to ensure a full understanding that survivorship and rehabilitation for people with cancer begins at diagnosis and continues with regular reassessment throughout their journey Establish project group Undertake data capture exercise for on the day waits in key areas within VCC e.g. OPD Utilise IQT methodology to identify areas of concern and possible changes to secure improvements Develop a business case to introduce automated check in facilities for patients at VCC and s secure funding Share learning from different areas to maximise the improvements Establish a Network wide project in liaison with Macmillan Clearly identify scope, deliverables and Identify recommendations and development of an action plan Develop plan Ensure all relevant findings from Identify other SSTs where follow up could be improved in this way Identify other tumour sites that would benefit Develop plan and begin roll out to other tumour sites 66 Continue to monitor and achieve targets Continue to monitor and achieve targets Ensure waiting times are routinely monitored and maintained Action to be removed if plans have been fully implemented

67 Further develop key worker concept Improve the patient environment where necessary Establish stepup fed facility at VCC timescales Work with CIG/network project to approve definitions and establish baseline Develop partnerships with LHBs to identify any gaps, new roles and resource requirements Undertake urgent compliance work project implemented by SST Consider VIP event for breast cancer services at VCC Develop plan to increase the number of patients with key workers Implement plan with key worker concept/roles going across organisational boundaries Further engage with LHBs and 3 rd sector to ensure patient pathways have an identified key worker Prioritise patient areas for improvement beginning with first floor ward Undertake improvements in other patient areas wards, OP, theatres Review patient environment with external partners and patient/carer representatives Work with HBs to provide the most appropriate accommodation for patients in an outreach setting Establish need/requirement for step-up facilities including identification of resource Evaluate and review project Identify if any areas of non compliance and plan remedial action Incorporate into ongoing site development plans Develop and implement the step up facility Work with Health Board critical care colleagues to assess VCC s requirement for step-up facilities (now and in future) 67

68 Objective Key Actions 2013/ / / /17 Providing evidence based care and research Develop a system for accurate and complete collection of toxicity data Develop performance information for post 90-day mortality rates for patients receiving radical radiotherapy Reduce the post 30 day mortality rates for patients receiving chemotherapy Identify scope of project in collaboration with SACT, IT and RDG New measure Establish baseline Agree collection methodology / definitions Utilise SABR implementation project to highlight issues with IT solutions for toxicity data Ensure acute data collected by any method Identify long term solutions available for data collection including appropriate IT support Secure necessary funding Establish baseline Agree collection methodology / definitions Test data quality with peers Publish data Utilise data to inform ongoing improvement clinical/ technological programme Work across network to ensure IT solutions available in each OP setting Ensure that each SST undertakes detailed and accurate acute & late toxicity data collection for use in assessment of patient outcomes Test data quality with peers Publish data Utilise data to inform ongoing improvement clinical/ technological programme Ensure ongoing programme of improvement is embedded in day to day practice Review process for data collection and ensure still fit for purpose Utilise data to inform ongoing improvement clinical/ technological programme Utilise data to inform ongoing improvement clinical/ technological programme 68

69 Objective Key Actions 2013/ / / /17 Supporting our staff to excel Increase the % of staff who would recommend VCC to friends and family needing care Support staff to receive all required statutory and mandatory training: 95% statutory training 95% mandatory training Establish reasons why some staff would not recommend VCC Establish project group across professions and work areas Develop robust training schedule Appointment of Trust-wide statutory and mandatory trainer Core skills matrix: e-learning to be promoted and rolled out from 2013 onwards MSS/ESS rollout for OLM in 2013/14 enabling employees to self-book onto courses Work with staff across the Division to respond to concerns regarding recommending VCC Proactive monitoring Review of training resource Ensure departments/ services have a training plan to ensure that compliance is attainable Ensure staff concerns are addressed Re survey staff on this particular question Proactive monitoring Adjust training plans to reflect changes in practice or evidence Develop a plan for any outstanding remedial actions Review compliance and create plan to rectify any areas of concern Adjust training plans to reflect changes in practice or evidence 69

70 Ensure all staff have a PADR Reduce sickness absence levels to improve staff attendance to 3.5% or less Manage staff work / life balance Appraiser training Monthly monitoring with departments Preparation of progress statistics Reports and feedback on progress to SMT Updated PADR paperwork Return to work interviews Use of Occupational Health assessments Sickness audits Stress risk assessments Use of sickness policy Promotion of Health and Wellbeing initiatives Consider applications in line with the Work-life Balance Policy Provision of support services Monthly monitoring with departments Preparation of progress statistics Reports and feedback on progress to SMT Return to work interviews Use of Occupational Health assessments Sickness audits Stress risk assessments Use of sickness policy Promotion of Health and Wellbeing initiatives Consider applications in line with the Work-life Balance Policy Provision of support services e.g. advice and counselling through Employee Assistance Programme (EAP) Provision of childcare vouchers, holiday child subsidy scheme Reports and feedback on progress to SMT Ensure that ongoing department and service plans include workforce, training and reflect PADR outcomes Reports and feedback on progress to SMT Ensure that ongoing department and service plans include workforce, training and reflect PADR outcomes Return to work interviews Use of Occupational Health assessments Sickness audits Stress risk assessments Use of sickness policy Promotion of Health and Wellbeing initiatives Consider applications in line with the Worklife Balance Policy Continued provision of support services, childcare vouchers, holiday child subsidy Review compliance and create plan to rectify any areas of concern 70

71 Develop capacity, capability and leadership to deliver strategic change Develop talent management and succession planning within the service: e.g. advice and counselling through Employee Assistance Programme (EAP) Provision of childcare vouchers, holiday child subsidy scheme N/A Roll out IQT Training initiative: Bronze Level Staff Silver Level Managers Explore with NLIAH funding for scientific training post in line with modernising scientific careers Review Pilot outcomes of VCC talent management initiative Develop succession plan and business case for NEQAS H&I Director post Review PADR arrangements dependent on Pilot outcomes scheme Review supportive structure and identify areas for further development Consider full roll out of revised PADR dependent on pilot outcomes Provide and support advanced technical training Assess training needs of the appropriate staff groups Identify training opportunities to ensure advanced techniques, technologies and ways of working can be implemented in a timely manner Secure funding stream Ensure plan is robust, flexible and sustainable to adjust to changing needs 71

72 Research and development The Trust s vision for research states that we will accelerate bench to clinic development of innovative treatments, provide state of the art facilities to attract and retain world leading staff and create a vibrant research hub. Velindre Cancer Centre wants to provide the required resources and technology to facilitate the delivery of evidence based care and research that is at least comparable with the best in the world. Objective Increase recruitment to radiotherapy clinical trials Increase early phase/locally funded/ pathway to portfolio trial activity Increase national RTTQA activity Baseline 2013/2014 All appropriate NCRI radiotherapy trials open with VCC within acceptable timeframe FIGARO and BIOPROP to open and recruit to target Annual strategic plan for expansion of Cardiff RTTQA approved by R&D committee Key Actions 2014/ / /17 Regular review of NCRI trial portfolio by RT Trials group to ensure VCC is open to all appropriate trials Technical requirements for upcoming trials identified and prioritised within RDG and associated working groups Local RTTQA requirements completed without incurring delaying the opening of trials Technical requirements for FIGARO and BIOPROP supported by RT Trials group and associated working groups Technical requirements for upcoming pathway to portfolio trials considered by RT Trials group and associated working groups and submitted to RDG for approval RTTQA management group to develop a strategic plan for expansion of trial work and associated research RTTQA management group to manage trial specific work: development of RT protocol, RTTQA programme, pre-trial and on-trial work, presentation and publication of results RTTQA management group to support appropriate funding for novel research concepts Evaluate practice for establishing clinical trials and ensure that it is still fit for purpose Ensure recruitment targets are met through active monitoring and engagement Ensure recruitment targets are met through active monitoring and engagement 72

73 Increase tissue collection for the Wales Cancer bank Upper GI/lung Charitable funds support for tissue collection post Establish need in each tumour site Collaborate with Local Health Boards to achieve 20% of patients consenting to donate tissue to the Welsh Cancer Bank. Collaborate with Local Health Boards to achieve 20% of patients consenting to donate tissue to the Welsh Cancer Bank. Ensure targets are met Review targets in line with changing clinical priorities Increase recruitment into clinical trials activity in line with and beyond national targets where possible Ensure maximum possible portfolio of clinical trials across tumour sites Target = 10% of newly diagnosed cancer patients recruited into well designed cancer studies Actual = 18% Establish baseline 10% Identify areas of growth and opportunity Achieve 30% of disease groups to include national or international leaders Increase the number of patients recruited into interventional clinical trials, contributing to the overall NISCHR target of 7.5%. 20% of patients each year recruited into clinical trials, contributing to the overall NISCHR recruitment target of 10% of patients into clinical trials. Patients entered into all national cancer trials in the UK (subject to national approval). 5% of all national cancer trials in the UK to have a Velindre principal investigator. Review targets in light of changing priorities Further develop capability and capacity to provide phase 1 trials across the disciplines Establish Early Phase research team BC for ongoing funding for phase 1 trials Identify areas of growth and opportunity Set realistic but challenging targets for numbers of trials across a range of tumour sites and disciplines Assess capability and capacity to ensure no areas of concern Develop an interventional radiology programme New measure New measure Engage with stakeholders to establish strategy and appropriate measures Implementation of strategy 73

74 Review space and accommodation issues connected to progressing the R&D agenda Cancer Centre wide accommodation project Develop a plan to highlight issues of accommodation and R&D in line with other infrastructure demands Engage with external partners and stakeholders to explore innovative ways in which to deal with this issue Review current plan and ensure it remains fit for purpose 74

75 Section 5: Improving the quality of Blood and Transplantation Service: Priorities and Action Plan

76 Where do we want to be by 2017: Our Vision of Excellence Provide leading blood services: - we want to be recognised as a blood service of excellence. - we want to provide leading edge services and technology which advance best practice in blood, blood components, stem cell donation and transplant immunology services. - we want to continuously improve the standard, safety and compliance of the service. Delivering the Welsh Blood Service experience - we want to provide donors with the best care and experience possible. - we want donors to routinely recommend us to friends and family without second thought. - we want donors to feel part of our family, enjoy the time they spend with us and feel fully valued for their life saving contribution. - we want to attract and retain the best staff who share our values and ethos. - we want to extend our work with local communities and educational providers to develop and improve our services. - we want to improve the standard of premises where donors donate. Meeting the needs of donors and partners - we want to continue to modernise services to provide improved access at a time and a place that is convenient to donors and is balanced with the needs of the service. This will support us in developing a donor base that meets future needs. - we want to attract more donors, and particularly those aged between 18 and we want to recruit new donors who are able to increase the number of Bone Marrow Volunteer samples (BMV). - we want to tailor our offering to provide donors with more opportunities to donate - we want to further develop our expertise and portfolio of diagnostic and transplant immunology services to meet both the needs of patients in Wales and our international customers. - we want to work with key stakeholders to achieve the maximum benefit from the establishment of an all-wales Blood Service. - we want our partners to rate our service as excellent. Outcomes comparable with the best elsewhere - we want to have clinical outcomes that are comparable with the best elsewhere. - we want to develop better information systems to measure our clinical outcomes and share information with our partners and donors. - we want to work across Wales to promote best practice in blood supply management and operate supply chain models that are the most efficient and effective possible making sure every drop counts 76

77 Benchmarking our service The Welsh Blood Service has a strong tradition of benchmarking with all UK blood services and in 2002 a subcommittee of the UK Forum was established to help enhance inter-blood service communication on a range of financial and non performance related issues, thereby identifying future risks, opportunities and service improvement requirements. A range of key performance indicators have been agreed between the four UK and the Irish Blood Services. By measuring relative performance, services have the opportunity to identify areas of improvement and learn from the best practices of others. The Welsh Blood Service is able to evidence positive improvement over the years in many of these indicators. Donations/Donors Attending NIBTS NHSBT SNBTS WBS IBTS Average 2004/ % 88.00% 84.80% 84.28% 79.80% 84.14% 2005/ % 86.86% 82.12% 82.06% 80.67% 82.94% 2006/ % 85.43% 80.78% 83.84% 79.64% 82.40% 2007/ % 85.35% 80.40% 85.26% 80.09% 82.54% 2008/ % 85.78% 81.77% 84.59% 81.26% 82.93% 2009/ % 86.44% 83.44% 84.74% 83.98% 83.92% 2010/ % 87.15% 84.27% 81.48% 84.60% 84.15% 2011/ % 88.24% 85.41% 85.20% 84.37% 85.38% Effect of Best Practice (Additional Donors Bled) 3,254 NA 6,871 3,484 6,708 20,316 Fig. 15 Number of whole blood donations recorded per 100 attending donors Average deferral rates improved for the 5 th year in succession to a record 85.38% (from 84.15%). All countries, with the exception of Ireland, saw reduced levels of donor deferral in 2011/12. The level of deferral is now slightly above that seen in 2004/05 although this disguises the fact that the introduction of several more stringent eligibility measures has had to be recovered. The Welsh Blood Service showed a marked increase in the year which is related to a re-introduction of Malaria and Hep B core testing. 77

78 Combined Processing and Collection Losses The difference combines session related losses and processing/testing related losses. NIBTS NHSBT SNBTS WBS IBTS Average 2004/ % 94.30% 93.20% 95.60% 92.90% 94.06% 2005/ % 95.12% 92.98% 95.41% 94.10% 94.46% 2006/ % 95.18% 93.60% 96.23% 94.25% 94.69% 2007/ % 95.42% 93.72% 95.78% 94.66% 94.68% 2008/ % 95.18% 94.20% 96.02% 94.64% 94.64% 2009/ % 95.18% 94.18% 96.04% 95.81% 94.56% 2010/ % 95.57% 93.67% 95.70% 95.57% 94.52% 2011/ % 95.68% 94.33% 94.00% 95.28% 94.35% Effect of Best Practice (Additional Donations Saved) 1,920 NA 2,792 1, ,935 Fig. 16 Number of banked, or validated, red cell units per 100 whole blood donations Platelet Wastage - % Expiry This indicator measures the number of platelet doses expiring within the Blood Services as a percentage of validated platelet doses produced. Overall losses due to expiry reduced from 12.57% in 2010/11 to 8.88% in 2011/12, the lowest level ever reported. Apheresis Platelet Expiry Apheresis NIBTS NHSBT SNBTS WBS IBTS Average 2005/ % 8.40% 9.70% 8.40% 9.40% 9.88% 2006/ % 8.98% 8.66% 6.04% 8.62% 8.20% 2007/ % 8.13% 9.90% 4.50% 8.90% 7.43% 2008/ % 9.20% 10.50% 5.13% 11.77% 9.36% 2009/ % 8.71% 10.98% 7.45% 17.28% 11.31% 2010/ % 7.99% 16.87% 8.28% 14.56% 11.34% 2011/ % 6.05% 14.59% 4.52% 11.50% 8.47% Fig. 17 % expiry platelet expiry for comparable blood services Apheresis wastage is a particular focus as the cost of this product is significantly higher than for pooled platelets. The overall level of wastage reduced for the first time in 4 years and markedly so. The large variation between countries shows that there is still significant potential to unlock savings. 78

79 Pooled Platelet Expiry Pooled NIBTS NHSBT SNBTS WBS IBTS Average 2005/ % 7.70% 16.20% 9.30% 17.80% 12.72% 2006/ % 8.19% 15.33% 6.07% 16.69% 11.75% 2007/ % 8.23% 14.70% 7.60% 11.30% 11.29% 2008/ % 10.60% 13.50% 8.75% 13.83% 12.98% 2009/ % 11.13% 15.04% 13.97% 15.40% 14.30% 2010/ % 11.73% 21.64% 13.59% 22.18% 17.27% 2011/ % 10.94% 14.37% 4.68% 16.42% 10.54% Fig. 18 % Pooled platelet expiry Pooled platelet expiry has reduced to its lowest level in the last 8 years. Pooled platelet expiry has benefited from many of the positive influences described under apheresis expiry. The predictability and reliability of apheresis supply is a key factor in being able to minimise pooled platelet production. The Welsh Blood Service has the lowest overall expiry rate (4.55%) Total Platelet Expiry Total NIBTS NHSBT SNBTS WBS IBTS Average 2005/ % 8.00% 12.40% 8.80% 14.60% 11.42% 2006/ % 8.62% 11.31% 6.05% 13.57% 9.94% 2007/ % 8.17% 11.80% 5.80% 10.16% 8.93% 2008/ % 9.70% 11.70% 6.58% 12.64% 10.68% 2009/ % 9.31% 12.47% 9.45% 16.68% 12.28% 2010/ % 8.79% 18.10% 9.52% 16.33% 12.57% 2011/ % 6.91% 14.54% 4.55% 12.63% 8.88% Fig. 19 Total platelet expiry 20.00% 18.00% 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% Platelet Expiry % 2005/ / / / / / /12 NIBTS NHSBT SNBTS WBS IBTS Average Fig. 20 % Platelet expiry 79

80 In addition to UK service comparative data the Welsh Blood Service contributes to the European Blood Alliance (EBA) benchmarking group. Established in 2006 the EBA executive group have taken a four phase approach, namely: Assess variation in EBA member operational practices and performance Identify the key factors that underpin good practice Support EBA members with the implementation of those factors Monitor and publish EBA Member examples of operational development, and as a consequence, performance improvement across a range of metrics. 80

81 Forecast Demand for services Whole blood Red Blood Forecast Demand /14 (WBS) 2014/15 (WBS) 2015/16 (All Wales Blood Service) 2016/17 (All Wales Blood Service) Fig. 21 Forecast red blood cell demand In recent times there has been a year on year reduction in the size of the whole blood donor panel. Although this has been roughly parallel to a reduction in demand for red cells, in line with other UK services, it is anticipated that there will be an increase in demand for whole blood to meet the needs of an ageing population. A priority for the service is to stem the loss of long term donors from the established panels and recruit new donors that will become lifetime volunteers. It will achieve this by putting in place a modernised service that meets the needs of changing demographics and lifestyles, and by employing recruitment strategies that will improve donor loyalty. The management of blood collection and provision of blood products to North Wales hospitals is currently administered and managed by NHSBT. However, in line with the Welsh Government vision of how the NHS will look in five years, the Minister for Health and Social Services announced on the 13 th June 2012 the need to establish an all-wales Blood Service. As such, North Wales collection and provision will transfer to the Welsh Blood Service by The number of units collected from Welsh clinics does not meet the demand for whole blood in the region to customer hospitals. The shortfall is supplied from NHSBT stocks collected from outside Wales. The shortfall in collection will need to be met by the Welsh Blood Service following the transfer and establishment of an all-wales Blood Service by The WBS has identified opportunities to increase collection to address the shortfall: New sessions identified in areas not currently serviced by NHSBT; 81

82 Increased session times or substitute panels; and, Where current sessions are below capacity, and local donor relations knowledge suggests that increase in capacity is achievable. The potential for additional collection activity will require investment to support the development of new donor panels that will require time to establish themselves. New donor recruitment will require a targeted campaign of activity between now and 2015 to ensure that the additional donors required have been recruited and are attending in preparation for the transition to the WBS by The Welsh Blood Service is therefore assuming steady state +/-1% over the forthcoming 3 years in terms of demand for whole blood including North Wales provision. Platelets Platelets Forecast Demand /14 (WBS) 2014/15 (WBS) 2015/16 (All Wales Blood Service) 2016/17 (All Wales Blood Service) Fig. 22 Forecast platelets demand The outlook for platelets is one of increasing demand. Platelets can be prepared from a number of whole blood donations (4) and then pooled, or directly from individual donors using a process known as apheresis. Apheresis is a procedure for collecting blood components. The device separates a certain blood component from blood, and the remainder returns into the blood donor s circulatory system. This automated process makes it possible to collect between 1 and 3 adult therapeutic doses of platelets from a donor in a single setting. Because only very few red blood cells are taken during apheresis, donors can give platelets more often than they can give whole blood. In 2011/12 the overall demand for platelets increased significantly by just over 8% in Wales with a total of 9,535 platelets issued to customer hospitals across South, mid and West Wales, of which 24.8% were pooled and 75.2% derived from apheresis collection. This stabilised in 2012/13 and is currently on track to increase by 2.7% during 2013/14 82

83 compared to the previous year. Demand in North Wales for the same period (currently serviced by NHSBT) amounted to a total of 2,029, of which 17.3% were pooled, 82.6% derived from apheresis collection and nearly 10% requiring Human Leukocyte Antigens (HLA) matching. We anticipate that our current donor base is capable of meeting overall platelet demand in the near term, but will need to invest in a long term recruitment and retention strategy to meet the projected 5% growth in demand by This strategy will also need to factor the additional collection requirements arising to support North Wales service provision and ensure capacity to meet a potential increase in HLA match requirements. In the future, platelet production will be a key area of focus for the Welsh Blood Service. The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) have recommended that the current requirement that UK Blood Services should produce 80% of platelets by apheresis be removed; and that Platelet Additive Solution (PAS) should be used for the suspension of platelets. In addition, the British Committee for Standards in Haematology (BCSH) guidelines on the use of single donor platelets for children born since 1/1/96 are also under review with the potential that this may be removed. However, it should be noted that clinical reaction to an increased utilisation of pooled platelets, in particular for children and those born post 1996 is as yet unknown, as such demand forecasting is difficult to predict at this time. As a result, the WBS is undertaking a review of its platelet production and is considering the future balance between apheresis and pooled platelets. The WBS will need to ensure that any future balance between platelet methods guarantees that we are able to meet the clinical requirements for HLA and HPA matched platelets. Operational implications for the WBS will also need to be carefully considered given the existing apheresis harness contract runs until 2015, IT infrastructure requirements, multiple change programmes underway and the cost effectiveness, implications of delivering a new service model. Consequently, a major programme of work is underway by the WBS to develop an Apheresis Strategy for the Service. This will be designed to ensure the WBS is best positioned to addresses all of the above factors, develop further our understanding of apheresis requirements for an all Wales Service, whilst ensuring continuous improvement in performance is achieved to support donor and patient outcomes. Stem cell donation and transplant immunology Demand for stem cell donation and transplant immunology services is also expected to increase due to a number of factors: Projected increase in chronic kidney disease where transplantation is the treatment of choice. 83

84 Continual advances in medicine and technology enabling transplant of increasingly complex cases where previously this wasn t possible. Welsh Government legislation for presumed consent will become effective in Wales by December UK strategy, Taking Organ Donation to 2020 that calls for NHS, public and professional bodies to work in partnership to ensure everyone who requires a transplant is able to receive one. Increased worldwide demand for unrelated stem cell transplants. 84

85 Our Priorities for the Future: by 2017 our blood and transplant service will... Equitable and timely access to services Improve retention of existing donors Increase the recruitment of new blood and BMV donors with a focus on younger donors Improve standard of premises in which blood donation takes place Implement new service model to support the provision of an all-wales Blood Service Safe and reliable services Meet demands for all blood components Meet all diagnostic Service requests in accordance with agreed turnaround times Improve performance against regulatory requirements and work towards a zero majors policy Reduce the number of Serious Adverse Blood Reactions and Events (SABRE) Implement all mandated changes to testing and emerging clinical priorities Retain our wholesaling license Welsh Bone Marrow Donor Registry (WBMDR) to achieve accreditation status with the FACT Joint Accreditation Committee-ISCT (Europe) Achieve CPA ISO accreditation for diagnostic laboratories and UK NEQAS for H & I Continue to meet all Health and Safety and Environment Agency legislative requirements First class service and donor experience Modernise our collection sessions and the way we interact and manage our donors Continue to improve the donation experience Review and develop a volunteer programme Continue to improve satisfaction ratings from our donors Continue to improve satisfaction ratings from our customer hospitals Respond to all concerns in a timely and effective way Strengthen our Community Partnership Forum with donors Identify and implement advances in technology Support Pathology Modernisation initiatives Providing evidence based care and research which is clinically effective Deliver clinical outcomes which are comparable with the best elsewhere Develop a Research and Development Strategy for the service Develop partnerships to create a targeted research and development programme Develop hospital partnerships to improve patient care Review laboratory service arrangements to consider real time PCR project Explore research opportunities and funding Supporting our staff to excel Support staff to receive all required statutory and mandatory training Ensure all staff have a PADR Support attendance at work Improve staff work/life balance Develop a flexible workforce which can respond to changing clinical needs Develop capacity, capability and leadership to deliver strategic change Develop talent management and succession planning within the service Continue to work in partnership with staff and their representatives Continue to embed a learning culture within the service Develop a flexible workforce which can respond to changing clinical needs Develop staff to support continuous improvement and quality management 85 Spending every pound well Ensure the provision of a new all-wales Blood Service represents value for money for NHS Wales Improve the supply chain Further reduce waste across the full range of services Improve the use of our estates Increase income generation Continue to participate in strategic joint procurement opportunities with UK and European Blood Services Explore further opportunities to improve any inappropriate use of blood Develop lean culture and ways of working to ensure effective use of resources

86 Our performance and quality ambitions by 2017 Dimension Equitable and timely access to services Safe and reliable services Ambition - 3% increase in the number of 1 active donors on the whole blood panel 50% increase in the number of active donors on the apheresis panel in line with clinical need and the establishment of an all Wales Blood Service - Hold a minimum of 1 Donor Awards Evening event in each geographical area per year - 30% increase in the number of new donors attracted (whole blood) - 60% increase in the number of new donors attracted aged (whole blood) new Bone Marrow Volunteer (BMV) samples - 30% of new Bone Marrow Volunteer (BMV) samples aged Review current baseline standards of premises in which blood donation takes place - All existing venues will be measured against the new baseline standard - Full implementation of an all-wales Blood Service - 100% of blood component requests met to satisfy clinical need - 98% of commercial product requests met - Develop platelet production strategy in response to SaBTO recommendation on the removal of the 80% target - 100% facilitation / import of HSC products for patients in Cardiff and Value UHB - 90% deceased donor typing / cross matching reported within 6 hours - 90% Anti-D & -cquantitation results provided to customer hospitals within 5 working days - 90% routine antenatal patient results provided to customer hospitals within 3 working days - 80% samples referred for red cell reference serology work up provided to customer hospitals within 2 working days - Work towards 0 critical and 0 major regulatory non-compliances across full range of services - Reduce number of reportable SABRE events from (8) to (5) - Maintain 100% to close SABRE reports to MHRA within 30 days - Accreditation retention: MHRA / HTA / CPA (UKAS)/ EFI/WMDA - WBMDR to achieve accreditation status with the FACT Joint Accreditation Committee-ISCT Europe (JACIE) - Achieve ISO (UKAS) accreditation for diagnostic laboratories and UK NEQAS for 1 Active donor = have donated within a 2 year period 86

87 Providing evidence based care and research which is clinically effective First class donor experience Histocompatability and Immunogenetics - Retain wholesaling license - Keep abreast of mandated changes to testing and emerging clinical priorities, for example: o Prion testing for vcjd o Introduction of a new microbiology contract o Review BACT alert testing contract o Implementation of Euroblood bag o Maintain compliance with Health & Safety Environment Agency Legislation - Develop a Research and Development Strategy for the service - Develop hospital partnerships to improve patient care e.g. undertake feasibility study to expand apheresis therapeutic services - Review laboratory service arrangements to consider real time PCR project - Explore research opportunities e.g. clinical effectiveness of non-invasive haemoglobin test - Roll out donor Self Assessment Health History (SAHH) - Roll out online donor appointment system - Roll out online self donor record management - Review and develop a volunteer programme - 70% of blood donors scoring 9/10 for satisfaction with overall service - 70% of customer hospitals scoring 9/10 for satisfaction with overall service - 90 % of concerns answered within 30 days - Strengthen our community partnership forum with donors - Continue to improve the donation experience with a feasibility study to assess semireclining donation chairs - Undertake a feasibility assessment to determine benefits of next generation sequencing technology for HLA typing - Explore research and clinical effectiveness of non-invasive haemoglobin test Supporting our staff to excel - 95% of statutory training delivered - 95% of mandatory training delivered - 100% of staff to receive PADR - sickness absence rate of 3.5% or less Spending every pound well - Ensure the provision of an all-wales Blood Service represents value for money for NHS Wales - <7% time expired platelets - <0.5% volume of waste (red cells) - <5% total losses prior to issue - Optimise estates footprint to support 16% reduction in carbon emissions for Velindre NHS Trust 87

88 Blood and Transplant Services Plan for 2013/ /2017 Quality and Performance Ambitions over the next 3 years Strategic Objective Theme Equitable and timely access to services Performance ambitions Equitable and timely access to services Improve retention of existing donors: - 3% increase in the number of active donors on the whole blood panel - 50% increase in the number of active donors on the apheresis panel - Hold a minimum of 1 Donor Awards Evening event per year in each geographical area served Baseline 2012/ , % 2013/ / / /2017 Maintain +1.0% +1.0% +1.0% Maintain +10% +10% +30% 100% 100% 100% 100% Improve recruitment of new donors and BMV samples, especially young donors: - 30% increase in the number of new donors attracted (whole blood) - 60% increase in the number of new donors attracted aged (whole blood) - 8,000 new Bone Marrow Volunteer (BMV) samples - 30% of new Bone Marrow Volunteer (BMV) samples aged ,864 4, % 9,750 5,362 2,000 30% 10,725 6,113 2,000 30% 11,000 7,078 2,000 30% 11,523 7,454 2,000 40% 88

89 Review minimum standard of premises in which blood donation takes place within local communities whilst maintaining the balance of donor need. Baseline standard in line with Good Manufacturing Practice requirements Review current baseline standards of premises 50% of venues will be measured against the new baseline standards per year 50% of venues will be measured against the new baseline standards per year 50% of venues will be measured against the new baseline standards per year Safe and reliable services Safe & reliable services Meet all blood component demand in line with clinical need: - 100% of blood component requests met to satisfy clinical need - 98% of commercial product requests met - Develop platelet production strategy in response to SaBTO recommendation to remove 80% apheresis target and that additive solution should be used for the suspension of platelets 100% 98% 70% 100% 98% Review existing Apheresis Strategy and conduct scoping exercise 100% 98% Develop new Apheresis Strategy 70% 100% 98% Take forward new Apheresis Strategy within the Service 70% 100% 98% Maintain and review as required Apheresis Strategy 65% Meet all transplant service requests: - 90% deceased donor typing / cross matching reported within 6 hours - 100% delivery of Haemotopoietic Stem Cell (HSC) internal targets - 100% facilitation / import of HSC products for patients in Cardiff and Vale UHB internal targets 100% 98% 100% 90% 100% 100% 90% 100% 100% 90% 100% 100% 90% 100% 100% 89

90 Meet all diagnostic service requests: - 90% Anti-D & -cquantitation results provided to customer hospitals within 5 working days - 90% routine antenatal patient results provided to customer hospitals within 3 working days - 80% samples referred for red cell reference serology work up provided to customer hospitals within 2 working days Improve performance against regulatory requirements: - 0 critical regulatory non-compliances across full range of services - 0 major regulatory non-compliances across full range of services - Reduce the number of reportable SABRE events - Maintain 100% to close SABRE reports to MHRA within 30 days Accreditation Retention: - MHRA - HTA - CPA - EFI - WMDA 90% 90% 80% % Retain Retain Retain Retain Retain 90% 90% 80% % Retain Retain Retain Retain Retain 90% 90% 80% % Retain Retain Retain Retain Retain 90% 90% 80% % Retain Retain Retain Retain Retain 90% 90% 80% % Retain Retain Retain Retain Retain Extend accreditation to include: - FACT Joint Accreditation Committee-ISCT Europe (JACIE) for WBMDR - ISO accreditation for: UK NEQAS H&I Diagnostic laboratories Not sought Not sought Not sought Gap analysis Not sought Not sought Apply Gap analysis Gap analysis Achieve Achieve Progress Retain Retain Achieve Retain wholesaling license Retain Retain Retain Retain Retain 90

91 First class donor experience First class donor experience Modernise our collection sessions and the way we interact and manage our donors: - Roll out donor Self Assessment Health History (SAHH) - Roll out online donor appointment system - Roll out online self donor record management Review and develop a volunteer programme N/A Develop Volunteer Strategy Continue to improve satisfaction ratings from our donors: - 70% of blood donors scoring 9/10 for satisfaction with overall service Continue to improve satisfaction ratings from customer hospitals: - 70% of customer hospitals scoring 9/10 for satisfaction with overall service Respond to all concerns in a timely and effective way: - 90 % of complaints answered within 30 days 0% 0% 0% Strengthen our Community Partnership Forum with donors: - Hold a minimum of 4 per year Not Continue to improve the donation experience: - Conduct feasibility study to assess semireclining donation chairs esurvey not live 0% 0% 0% 100% 0% 0% Finalise Volunteer Strategy 100% 100% 100% Develop supporting business case 100% 100% 100% 68% 69% 70% 71% Not assessed 68% 69% 70% 71% 51% 70% 80% 90% 90% established N/A Launched Commence review of existing donation chairs 4 per year Feasibility study to determine viability of semi-reclining Launch new volunteer programme Extend to include a North Wales forum Trial and development of business case Take forward phased roll out 91

92 bleed couches Supporting our staff to excel Keep abreast of advancements in technology: - Undertake a feasibility assessment to determine benefits of next generation sequencing technology for HLA typing N/A N/A Feasibility study of next generation sequencing for HLA typing Secure necessary funding Business case development Take forward next generation sequencing typing for HLA within the service Supporting our staff to excel Support staff to receive all required statutory and mandatory training: - 95% statutory training 78% 85% 90% 95% 95% - 95% mandatory training 78% 85% 90% 95% 95% Ensure all staff have a PADR 60% 80% 90% 100% 100% Reduce sickness absence levels to improve staff attendance: - sickness absence rate of 3.5% or less 4.7% 4.7% 4.2% 3.9% 3.5% Manage staff work / life balance: 1.21% 1.21% 1% 0.9% 0.9% - Reduce the percentage of staff on sickness absence due to stress related illness Develop a more flexible workforce to meet changing service needs Develop capacity, capability and leadership to deliver strategic change Phased roll out of redesigned blood collection roles N/A Complete roll out of redesigned blood collection roles Scope change management / leadership requirements to support delivery of Increase take up of fully multi-skilled blood collection roles Pilot and initiate change management / leadership development programme to Increase take up of fully multiskilled blood collection roles Further roll out of change management / leadership development programme and IQT Training initiative 92

93 major strategic change within the service support major strategic change within the service Roll out IQT Training Spending every pound well Develop talent management and succession planning within the service: N/A N/A Initiate Pilot Talent Management initiative within the Service Roll out talent management strategy within the service Review impact of talent management strategy within the service Reduce volume of waste across the full range of services: - <7% time expired platelets - <0.5% volume of waste (red cells) - <5% total losses prior to issue 4.3% 0.1% 6.9% <7% <0.5% <6% <7% <0.5% <5% <7% <0.5% <5% <7% <0.5% <5% Improve optimisation of Estates footprint: - Work to support 16% reduction in carbon emissions target for Velindre NHS Trust Business as usual (BAU) carbon emissions Support 10% reduction in carbon emissions target for Velindre NHS Trust as a whole Support 15% reduction in carbon emissions target for Velindre NHS Trust as a whole Support 16% reduction in carbon emissions target for Velindre NHS Trust as a whole Support 16% reduction in carbon emissions target for Velindre NHS Trust as a whole How will we achieve it 93

94 Strategic Objective Theme Equitable and timely access to services Key Action Equitable and timely access to services Implement new service design model to support realisation of an all-wales Blood Service and supporting infrastructure 2013/ / / /2017 all-wales Blood Service Develop comprehensive Confirm service design Programme Board - service design model model including staff established with ToR structures and the agreed necessary supporting infrastructure Develop robust project plan agreed with all key stakeholders Develop overarching communication plan to ensure programme of effective stakeholder engagement that supports delivery of an all-wales Blood Service Support development of comprehensive business case identifying transitional and ongoing costs Confirm and support consultation arrangements regarding staff TUPE Full -implementation of service design model and agreed Trust support to identified transitional and ongoing costs to providing an all- Wales Blood Service in line with key strategic priorities Improve retention of existing donors: - 3% increase in the number of active donors on the whole blood panel - 50% increase in the number of active donors on the apheresis panel Re-engage with staff and donors on opening times and utilisation of the appointment system to tailor our offering to provide donors with more opportunities to donate in line with Further develop application of smart phone technology and social media platforms in donor communications Ensure effective arrangements are in place to hold sufficient Donor Deliver overarching communication plan to key stakeholders Extend provision of Donor Awards Evening events to North Wales in line with the establishment of an all-wales Blood Service Continuous monitoring of esurvey donor feedback to address as appropriate 94

95 - Hold a minimum of 1 Donor Awards Evening event in each geographical area per year Improve recruitment of new and BMV donors (especially young donors): - 30% increase in the number of new donors attracted (whole blood) - 60% percent of new donors attracted aged (whole blood) - 8,000 new Bone Marrow Volunteer (BMV) samples by % of new Bone Marrow Volunteer (BMV) registrations aged donor preferences Ensure effective arrangements are in place to hold sufficient Donor Awards Evenings Continuous monitoring of esurvey donor feedback to address as appropriate Implement digital telephony within Donor Relationship Management (DRM) to support donor management, recruitment and retention strategies Establish Bone Marrow Volunteer (BMV) Recruitment Steering Group Develop BMV Recruitment Strategy to: (1) Provide a road map for the strategic coordination of future recruitment activities; (2) Engage and raise our profile with donors Awards Evenings Continuous monitoring of esurvey donor feedback to address as appropriate Explore opportunities to help better understand the motivation and needs of young blood donors to help secure our future donor base Strengthen our education and ambassador programme to build links and relationships with students so they become engaged volunteers and champions for the service. Explore opportunities from Phase 2 eprogesa: (1) online donor portal; (2) app technology and electronic point of care solutions to capture blood collection information at the bedside; (3) edonor Relationship Module (edrm) to improve campaign and marketing drives for the future service Explore further opportunities from Phase 2 eprogesa 95

96 Improve minimum standard of premises in which blood donation takes place: Full implementation of an all- Wales Blood Service: (3) Identify clear marketing plans; (4) Explore the use of social media and ICT to engage donors and registry members. Review current baseline standards of premises Develop comprehensive service design model Develop robust project plan agreed with all key stakeholders Develop overarching communication plan to ensure programme of effective stakeholder engagement that supports delivery of an all-wales Blood Service Develop detailed specification and project plan for the migration of donor database 50% of venues will be measured against the new baseline standard per year Confirm service design model including staff structures and the necessary supporting infrastructure Support development of comprehensive business case identifying transitional and ongoing costs Confirm and support consultation arrangements regarding staff TUPE Deliver overarching communication plan to key stakeholders Work with commercial 50% of venues will be measured against the new baseline standard per year 50% of venues will be measured against the new baseline standard per year Full implementation of service design model and agreed Trust support to identified transitional and ongoing costs to providing an all-wales Blood Service in line with key strategic priorities 96

97 Support NHSBT with the planned relocation of the Caernarvon team base Manage and agree capital assets and equipment list during transfer of service suppliers and NHSBT for robust, validated and seamless migration of North Wales donor database Safe and reliable services Safe & reliable services Meet all blood component demand in line with clinical need: - 100% of blood product requests met to satisfy clinical need - 98% of commercial product requests met - Develop platelet production strategy in response to SaBTO recommendation to remove 80% apheresis target and that additive solution should be used for the suspension of platelets Strengthen planning arrangements to help develop a more targeted collection programme that accounts for variations in donor attendance throughout clinic sessions and by clinic type in line with donor preferences Develop a new conversation with donors and staff regarding clinic opening times to ensure that we can anticipate their needs and translate into appropriate Implement new blood agitators on the mobile donation units (bloodmobiles) to support a more efficient blood collection model Roll out two tier medical health screening process Understand emerging development of HLA matched platelets preference by clinicians Develop economic model for the PAS business case on the % platelet method proposed Review apheresis Implement Phase 2 eprogesa (e-drm module) to develop donor informatics capability to segment donor panels and offer sophisticated donor profiling to improve donor recruitment and retention Embed Phase 2 eprogesa (e-drm module) to develop donor informatics capability 97

98 Meet all transplant service requests: - 90% deceased donor typing / cross matching reported within 6 hours - 100% delivery of Haemotopoietic Stem Cell (HSC) products to stakeholders in full - 100% facilitation / import of HSC products for patients in Cardiff and Vale UHB service plans. Work with staff to support realisation of the optimum skill mix. Increase the number of collection days serviced by the mobile blood donation centres Establish project group to conduct apheresis scoping exercise to review apheresis % required and assess the potential introduction of PAS Extend BMV donor high resolution HLA typing at registration to reduce time taken to provide stem cells for transplantation to improve patient outcomes Implement UK Stem Cell oversight committee recommendations regarding alignment of donor registries donor panel requirements to meet clinical requirements for HLA and HPA matched platelets Monitor and review service performance to ensure it continues to meet requirements 98

99 Meet all diagnostic service requests: - 90% Anti-D & - cquantitation results provided to customer hospitals within 5 working days - 90% routine antenatal patient results provided to customer hospitals within 3 working days - 80% samples referred for red cell reference serology work up provided to customer hospitals within 2 working days Improve performance against regulatory requirements: - 0 critical regulatory non-compliances across full range of services - 0 major regulatory noncompliances across full Welsh Bone Marrow Donor Registry (WBMDR) to join the National Marrow Donor Programme (NMDP) as a Donor Centre improving the visibility of welsh donors to American transplant centres Continue to monitor and review service performance to meet hospital requirements Prepare for MHRA inspection December 2013 Implement detailed audit programme Continue to develop and deliver Good Consider opportunities regarding deployment of resources into key departments across the service Prepare for 2015/16 MHRA inspection Extend self inspection audit programme to targeted areas Extend self inspection audit programme to targeted areas 99

100 range of services - Reduce the number of reportable SABRE events - Maintain 100% to close SABRE reports to MHRA within 30 days Manufacturing Practice (GMP) training provision Investigate and monitor serious adverse events (internal / external), advise preventative actions and lessons learnt Extend provision of Root Cause Analysis training Review ongoing training Accreditation Retention: - MHRA, HTA, CPA and EFI Extend accreditation to include: - FACT Joint Accreditation Committee-ISCT Europe (JACIE) for WBMDR - CPA ISO accreditation for diagnostic and External Quality Assessment laboratory Support and prepare service for all accredited inspection programmes Gap analysis on standards Retain wholesaling license Continue to offer value for money and meet all hospital requests Keep abreast of mandated changes to testing and emerging clinical priorities for example: - Club 96 impact - Pathogen inactivation Monitor and review mandated changes Dedicated quality resources to be embedded into key department Develop action plan to address outcomes of gap analysis Continue to offer value for money and meet all hospital requests Implement new replacement blood testing systems via WG funding Training & self inspection audits Review inspection findings and address with action plan Ongoing monitoring and self inspection Continue to offer value for money and meet all hospital requests Consider all mandated changes for an all-wales Blood Service Continue to offer value for money and meet all hospital requests Consider all mandated changes for an all-wales Blood Service 100

101 - Prion testing for vcjd - Introduction of new microbiology contract Award microbiology contract and implement new changes Monitor and review contract Monitor and review contract and include in All Wales Monitor and review contract - Review BACT alert testing contract Monitor and review with NHSBT Monitor and review contracts Monitor and review contract and include in All Wales Monitor and review contract - Implementation of new replacement blood testing systems Develop business case for WG Implement new equipment Monitor and review contract and include in All Wales Monitor and review contract Providing evidence based care and research which is clinically effective Providing evidence based care and research which is clinically effective Develop a Research and Development Strategy for the service Develop hospital partnerships to improve patient care N/A Develop R&D strategy for the WBS Explore NLIAH funding iron deficiency anaemia and patient ID into theatre project N/A Medical Director to engage with hospital partners Explore opportunities with implementation of an all-wales Blood Service Undertake feasibility study to expand apheresis therapeutic services Explore opportunities with implementation of an all-wales Blood Service Enhance relationships with North Wales customer hospitals Review laboratory service arrangements to consider real time PCR project Review service structure and strategy in light of resignation of Consider submission of a business case to WHSSC to seek redistribution of LHB If required pending business case approval take forward real time Monitor and review 101

102 service lead funding for this patient service enhancement PCR project development as patient focussed service Explore research opportunities: - Explore research and clinical effectiveness of non-invasive haemoglobin test Undertake feasibility study of non-invasive haemoglobin tests Develop user requirement specification Develop supporting business case with a view to taking forward key recommendations Implement noninvasive haemoglobin test across the collection teams Monitor and review First class donor experience First class donor experience Modernise our collection sessions and the way we interact and manage our donors: - Roll out donor Self Assessment Health History (SAHH) - Roll out online donor appointment system - Roll out online self donor record management Review and develop a volunteer programme Continue to improve satisfaction ratings from donors: Scope donor engagement requirements Commence development of Volunteer Strategy Review and analyse results of esurvey Donor engagement and market demonstration research Implement Phase 1 eprogesa Finalise Volunteer Strategy Develop supporting plan Identify and implement key Maintain and manage and implement at an all- Wales level Phase 2 eprogesa Launch new volunteer programme in South and West Wales Review donor satisfaction esurvey Launch new volunteer programme North Wales Review donor satisfaction esurvey 102

103 - 70% of blood donors scoring 9/10 for satisfaction with overall service Continue to improve satisfaction ratings from customer hospitals: - 70% of customer hospitals scoring 9/10 for satisfaction with overall service Respond to all concerns in a timely and effective way: - 90 % of concerns answered within 30 days Review and analyse results of customer hospitals survey Implement new standard operating procedure improvements resulting from esurvey analysis Improve estates and facilities for blood donation Determine optimum service provision regarding appointment times and benefits from improvements in 2014/2015 Develop new set of improvement actions and implement and benefits from improvements in 2015/2016 Develop new set of improvement actions and implement Continue to strive for improved satisfaction by engaging with customer hospitals Continuous monitoring and review of concerns themes and timelines of responses Strengthen our Community Partnership Forum with donors: - Hold a minimum of 4 per year Establish groups in the following four areas: (1) West Wales; (2) mid Wales; (3) South Wales and (4) East Wales. Each group will meet up at least once per year to discuss different aspects of: - Service delivery - Recruitment & Hold a minimum of four forums across each geographical area serviced Extend Community Partnership Forum to North Wales in line with the establishment of an all- Wales Blood Service 103

104 Retention - Partnership working Continue to improve the donation experience: - Conduct a feasibility study to assess semi-reclining donation chairs Identify and implement advancements in technology Supporting our staff to excel Point of Care research to establish need Feasibility study to determine viability of alternate semireclining bleed couches Determine benefits of next generation sequencing technology for HLA typing Develop business case to increase funding for high resolution typing Trial and development of business case Engage commissioners on benefits of funding for high resolution typing with an aim of securing funding Secure funding for All Wales Blood Service changes Implementation Supporting our staff to excel Support staff to receive all required statutory and mandatory training: - 95% statutory training - 95% mandatory training Develop robust training schedule Appointment of Trust-wide statutory and mandatory trainer Core skills matrix: e-learning to be promoted and rolled out from 2013 onwards MSS/ESS rollout for OLM in 2013/14 enabling employees Proactive monitoring Review of training resource Proactive monitoring Proactive monitoring 104

105 to self-book onto courses Ensure all staff have a PADR Appraiser training Monthly monitoring with departments Preparation of progress statistics Reports and feedback on progress to SMT Updated PDR paperwork Monthly monitoring with departments Preparation of progress statistics Reports and feedback on progress to SMT Continue to deliver training / refresher training Reduce sickness absence levels to improve staff attendance: - sickness absence rate of 3.5% or less Return to work interviews Use of Occupational Health assessments Sickness audits Stress risk assessments Use of sickness policy Promotion of Health and Wellbeing initiatives Manage staff work / life balance Consider applications in line with the Work-life Balance Policy Provision of support services e.g. advice and counselling through Employee Assistance Programme (EAP) Provision of childcare vouchers, holiday child subsidy scheme Develop a more flexible workforce to meet changing service needs Develop capacity, capability and leadership to deliver strategic change Complete roll out of redesigned blood collection roles Work with Public Health Wales, Academi Wales and Higher Education Institutions. Scope leadership and change management Identify further opportunities for improving scope / skill mix for staff Work with staff to support realisation of the optimum skill mix Take forward partnership working arrangements to deliver targeted leadership and change management development 105 Embed leadership and change management initiatives within the service Continue roll out of IQT Training initiative Review impact of leadership and change management development programme within the service and assess further

106 development programme requirements including Lean programme Roll out IQT Training initiative requirements Continue roll out of IQT Training initiative Develop talent management and succession planning within the service: Embed a learning culture within the service: Initiate review of Pilot outcomes of VCC talent management initiative Explore with Workforce Education Development Service (WEDS) funding for scientific training post in line with modernising scientific careers Take part in World Quality Day 2013 to promote awareness of the quality agenda and that every member of staff has a responsibility to participate to help raise standards Continue publication of staff newsletter Quality Matters to raise the profile of quality issues and promote Complete review of Pilot outcomes and develop plans to take forward talent management strategy within the service Develop succession plans within the WBS Roll out talent management strategy within the service Review impact of talent management strategy within the service Plan and work not only at building individual capability, but also team, and collaborative and co-operative capabilities to promote a culture of learning QA Department to hold annual event at WBS to promote learning Targeted GMP training programme that focuses on key lessons / issues for the Service Continue publication of staff newsletter Quality Matters to raise the profile of quality issues and promote learning within the organisation Promote CPD attendance and sharing of learning via papers / lectures to staff within the Service 106

107 learning within the organisation Spending every pound well Spending every pound well Ensure the provision of a new all- Wales Blood Service represents value for money for NHS Wales: Ensure all aspects of service costs scoped out in service design model. As a minimum transitional capital and revenue costs need to be understood Produce internal business justification case to secure funding from WHSSC Implement all-wales Blood Service Implement all-wales Blood Service Explore opportunities to improve the supply chain Conduct scoping exercise to assess viability and ROI for introduction of ambient overnight hold within the processing laboratory Pending recommendations of scoping exercise, develop supporting business case to take forward spend to save initiative Ensure supporting infrastructure requirements within Collections can be achieved to facilitate ambient overnight hold within the service Explore a number of initiatives via the BBTT and work to develop existing arrangements within the supply chain pathway to help maximise the use of donated blood and platelets and ensure continuous improvement in blood supply management Reduce volume of waste across the full range of services: Maintain good inventory practice e.g. First in First Out (FIFO) principle in line with fluctuating demand 107

108 - <7% time expired platelets - <0.5% volume of waste (red cells) - <5% total losses prior to issue based on clinical need by blood group e.g. CMV status Improve optimisation of Estates footprint: - Support 16% reduction in carbon emissions target for Velindre NHS Trust Work towards principles of ISO environmental building standards once professional support identified Decommission Carmarthen Unit 20 PC shutdown at night once updates have been carried out. Interface the split units to the BMS to prevent the two systems fighting each other. The BMS would control the air handling units (AHU) and the split air conditioning units off of the space temperature 2. Boiler replacement: replace 2 of the 5 boilers with two lead condensing boiler so as to improve the combustion efficiency from 80% to 90% for most of the heat load Lighting controls: Bocam Park closure Potential expansion of WBS estate in line with the needs of an all-wales Blood Service Expansion of WBS estate in line with the needs of an all- Wales Blood Service 2 The AHU s would supply air at a lower temperature and the splits would be used to provide top-up heating and cooling. Low heat gain areas without splits would have a moisturised volume control damper fitted. 108

109 Increase income generation Establish a Business Planning Sub Group to explore commercial opportunities for the service Join National Marrow Donor Panel (NMDP) to extend potential to generate income to service for donor marrow Secure additional renal transplantation service income from future renal transplantation projections daylight control can be fitted to most of the corridor and entrance foyer lighting. These areas are well day lit because of the courtyards. Review WBS estates footprint in readiness for the establishment of an all-wales Blood Service Explore opportunities within university networks that specialise in R&D and or laboratory training regarding commercial products available from the service Explore income opportunities in line with all-wales Pathology modernisation programme requirements relating to the transportation of results and tests Review and offer WASPS scheme to North Wales community 109

110 Continue to participate in strategic joint procurement opportunities with UK and European Blood Services identified in business case developed jointly with Cardiff & Vale Health Board and renal network via WHSSC joint committee between Health Boards and Trusts Ensure participation and / or oversight with all UK & European identified business opportunities available Explore further opportunities to improve any inappropriate use of blood Improve efficiency of existing WTAIL IT resources Review of service moving forward Develop nurse prescribing programme Review education, usage and audit work Explore existing IT system for on-line EQA results entry Engage stakeholders and implement recommendations of service review If required develop business case Scope implementation requirements Review plans for further development upon introduction of all-wales Blood Service Take forward implementation of on-line EQA results entry Increased utilisation of IT generated customer reports 110

111 111 P age Section 6: Developing a culture of high quality and continuous improvement

112 Supporting Staff to Excel The Trust has a committed and highly talented workforce which makes a difference to patients and donors on a daily basis. In order to sustain this we need to ensure that we fully understand the challenges that face us over the coming years and respond to them effectively to ensure we create the environment, opportunities and support for our staff to continue to grow and achieve their potential. A few things on our mind... Recruiting to key Workforce Posts The success of Velindre NHS Trust depends on the staff who work for us. We continuously strive to recruit the right people, with the right knowledge, skills and experience, at the right time, and support them to achieve their potential and delivery of the quality care we expect. Whilst the recruitment of staff has not historically been difficult, there are a number of challenges within the external environment which we need to be mindful of. i. Nursing Workforce The Royal College of Nursing has warned of unprecedented uncertainty about the future nursing workforce, due to the numbers reaching retirement age (Wales: 29% over the age of 50 and 12% over the age of 55 ) and the agreed shift to a graduate entry profession, which has the potential to discourage new entrants into a career in nursing. These issues pose a real challenge to the future supply of nurses and the ability of the workforce to support the delivery of extended healthcare support workers roles and addressing and moving away from the traditional skill mix model. Whilst the Trust has traditionally been able to recruit to its nursing vacancies, it cannot become complacent as 16% of the Trust s workforce is nurses. We must therefore consider how we can use the nursing and healthcare support worker workforce differently in the future, to address potential qualified nursing shortages and maintain safe, productive and effective services. When developing our workforce plans we have considered the age demographic of our current nursing workforce and made projections of future numbers based on our knowledge and expertise. We have, and will continue to seek, opportunities to be proactive in developing existing roles and creating new roles which offer greater job satisfaction and flexible career paths for the nursing workforce. This will enable professionals to cross boundaries and to work in broader roles, such as research, policy development and management, which allow people to contribute more fully to the enhancement of care and service delivery and modernisation, within a constrained financial environment. 112 P age

113 ii. Allied Health Professional Workforce (AHPs) The future supply of AHPs is a cause for concern within Wales due to the age profile of this staff group, with 22% of the workforce over the age of 50 and 10% are over the age of 55. Consequently, if nothing changes, there is a significant risk that the there will be a shortage of senior and specialist AHP staff within NHS Wales within the next 5 to 10 years. This position may be further affected by reductions in education commissioning and the inability of NHS organisations to offer supervised clinical placements, which are a key component of the current training programme. This will result in a reduction in new entrants at a time when many experienced staff will be retiring. The Centre for Workforce Intelligence (CfWI) is currently undertaking a review of those AHP professions which have been identified as having the most significant future workforce issues. The professions currently being reviewed, which could have an impact on the Trust are diagnostic radiographers and therapeutic radiographers. At Velidre, 10% of the Trust s total workforce are AHPs, with a significant proportion of these being radiographers. The demands for both of these roles within the Trust and the NHS are increasing. Demand for diagnostic radiographers is also being driven up due to Welsh Government policy initiatives such as the National Stroke Strategy and the development and extension of screening programmes. Improved access to radiotherapy treatment is also increasing the demand for therapeutic radiographers. The pressures are accentuated by the high attrition rate on these training courses. Thus, there is a significant risk that in the future demand for radiographers will far outstrip supply and the Velindre may experience recruitment difficulties within these specific staff groups. iii. Healthcare Scientist Workforce (HS) The future supply of HS is a cause for concern due to the age profile of this staff group in Wales with 32% over the age of 50 and 17% over the age of 55. Consequently, almost 50% of the existing healthcare sciences workforce could retire within the next 5-10 years. In recent years the number of students taking science based qualifications and graduating with science based degrees has declined. Due to the decline in graduate numbers, the NHS currently has to actively compete with private sector industries to attract graduates and experienced staff to fill vacancies. Unless the NHS can offer attractive employment packages or excellent career pathway opportunities to potential applicants, it may not be able to attract the high calibre healthcare scientist it requires to maintain the delivery of high quality services. Given the rapid pace of technological and organisational change within the NHS, this could prematurely increase attrition rates, especially for those staff nearing retirement age. This would result in the most experienced members of this workforce leaving the service, with a real 113 P age

114 possibility of the Trust not being able to fill the vacancies, in what is increasingly becoming recognised as a shortage profession. At Velindre, HS make up 7.5% of the Trust s overall workforce and given their age profile, the technological challenges, and the shortage of newly qualified graduates, we are likely to experience recruitment and retention difficulties in the future. iv. Medical Workforce The medical workforce (consultants) makes up 7% of the entire Trust workforce numbers. It however accounts for approximately 18% of the staff budget expenditure. Over the last decade the size of this staff group in Wales has increased significantly, as have the associated costs. The introduction of the Consultant Contract in Wales was intended to assist NHS organisations in service modernisation. There have been some positive benefits from this, although it has not perhaps achieved the full range of expected benefits initially identified. Over the past decade the NHS in Wales, and Velindre, have been able to recruit more medical staff. However, it is unlikely that the rate of growth will continue over the next decade given the forecast resource position. Velindre will therefore need to continue to find better ways to meet the clinical needs of patients using innovative clinical and technological practice. v. Succession Planning The Trust recognises that succession planning is a key tool for securing the future success of the organisation to ensure that there are no critical shortages in key roles and posts in the future. The Trust does not currently have a robust succession planning process, although an internal talent management tool has been developed and is currently being piloted. The key challenge for the Trust is to proactively identify, develop and nurture talent at all levels within the organisation, to ensure that it has a supply of healthcare workers, healthcare professionals and clinical and non clinical managers and leaders to fill those posts which are critical to the successful delivery of our services. It must also ensure that any such process balances the aspirations of individual employees and can meet the future requirements of the Trust, which are likely to change and evolve relatively quickly in the current political and financial environment. Our succession planning process must also recognise that there will be posts which cannot or should not be filled from the internal pool of talent because there is a need to recruit an external candidate with fresh insight and a different set of skills / competencies. The Trust moving forward must therefore ensure that succession planning is not only part of the Workforce and Organisational Development Strategy but is an integral part of workforce planning process. 114 P age

115 vi. Staff Engagement The Trust is committed to being a great employer and delivering quality, care and excellence. The NHS Wales Staff Survey 2013 has provided us with a wealth of information from our staff at an important time in the development of the NHS in Wales. We achieved a 52% response rate, which in survey terms was categorised as high and an overall engagement index of 3.69 (on a scale of 0 5) with index scores for each area:- Intrinsic psychological engagement (3.75); Ability to contribute towards improvements at work (3.42); and Staff advocacy and recommendation (3.9). Whilst these scores can be viewed positively, the Trust recognises that there is always more work to do. All leaders, managers and staff within the organisation are being supported and encouraged to become actively engaged in the decisions made within the organisation at a strategic and operational level. This is essential as engaged staff are likely to be productive and committed and to go the extra mile for patients and donors. vii. Supporting attendance at work Over the past two years the Trust has experienced an increase in both short and long term sickness absence. This is consistent with the picture across the NHS and wider public services in Wales. We have identified work related stress as the most prevalent reason for both short term and long term sickness absence within the Trust. Whilst of concern, it mirrors the wider public sector where stress is the most common reason. We are very committed to supporting staff to attend work as there are direct links with the quality of care provided to patients and donors, and it supports positive well-being of staff. We are working towards a 1% reduction in sickness absence over the next two years using a variety of approaches. We have submitted a detailed Supporting Attendance action plan to the Welsh Government and are currently implementing it. 115 P age

116 Putting strong foundations in place for our staff Developing strong workforce enablers to achieve Delivering Excellence We have identified a series of workforce enablers will support the development of a motivated and high performing workforce within the Trust. Strong leadership / Role Modelling: we will support staff in developing a strong culture of high performance through effective leadership, management. This will be founded upon our values and behaviours and seeks to provide the required learning opportunities and experience to all staff on their journey. Competency Based Recruitment Processes: we will recruit staff based on their knowledge, skills, competende and potential for development. Supporting health and well-being: we are committed to providing support and opportunities for our staff to maintain their health, well-being and safety. We aspire to develop culture and supporting programme that enables us to be viewed as an exemplary employer. Comprehensive Education and Development Programme: we will ensure that our development programmes are appropriate, challenging and accessible to our staff and offer the opportunity to apply the learning in a practical way. Succession Planning: we will develop a strong partnership with our staff to support and actively manage their progression within the organization. This will allow staff to experience new opportunities and enable the organisation to manage the future in a planned way. Managing staff performance: we will use an effective performance appraisal system to continuously improve team and individual performance. It will be aligned to our values, competences and reward systems and will assist staff in achieving their potential. Staff Engagement: we recognise that a fully engaged workforce is critical to our success and is vital if staff are to fulfill their potential and patients and donors are to receive the highest quality services. We wish to develop a culture and reputation that makes us an the employer of choice nationally and internationally. 116 P age

117 Workforce Plans We have been developing our workforce plans in accordance with our plans. The plans are indicative at this stage and subject to ongoing discussions internally, with commissioners and Welsh Government. Velindre Cancer Centre Pay scale Baseline 2013/14 FTE Band Band Band / / /17 FTE Band Band Band FTE Band Band Band FTE Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Jnr Dr Registrar 7.20 Consultant Jnr Dr Registrar 3.20 Consultant Jnr Dr Registrar 3.20 Consultant Jnr Dr Registrar 3.20 Consultant Total Total Total Total Overall numbers in Velindre Cancer Centre likely to increase in the future as a result of the increasing incidence of cancer, the complexity of treatment and the introduction of new services which have commissioner support and funding. These include Stereotactic body radiotherapy, surgical radiotherapy and image guided radiotherapy. There are also a range of additional and important service developments which are in the early stages of development such as organ motion control, advanced vivo dosimetry and increased access rates. The full workforce implications of these are not yet fully determined or agreed with commissioners. The addional area of focus is the continued transformation of the workforce in relation to scope of practice, skill mix and patterns of working which provides better quality care in a more efficient and productive way. A significant amount has already been achieved in this regard but further opportunities will be continuously sought to make our workforce fit for the future in a sustainable way. 117 P age

118 Welsh Blood Service Pay scale 2012/ / / / /17 FTE Band Band Band Band FTE Band Band Band Band FTE Band Band Band FTE Band Band Band FTE Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Band Consultant 3.20 Consultant 3.70 Consultant 3.70 Consultant 3.70 Consultant 3.70 Total Total Total Total Total The above table excludes details regarding staff uplift from 2016 to provide an all Wales Blood Service. It is anticipated that the establishment of an all Wales Blood Service will result in the TUPE transfer of additional staff across a variety of bandings. Furthermore, preliminary work undertaken by the Service Design workstream has identified the potential requirement for a stock holding unit in north Wales, which would require 24/7, cover 365 days per year. As such, additional staff to man this facility and dedicated drivers to transport blood from Llantrisant in the south, to the north Wales stock holding unit and onwards to the surrounding hospitals would be required as a minimum. 118 P age

119 Our approach to Organisational Development Enabling the Strategic Plans through Organisational Development We recently published an Organisational Development Strategy which identifies that successful organisations rely upon the continuous development of people and a supportive organisational culture. The key elements of the strategy are set out in Fig. 23. Employee Relations & Engagement Health & Wellbeing Management & Leadership PADR Service Improvement Talent Management Team Working Training, Education & Development OD Strategic Vision Workforce & OD professionals providing a flexible and responsive service to all members of staff and management which enables exemplary employee relations in all areas of the organisation. All staff are able to make the connections between the Trust s objectives and the valuable contribution that their role and that of their colleagues makes, which results in them experiencing increased job satisfaction and increasing their commitment to delivering quality, care and excellence. To maintain and improve the health and wellbeing of our entire workforce, which increases the Trust s ability to deliver safe and effective services, to our patients and service users Managers throughout the organisation being confident and competent in fulfilling their management role, and all members of staff feeling empowered to fulfil their personal leadership role regardless of role or seniority Every member of staff having a high quality individual Performance Appraisal & Development Review at least annually All individuals, teams & departments engaging with ongoing service improvement cycles which results in understanding service needs and seeking to establish a workforce which provides high quality and excellence through effective deployment of appropriate knowledge, experience and skills Ensuring that the organisation explores, recognises and nurtures the potential and talent of every member of staff Teams throughout the organisation seeking to reflect on performance on a regular basis, and align team activities to service needs alongside pursuit of exemplary team working practices Every member of staff ensuring to meet the mandatory and statutory training needs required of their role and to further engage in continuous personal and professional development as influenced by service needs and individual aspirations Fig. 23 Key elements of successful organisational development Supported by Workforce policies & procedures Working Differently Working Together Staff Engagement Strategy Working Differently Working Together Health & Wellbeing Strategy Working Differently Working Together Training Prospectus Training Plan Working Differently Working Together PADR Policy PADR Handbooks Training Plan Workforce Planning 1000Lives+ IQT Skill Mix Reviews Revised PADR Form (inc Talent Tool) Talent Management Process Working Differently Working Together Training Prospectus Training Plan Training Prospectus Training Plan 119 P age

120 Following the publication of the strategy, a number of developments have occurred which will require further and ongoing work from an organisational development persecptive:- The development of a vision, and model and facilities for cancer services. Creation of an all-wales Blood Service. The all-wales WfIS project is creating a renewed momentum in relation to workforce information and e-learning, which creates tangible opportunities and benefits for Velindre NHS Trust. The Velindre NHS Trust Staff Survey results have been analysed locally and understanding of staff opinion and establishment of resultant action continues to develop. To support the achievement of the Trusts ambition, an organisational development programme has put in place which is set out in Table 2. This will be continuously reviewed and revised in light of changing needs. 120 P age

121 Table 2 Organisational Development Programme 2014/ /2017 Action OD Strategic Vision Employee Relations & Engagement Health & Wellbeing Management & Leadership 2014/ / / Establishment of a Trust-wide Staff Engagement group 2. Adoption of the WDWT Staff Engagement Toolkit 3. Staff Survey results analysis & report generation 4. Publication of related managerial guidance & support on Trust intranet site 5. Review of WfOD structure & service provision 12. Approval of revised Trust Health & Wellbeing Action Plan 13. Re-launch of the Trust s Sickness Absence Management Group 14. Publication of a Trust-wide Sickness Absence Management Plan 15. Submission of bid for funding to support recruitment of a Sickness advisior 16. Retention of the Work Gold Award 21. Maintain provision of in-house management & leadership 6. Embedding of principles via discrete staff engagement activity 7. Measurement of staff engagement index via Trust-wide Pulse Survey 8. Implementation of any revised WfOD structure 17. Continued action against Trust s Health & Wellbeing Action Plan 18. Achievement of Work Platinum Award 23. Extend provision of in-house management & leadership 9. Continued embedding of principle via discrete staff engagement activity 10. Measurement of staff engagement index via Trust-wide Pulse Survey 11. Efficacy review of any revised WfOD structure implementation 19. Continued action against Trust s Health & Wellbeing Action Plan 20. Maintenance of Work Platinum Award 25. Retain ILM Centre accreditation 121 P age

122 PADR Service Improvement Talent Management development programmes 22. Develop Trust-wide understanding, & adoption, of Clinical Leadership principles 27. Pilot revised PADR process in each Division of the Trust 28. Evaluate pilot & amend process as necessary 29. Use Staff Survey results to establish baseline of PADR activity 38. Launch IQT training programme within Corporate, VCC and hosted organisations 39. Meet 1000Lives+ target of 25% headcount trained in service improvement methodologies 40. Maintain ongoing Service Improvement projects e.g. VIP and D2D activity within the VCC and WBS 50. Establish a Talent Tool for Velindre NHS Trust development programmes to include an ILM Level 2 Team Leader Award 24. Embed Trust-wide implementation of distributed Clinical Leadership 30. Launch revised PADR process throughout the Trust 31. Establish robust process of data collection to support measurement of PADR activity 32. Use PADR activity data to support deployment of training & support to increase PADR activity where necessary 33. Launch a PADR Quality Assurance process throughout the Trust 41. Launch IQT training programme within WBS 42. Maintain IQT training programmes within Corporate, VCC and hosted organisations 43. Meet 1000Lives+ target of 25% headcount trained in service improvement methodologies 44. Embed IQT training principles in daily practice for all staff groups 45. Consider establishing a Corporate Service Modernisation/Improvement team of specialist staff 54. Launch Talent Tool & Pipeline guidance throughout the Trust 26. Maintain Trust-wide implementation of distributed Clinical Leadership 34. Evaluate PADR Quality Assurance process 35. Use PADR Quality Assurance data to support discussions in relation to action 36. below 36. Maintain PADR activity data collection & analysis 37. Maintain provision of training & support where necessary 46. Maintain IQT training programmes throughout the Trust 47. Meet 1000Lives+ target of 25% headcount trained in service improvement methodologies 48. Continue to embed IQT training principles in daily practice for all staff groups 49. Seek to measure service improvement ethos within the Trust 56. Maintain use of Talent Tool & Pipeline 122 P age

123 51. Pilot the Talent Tool within the revised PADR process 52. Evaluate pilot & amend process as necessary 53. Establish Talent Pipeline guidance to support use of the Talent Tool 55. Measure efficacy throughout the Trust via the PADR Quality Assurance process throughout the organisation 57. Continue to provide training & support where necessary Team Working Training, Education & Development 58. Increase the number of Aston trained facilitators within the Trust x Increase awareness of Aston Team Working principles within the WfOD community via an in-house training workshop 60. Continue to provide Aston Team-based Working workshops throughout the organisation where appropriate 65. Establish scope of IT infrastructure requirement to enable access to e- Learning for all staff 66. Appoint Mandatory & Statutory Trainer post to improve range of delivery options 67. Integrate e-learning Lead responsibility into an existing WfOD role 68. Increase completion of Mandatory & Statutory training via e-learning by 20% 69. Maintain ongoing evaluation of training, education & development opportunities to ensure in-house 61. Increase provision of Aston Teambased Working workshops via increased referral from WfOD and improved marketing 62. Establish a process for capturing Aston-related activity within the Trust 63. Evaluate the benefits of Aston Team-based Working workshop activity 73. Review impact of Mandatory & Statutory trainer role on training compliance 74. Achieve 95% Mandatory & Statutory compliance across the organisation 75. Increase completion of Mandatory & Statutory training via e-learning by 15% 76. Maintain ongoing evaluation of training, education & development opportunities to ensure in-house provision is meeting service needs 77. Establish online Study Leave Form which allows data capture of 64. Continue to increase, or maintain, provision of Aston Team-based Working workshops via increased referral from WfOD and improved marketing 81. Increase completion of Mandatory & Statutory training via e-learning by 10% 82. Maintain ongoing evaluation of training, education & development opportunities to ensure in-house provision is meeting service needs 83. Maintain high levels of inhouse training evaluation 123 P age

124 provision is meeting service needs 70. Analyse in-house training evaluation 71. Improve communication with learners via Intranet/Internet by refreshing/redesigning content 72. Recruit a fixed-term post to re-model Medical Education administration external learning attendance 78. Analyse external learning attendance to ascertain themes, seek to exploit economies of scale or bring provision in-house 79. Launch revised online in-house training evaluation process & increase completion by 25% 80. Evaluate impact of fixed-term Medical Education post & make case for permanent appointment if appropriate 124 P age

125 Our approach to Quality Improvement We are committed to the continuous improvement of the quality of our services and view quality improvement as core business as it will assist us in moving from short-term performance improvements to sustained organisation-wide patient and donor care improvements. The terms quality and quality improvement mean different things to different people in different circumstances and within healthcare, there is no universally accepted definition of quality. However, a number of common domains are universally acknowledged. These state that healthcare must be: Safe Effective Patient-centred Timely Efficient Equitable The definitions seen in the literature often regard quality as the degree of excellence in healthcare and recognise that it is multi-dimensional. Similarly, there is no single definition of quality improvement. What is commonly seen is a description of a systematic approach that uses specific techniques to improve quality. One important ingredient in successful and sustained improvement is the way in which the change is introduced and implemented. The key elements are the combination of a change (improvement) and a method (an approach with appropriate tools), while paying attention to the context in order to achieve better outcomes. Just as there is no single definition of quality improvement there is no single approach. What is needed is a combination of approaches, context specific, to ensure sustained improvements. As illustrated above, quality improvement draws on a wide variety of methodologies, approaches and tools. Many of these share some simple underlying principles, including a focus on: Understanding the problem, with a particular emphasis on what the data tell you; Understanding the processes and systems within the organisation, particularly the patient/donor pathway, and whether these can be simplified; Analysing the demand, capacity and flow of the service; Choosing the tools to bring about change, including leadership and clinical engagement, skills development and staff and patient/donor participation; and, Evaluating and measuring the impact of a change. 125 P age

126 Regardless of the approach used, how the change is implemented (including factors such as leadership) clinical involvement and resources, is vital for success. We are currently in the process of reviewing our approach to quality improvement across the Trust. Whilst this is undertaken, we will continue to deliver against our established quality improvement programme which is set out in Table P age

127 Table 3 Quality Improvement Programme 2014/ /2017 Year Velindre Cancer Centre Welsh Blood Service Continue VCC Improvement Programme of service improvement work including: review pathways for radical radiotherapy for specific patient groups (including lung and neurology patients) with a view to reducing waiting times seek to spread lessons from the urology outpatient VIP work to other cancer sites to improve patient experience and waiting times review of chemotherapy/ SACT services to ensure wherever possible patients are treated locally to home Continue to actively participate on national 1000 Lives programmes; including care of critically ill, infection prevention etc. Evaluate results of All Wales cancer survey results and development, as appropriate as action plan to address any issues. Develop a Customer Service Culture amongst frontline staff to improve the donation experience. Scope engagement of both staff and donors on the introduction and roll out of new technology in the donation pathway. Pursue collaborative working with a wide range of individuals and organisations, in particular Higher Education Institutions, to develop a lean culture and ways of working to maximise best use of resources within the Service and strive for continual best practice. Explore how we incorporate continuous improvement and capture IQT into major programmes of work. Develop our participation in the national 1000 Lives / 1000 Lives Plus programme with a specific focus on how new technology impacts on the Service. Trust-wide Increase by 25% from baseline year of 2013/14 the % staff trained in IQ at bronze and silver levels. Pursue collaborative partnership with Cardiff University Business School for access to academic improvement science and mathematical modelling expertise. 127 P age

128 Commence work with Health Boards on improving pathways for patients, whose needs cross VCC and HBs. Review and analyse data collection of palliative care (i.e. preferred place of care etc) and then develop implementation plan to improve performance to meet patients requests. Work with Health Boards to develop Acute Oncology Services (AOS) in all Local Health Boards supported by Velindres Acute Oncology Service hub Continue to actively participate on appropriate areas of work from the national 1000 Lives programme Review VIP work to date and develop priorities for 2015/16 Continue work with Health Boards around clinical pathways for oncology patients with complex requirements e.g. deteriorating patients Continue development with Health Boards of AOS Scope the WBS business intelligence requirements to ensure our operations are underpinned by highly effective and efficient management data to support and ensure continuous Service improvement. Review work to date and develop further priorities. Continue the development of lean initiatives to support continual step changes in performance ensuring quality improvement remains at the forefront of everything we do. Co-ordinate and secure the necessary resources to establish effective Business Information Systems to continually improve the way we work and support our ambition to be the best in class Identify potential programmes of research in improvement science and develop opportunities for researchers. Consider opportunities afforded through Business Case development for new Cancer Centre for local faculty development. 128 P age

129 blood collection service. Identify potential programmes of research across the organisation that will support donor and patient outcomes and continual Service improvement. Continue to actively participate on appropriate areas of work from the national 1000 Lives / 1000 Lives Plus programme Continue VIP work programme to meet identified quality and performance improvement areas Actively contribute to national 1000 Lives programmes relevant to VCC In line with the establishment of an all Wales Blood Service take forward initiatives and programmes of work to ensure appropriate arrangements are in place to promote IQT, Business Intelligence and continuous improvement on an all Wales basis. 129 P age

130 130 P age Section 7: Enabling Transformation: improving the infrastructure

131 Information, communication and technology plan Velindre Cancer Centre The ICT programme for the Velindre Cancer Centre has been developed to support the significant change programme necessary to underpin the information requirements of the clinical service and those of the patient. Whilst treatment for cancer is increasingly successful, it is also becoming much more complex, both in terms of treatments being offered and patient pathways which may traverse primary, secondary, tertiary, community and social care. The emerging Cancer Centre ICT requirements must be balanced with the ongoing operational service, ensuring that we can continue to support the patient s cancer journey but also addressing the evolving needs of the patients and healthcare professionals across organisations as new pathways and treatment options become available. The key components of the IM&T plans include: Local ICT Change Programme These projects will be implemented within the Cancer Centre to the benefit of clinicians and patients. Examples include the ability for clinicians to access their s and work calendars on their own mobile devices, and technical upgrades to the rooms where cancer multi-disciplinary team meetings are held to improve their access to relevant information when discussing patient treatment. National ICT Change Programme The availability of information at the point of care is key to managing the increasing complexity of cancer care delivery, and an integrated view of the health record is critical. The Cancer Centre has an electronic patient record (Canisc) which is also a national oncology patient record, and the system is being developed to support the information requirements for the Cancer Services in Wales, and is endorsed by Welsh Government. The National ICT Change Programme objectives are based on the Wales Integrated Services Strategy and the Cancer Delivery Plan. They include the implementation of national products within the Cancer Centre, such as the Welsh Clinical Portal, the national picture archiving system, the new laboratory information management system, and the ability through the Welsh Clinical Communications Gateway to transfer documents electronically between primary secondary and tertiary care. This programme of work will provide significant benefits for patient safety, with health care professionals having more information available at the point of care, thereby supporting decisionmaking and reducing any chance of inappropriate treatment or medication errors. The change programme also delivers more patient-focussed care with information from a variety of systems and sources being brought together. 131 P age

132 Patient Centric Improvements The change programme has taken into account feedback from the Patient Liaison Group, and includes some significant improvements for anyone visiting the Cancer Centre. Examples include the ability to access the internet using their own devices, and by the end of 2015/2016 the introduction of a patient entertainment system. The patient experience will also be improved through the introduction of an electronic holistic needs assessment, and a self check-in system in outpatients. Operational maintenance/project delivery programme The Cancer Centre must respond to an evolving set of operational support requirements, and a detailed infrastructure programme plan has been developed for such projects as the standardised desktop, server replacements, infrastructure enhancements etc. However, the same resource is also responsible for implementing the ICT Change Programme, and the organisation recognises that the operational needs of the service may impact on the ability of the team to deliver the ICT change programme. 132 P age

133 Table 4 Velindre Cancer Centre Information, Communications and Technology Programme Strategic Priority Area ICT: Key Actions Velindre Cancer Centre 2013/ / / /17 Equitable and timely services Provide staff with accurate information at the point of care. Availability of pathology results from across Wales within the electronic patient record, Canisc, (EPR) from the new national laboratory system. Use of mobile carts/handhelds on wards and Day Units to allow clinicians access to patient information Safe and reliable services Providing evidence based care and research which is clinically effective Supporting our staff to excel 133 P age Implementing new technology to enable documentation to become a formal record within the EPR. Rolling programme of data quality improvement, & availability of data to support the health informatics agenda. Ensure that staff have electronic access to important clinical information from other organisations during treatment discussions. Improve the resilience and performance of ICT to facilitate patient care Mobile Device Management Integration of the EPR (Canisc) with the WCCG, allowing ereferrals and edischarges between primary and secondary care Data Quality project Cancer multi disciplinary meeting room upgrades Infrastructure Infrastructure Action Plan Review Standardised Desktops PC and Laptop replacement programme Infrastructure Refresh Programme Implementation of an integrated EPR (Canisc)with the Welsh Clinical Portal Implementation of a new electronic multidisciplinary team module within the EPR

134 Table 4 Velindre Cancer Centre Information, Communications and Technology Programme Strategic Priority Area ICT: Key Actions Velindre Cancer Centre 2013/ / / /17 First class patient experience Improve the overall patient experience. Patient Internet Access Patient Self-Check in Beyond Breast Cancer Patient Entertainment System Spending every pound well Digitisation project to allow patient services to be run entirely electronically and reduce the dependence on paper records. Paperlite Project 134 P age

135 Velindre Cancer Centre ICT Programme 135 P age

136 Welsh Blood Service The IM&T programme for the Welsh Blood Service reflects the need to maintain regulatory compliance while supporting the significant change programmes currently being implemented across the Service. In order to achieve this there is a prioritised balance between the operational project delivery programme, which acts as an enabler for operational departments to gain efficiency of service provision, and the delivery of new systems and services, which are aligned with international transfusion practices and ensure the Service has supporting systems that are fit for purpose for the future. The key components of the IM&T plan are: An operational project delivery programme (including continuation of the infrastructure improvement programme) Implementation of a Blood Establishment Computer System (BECS) Implementation of the All Wales Laboratory Information Management System (LIMS) Software solutions to support the emergence of an All Wales Blood Service Operational Project Delivery programme Alongside a significant IM&T modernisation programme, the WBS is required to respond to a constantly evolving set of operational requirements. The WBS currently has a detailed software development work plan with activity currently planned until the end of The majority of the software development is focused on development of the WTAIL systems, however it is known that there are complex laboratory instrument procurements planned for 2014, that may require software development to existing blood management systems. Such operational requirements significantly impact on the service s ability to deliver the IM&T modernisation programme, as resource, whether it is IM&T, Validation, Quality or Operational, is prioritised to the operational projects. In addition to this, the WBS infrastructure is continually evolving and a detailed infrastructure plan exists to manage work programmes such as server replacements, PC roll out plans, encryption and other infrastructure enhancements such as IP telephony As a result of these current operational work plans existing software and technical skill sets will need to be maintained to ensure competency and appropriate levels of support are in place for the service into the future. Furthermore it is increasingly apparent that eprogesa is requiring the development of middleware solutions to support long term operational requirements, and this further strengthens the need to retain these specialist skills. 136 P age

137 All of the work performed against the operational project delivery plans is subject to strict regulatory control, with every activity reviewed and impact considered against Good Manufacturing Practice (GMP). A significant challenge for the operational project delivery plans is that mandated requirements don t often materialise with long lead in times. The plan has to be responsive to key operational issues and sometimes there is only a very limited period of time before the requirement/benefit needs to be realised. For example, working is ongoing on projects such as standardisation of labelling for blood components and tissues, it is likely that things will be mandated in 2014/2015 however, there is no clear scope of the change or indeed the timeline to be met. As a result of this limited planning time, resources constantly have to be reviewed and reprioritised to manage the successful delivery of the operational project delivery plan. This can on occasions result in delivery times being amended. Blood Establishment Computer System (BECS) In 2010, the WBS began a procurement exercise to purchase a new Blood Establishment Computer System (BECS). The BECS will ensure that blood can be safely collected, processed, tested, labelled and issued to hospitals across Wales. The new BECS will deliver a number of benefits including: Enhanced functionality to support the recruitment and retention of donors; Business intelligence reports to support operational decision making; The provision of more information on session to support the donation process; Ability to collect donor and donation information on session; Ability to respond quickly to regulatory changes/operational requirements. Following the procurement process, MAK-System was identified as the successful supplier, to deliver their eprogesa system. One of eprogesa primary benefits is to integrate all parts of the service. As a result there is a constant requirement for numerous operational, technical and quality resources to be made available in order to support its implementation. eprogesa is a highly configurable system which requires detailed analysis and opportunities for future process redesign. However with a high degree of configurability the system is susceptible to regular change. This can be viewed as a negative and sometimes leads to difficulties in agreeing a final system state. By the end of 2013 the WBS plans to have determined its final system state. From here the service will validate the system during the first half of 2014, before moving the system into operational services during the second half of Once operational, the WBS will then focus on the many enhancements eprogesa has available to its user base, such as its online donor portal, app technology and electronic point of care solutions to capture blood collection information at the bedside. It will also explore the use of its edonor Relationship Module (edrm) to improve campaign and marketing drives for the future service. 137 P age

138 All Wales Laboratory Information Management System (LIMS) The National Pathology Programme was established to direct the modernisation of pathology services across Wales. Part of the programme s focus is on improvements to IM&T, delivered through an All Wales Laboratory Information Management System (LIMS). The Programme recognised some shortfalls in current organisational laboratory systems and identified a number of benefits through an All-Wales LIMS including: Enables a complete patient pathology record; Ability to provide tests from regional laboratories; Reduction in costs for system support and future developments; Supports future Pathology modernisation work; and, Supports the establishment of Health Boards / re-organisations across Wales. NHS Wales Informatics Service is leading the LIMS programme. In June 2010, a contract was signed on behalf of NHS Wales with InterSystems to purchase and implement the TrakCare Laboratory System across Wales. The WBS will be implementing LIMS in two stages: Antenatal & Antibody testing (Blood Transfusion Modules) Welsh Transplantation and Immunogenetics Laboratory (WTAIL Modules) The programme has required a large resource commitment from WBS and a number of all-wales work streams have been established to support the work. Both Blood Transfusion and WTAIL modules will require significant regulatory control and to this end timelines for both are still being planned. At present Blood Transfusion is planned to be rolled out across Wales towards the end of 2014 and into The WTAIL modules will require some development and engagement with third party suppliers in order to deliver the required functionality. Therefore the go-live for WTAIL is anticipated towards the end of 2015 and into early This aspect of LIMS will also require significant internal IM&T resource to support the migration from existing WTAIL systems. All Wales Blood Service In line with the Welsh Government (WG) vision of how the NHS will look in five years, the Minister for Health and Social Services announced on the 13 June 2012 the need to establish an All Wales Blood Service. This statement included a clear intention to move towards establishing such provision by 2016, with significant progress evident by Subsequently, on 20 September 2012, Welsh Government wrote to the Chief Executive of the Velindre NHS Trust with Terms of Reference for the project board as agreed by the Minister. A significant IM&T project has been initiated to support this programme of work. This work primarily involves the migration of a defined data set from NHS Blood and Transplant (NHSBT) 138 P age

139 computer systems to the WBS blood management systems, but also requires a review of infrastructure requirements. As with all blood transfusion related projects, strict governance, control and change management is required. The work is being performed in co-operation with WBS, Velindre NHS Trust, NHSBT, Betsi Cadwaladr University Health Board (BCUHB) and Welsh Government representatives. 139 P age

140 Table 5 Welsh Blood Service Information Communications and Technology Programme Strategic Priority Area Key Actions Welsh Blood Service 2013/ / / /2017 Equitable and timely services Safe and reliable services Supporting our staff to excel Spending every pound well Providing evidence based care and research which is clinically effective Supporting our staff to excel Operational Project Delivery Programme Software solutions to support introduction of new microbiology analysers Software to support the use of Euroblood Pack Software solutions to support the implementation of new Autoscopes Software enhancements to ensure an alignment of the WBS with international donor registries Software to support the outsourcing of HLA Typing Software solutions to support automated grouping analysers Future operational projects to ensure regulatory compliance Equitable and timely services Safe and reliable services Supporting our staff to excel Implementation of a Blood Establishment Computer System (BECS) Enhanced functionality to support the recruitment and retention of donors Online donor appointments Online donor record management Integration with North Wales teams Hospital Web Ordering Bedside PDAs 140 P age

141 Strategic Priority Area Key Actions Welsh Blood Service 2013/ / / /2017 Providing evidence based care and research which is clinically effective The provision of more information on session to support the donation process Online Donor Health Questionnaire Ability to collect donor and donation information on session Ability to respond quickly to regulatory changes/operational requirements Business intelligence reports to support operational decision making Equitable and timely services Safe and reliable services Supporting our staff to excel Implementation of an All Wales Laboratory Information Management System (LIMS) Standardisation of Blood Transfusion practices Enables a complete patient pathology record Integration of WTAIL LIMS with national systems (eg LIMS, WCP) 141 P age

142 Strategic Priority Area Key Actions Welsh Blood Service 2013/ / / /2017 First class patient experience Ability to provide tests from regional laboratories Reduction in costs for system support and future developments Electronic transfer of test results and reports Improved visibility of blood stocks across Wales Equitable and timely services Safe and reliable services Supporting our staff to excel Spending every pound well All Wales Blood Service Migration of donor records from NHS Blood & Transplant (NHSBT) Implementation of supporting infrastructure A single blood collection process for Wales 142 P age

143 Strategic Priority Area Key Actions Welsh Blood Service 2013/ / / /2017 Safe and reliable services Supporting our staff to excel Spending every pound well Infrastructure Improvement Programme IP telephony Server, PC & Laptop replacement Standardised Desktops 143 P age

144 Welsh Blood Service High Level ICT Programme Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar eprogesa Implementation eprogesa Enhacements All Wales LIMS Blood Transfusion All Wales LIMS WTAIL All Wales Blood Servcice Migration & Infrastructure Infrastructure Replacement Programme Operational Project Delivery Programme (Software & Infrastructure) Existing Systems Maintenance & Support Training / Best Practice / Innovation 144 P age Key: Change Programmes Business As Usual Staff Development

145 Capital Plans and Resource Requirements Velindre NHS Trust is capital intensive and requires continuous capital investment to maintain service delivery. Cancer care is fast-moving and there will continue to be a requirement to invest in new equipment to keep pace with advances in patient treatments, particularly in radiotherapy. The Welsh Blood Service also requires capital investment to maintain its excellent quality and highly regulated services. The capital requirements of the Trust operate at three distinct levels; (i) strategic; (ii) service development; and, (iii) operational. The main priorities in each of these areas are summarised below. 145 P age Strategic Capital Requirements The development of a new cancer campus: the initial capital requirements are related to the purchase of land and development of business cases (Strategic outline programme, strategic outline case and full business case); Transfer of the provision of blood and transplantation services in North Wales from the English Blood and Transfusion Service to the Welsh Blood Service: the initial capital requirements are related to the acquisition of estates and facilities in North Wales to operate the service; A range of national patient information systems and enabling technologies: the main focus will be on the development and implementation of electronic patient records and the all-wales LIMS (WTAIL)(Blood Transfusion) systems. Service Development Capital Requirements The development of a range of new services including SBRT and enhanced radiotherapy planning facilities for IMRT and HDR: capital requirements will be sought through business cases to commissioners and Welsh Government; Provision of additional and more capable LINACS, MRI scanners and related infrastructure to meet increased demand: the complexity of treatment is changing and we need to be more capable to provide new treatments and technology such as SBRT and IGRT. Operational Capital Requirements Statutory compliance, backlog maintenance and accommodation: the Cancer Centre is sixty years old and has significant issues related to statutory compliance, backlog maintenance and providing an environment that is suitable for patients and staff. There are a number of specific issues which need to be resolved very quickly including

146 the replacement of the water distribution system and bracytherapy theatres, and significant improvements to the patient environment to improve the patients experience and service effectiveness; Equipment Replacement Programme: replacement of very expensive items of equipment is required such as CT simulators, CT scanner, gamma camera and linear accelerator for the Velindre Cancer Centre and blood testing systems for the Welsh Blood Service. The Trust recognises that our capital requirements for the next three years are more than double the Trust s current allocation. However, they are a true representation of need across the Trust. We have undertaken an initial prioritisation exercise which has identified a set of level one priorities. We have been successful in securing additional capital resources in previous years and will be pursuing this route during 2014/2015 in order to address the other salient issues. However, we recognise that this cannot be relied upon and we have plans in place to manage the position if we are unable to access capital funds over our stated allocation of circa 1million. 146 P age

147 Capital Programme 2013/ 's Welsh Government Business Cases - Approved: VCC - Replacement Linac In Bunker 4 4,260 VCC - Replacement MRI Scanner 1,531 VCC - Enhanced Radiotherapy Planning Facilities for IMRT & HDR Brachytherapy 506 VCC - New Cancer Centre SOP/SOC Feasibilty Study 110 VCC - Pharmacy E Reader & Software 9 VCC & WBS - Capital Works 1,289 VCC - Transfer of Land/Buildings (Post Grad) 5,750 WBS - Replacement of Blood Grouping Analysers 410 Sub-Total 13,865 Discretionary Capital Schemes - Approved: VCC - Estates Schemes 361 VCC - IT Infrastructure 44 WBS - Replacement Equipment 220 WBS - Estates Schemes 60 WBS - IT Infrastructure 318 Sub-Total 1,003 TOTAL 14, P age

148 Capital Programme 2014/ 's Welsh Government Business Cases - Approved: VCC - Replacement Linac In Bunker Sub-Total 150 Welsh Government Business Cases - Submissions Expected: VCC - Site Development/Cancer Centre 1,350 VCC - Accommodation Project 2,500 VCC - Replacement of Water Distribution System Phase VCC - Theatre Refurbishment/DevelopmentDevelopment 530 VCC - Replacement Linac within Bunker 2 4,000 WBS - Replacement of Blood Grouping Analysers 600 WBS - BECS/eProgesa Phase Carbon Reduction Commitment Schemes 245 Sub-Total 10,125 Discretionary Capital Schemes: VCC - Replacement Equipment 640 VCC - Estates Schemes 693 VCC - IT Infrastructure 480 WBS - Replacement Equipment 346 WBS - Estates Schemes 381 WBS - IT Infrastructure 350 Corporate Headquarters - IT Infrastructure 10 Sub-Total 2,900 Discretionary Capital Schemes: VCC - Donated Asset (First Floor Ward) 421 VCC - Donated Asset (Fluorescence Microscope) 60 Sub-Total 481 TOTAL 13, P age

149 Capital Programme 2015/ 's Welsh Government Business Cases - Submissions Expected: VCC - Site Development FBC Work 2,365 VCC - Accommodation Project 1,000 VCC - Replacement of Water Distribution System Phase VCC - Replacement Linac within Bunker 2 1,500 VCC - Replacement of CT Scanner 1,100 VCC - Replacement of CT Simulator (1) 1,000 VCC - Radiotherapy Verification System 500 WBS - All Wales Blood Service Programme 300 WBS - BECS/eProgesa Phase Trust - Electronic Document Records Management System 500 Sub-Total 9,115 Discretionary Capital Schemes: VCC - Replacement Equipment 585 VCC - Estates Schemes 270 VCC - IT Infrastructure 583 WBS - Replacement Equipment 559 WBS - Estates Schemes 520 WBS - IT Infrastructure 140 Corporate Headquarters - IT Infrastructure 10 Sub-Total 2,667 TOTAL 11, P age

150 Capital Programme 2016/ 's Welsh Government Business Cases - Submissions Expected: VCC - Site Development 50,000 VCC - Replacement Linac 5,000 VCC - Replacement of Gamma Camera 1,000 VCC - Replacement of CT Simulator (2) 1,000 VCC - Microselectron 500 WBS - Apheresis Equipment 750 WBS - All Wales Blood Service Programme 3,000 WBS - BECS/eProgesa Phase Sub-Total 61,500 Discretionary Capital Schemes: VCC - Replacement Equipment 350 VCC - Estates Schemes 282 VCC - IT Infrastructure 530 WBS - Replacement Equipment 560 WBS - Estates Schemes 150 WBS - IT Infrastructure 100 Corporate Headquarters - IT Infrastructure 15 Sub-Total 1,987 TOTAL 63, P age

151 151 P age Section 8: Spending our resources effectively

152 Financial Strategy Our financial strategy has been developed on the following assumptions: We will continue to receive flat cash from the Health Boards. There will no uplift to the funding currently provided other than for NICE and High Cost Drugs that are funded on an actual basis. Public sector pay increases will be limited to 1% per year applies. The assumptions have led to the following financial projections: A 1% wage award has been built into the strategy at a cost of 0.414millions in year one, 0.403millions in year 2, and rising to millions in year three. Staff entitlement to receive incremental progression through the payscales has also been included at a cost of millions in year one, millions in year 2, and millions in year 3. Incremental costs have been calculated in detail based on each staff member s current point on the payscale and their ability to move up annually to a next increment. The year two increase is due to a cohort of staff regraded as part of Welsh Blood Service modernisation programme who will be entitled to one further increment in year two before reaching the top of the new payscale. Local divisional cost pressures have been included, in line with the approach adopted in previous financial years to ensure that all issues of financial risk are identified and managed. The divisional plans include approved business case funding. Expenditure increases have been included in both the staff and non staff budgets with the approved funding increases shown against the income due from the relevant Health Boards. Funding has been included for Intensity Modulated Radiation Therapy (IMRT) at Velindre Cancer centre for 2.55 WTE and associated non staff costs at 73k in 2014/15. The most significant of these developments relates to the Velindre Cancer Centre and the Stereotactic Body Radiation Therapy (SBRT) development which will require an additional whole time equivalent staff which are funded together with the associated non-staff costs to a value of 854k in 2014/15. There Trust is required to achieve savings requirement of 5.57% in year one, 3.86% in year two and 3.99% in year 3 to achieve a balanced position. Plans are in place for the delivery of the savings with year one (2014/2015) being well detailed and the following two years still considered to be in development. 152 P age

153 Financial Plan 2014/ / / / /17 1. High Level Summary NHS/WHSSC/WG Income 2013/14 Other Income Total Revenue Comparator - see note below 2 Underlying deficits and cost pressures b/f 3 New WG allocations 4 New Cost Pressures Cost Growth Pay Inflation Pensions Costs Non pay Inflation Travel Allowance Changes Statutory Compliance and National Policy Continuing Health Care Funded Nursing Care Prescribing Total Inflationary costs Demand / Service Growth NICE and New High Cost Drugs Continuing Heath Care Funded Nursing Care Prescribing Specialist Services Demographic / Demand on Acute Services Demand / Growth m m m LocalService/Cost Pressures Velindre Cancer Centre Welsh Blood Service Corporate Local Cost Base Change Savings Plans/Cost Avoidance Pay & Employee Benefit Expenses Non Pay Primary Care Contractor Medicine Management Continuing Care and Funded Nursing Care Commissioned Services Income Total Savings Plans Forecast Outturn Comparator based on H&CHS expenditure - note 3.3 of 2011/12 accounts adjusted as follow less Depreciation and Impairments (note 3.3 of the accounts) less Hosted Services plus Prescribing (note 3.1 of the accounts) plus Continuing Health Care (note 3.2 of the accounts) plus Funded Nursing Care (note 3.2 of the accounts) 153 P age

154 VELINDRE NHS TRUST FINANCIAL PLAN 14/15 to 16/17 YEAR 1 BASE YEAR - TRUST BOARD AGREED FINANCIAL STRATEG Y PLAN 2013/14 Adjustments in Plan to 14 / 15 PLAN 2014/ Income Powys LHB Core Funding ABMU LHB Core Funding AB LHB Core Funding C&V LHB Core Funding CT LHB Core Funding HD LHB Core Funding WHSSC Core funding (WBS) WHSSC Core funding (VCC) Welsh Government Trust revenue 000 (416) (1,928) (8,768) (5,518) (3,571) (293) (21,005) (7,822) (603) (49,924) 13/14 Savings IMRT & Staff Cost Non Staff Cost New Savings D2D release made SBRT Presures Presures requiremen Plan (2) (7) (28) (21) (14) (1) (854) Income Powys LHB Core Funding ABMU LHB Core Funding AB LHB Core Funding C&V LHB Core Funding CT LHB Core Funding HD LHB Core Funding WHSSC Core funding (WBS) WHSSC Core funding (VCC) Welsh Government Trust revenue 000 (418) (1,935) (8,796) (5,539) (3,585) (294) (21,005) (8,676) (603) (50,851) Delegated Expenditure Control Limits Div Savings Income Staff Non Staff Required DECL VCC (24,828) 28,215 22,599 (1,921) 24,065 WBS (10,717) 12,307 17,584 (945) 18,229 Corp (430) 3,479 1,027 (301) 3,775 46,069 (1,921) ,668 (2,149) (945) (1,112) (262) (301) (116) Delegated Expenditure Control Limits Div Savings Income Staff Non Staff Required DECL VCC (24,828) 27,702 24,267 (2,149) 24,992 WBS (10,717) 12,029 17,767 (1,112) 17,967 Corp (430) 3,217 1,366 (116) 4,037 46,996 Depreciation 3,855 Depreciation 3, P age

155 VELINDRE NHS TRUST FINANCIAL PLAN 14/15 to 16/17 Year 1 Year 2 PLAN 2014/15 Adjustments in Plan to 15 / 16 PLAN 2015/ Income Powys LHB Core Funding ABMU LHB Core Funding AB LHB Core Funding C&V LHB Core Funding CT LHB Core Funding HD LHB Core Funding WHSSC Core funding (WBS) WHSSC Core funding (VCC) Welsh Government Trust revenue 000 (418) (1,935) (8,796) (5,539) (3,585) (294) (21,005) (8,676) (603) (50,851) 14/15 Savings made Staff Cost Presures Non Staff Cost Presures New Savings requiremen Income Powys LHB Core Funding ABMU LHB Core Funding AB LHB Core Funding C&V LHB Core Funding CT LHB Core Funding HD LHB Core Funding WHSSC Core funding (WBS) WHSSC Core funding (VCC) Welsh Government Trust revenue 000 (418) (1,935) (8,796) (5,539) (3,585) (294) (21,005) (8,676) (603) (50,851) Delegated Expenditure Control Limits Div Savings Income Staff Non Staff Required DECL VCC (24,828) 27,702 24,267 (2,149) 24,992 WBS (10,717) 12,029 17,767 (1,112) 17,967 Corp (430) 3,217 1,366 (116) 4,037 46,996 (2,149) (2,115) (1,112) (1,206) (116) (141) Delegated Expenditure Control Limits Div Savings Income Staff Non Staff Required DECL VCC (24,828) 26,034 25,189 (1,403) 24,992 WBS (10,717) 11,221 18,336 (873) 17,967 Corp (430) 3,255 1,281 (69) 4,037 46,996 Depreciation 3,855 Depreciation 3, P age

156 VELINDRE NHS TRUST FINANCIAL PLAN 14/15 to 16/17 Year 2 Year 3 PLAN 2015/16 Adjustments in Plan to 16 / 17 PLAN 2016/ Income Powys LHB Core Funding ABMU LHB Core Funding AB LHB Core Funding C&V LHB Core Funding CT LHB Core Funding HD LHB Core Funding WHSSC Core funding (WBS) WHSSC Core funding (VCC) Welsh Government Trust revenue 000 (418) (1,935) (8,796) (5,539) (3,585) (294) (21,005) (8,676) (603) (50,851) 15/16 Savings made Staff Cost Presures Non Staff Cost Presures New Savings requiremen Income Powys LHB Core Funding ABMU LHB Core Funding AB LHB Core Funding C&V LHB Core Funding CT LHB Core Funding HD LHB Core Funding WHSSC Core funding (WBS) WHSSC Core funding (VCC) Welsh Government Trust revenue 000 (418) (1,935) (8,796) (5,539) (3,585) (294) (21,005) (8,676) (603) (50,851) Delegated Expenditure Control Limits Div Savings Income Staff Non Staff Required DECL VCC (24,828) 26,034 25,189 (1,403) 24,992 WBS (10,717) 11,221 18,336 (873) 17,967 Corp (430) 3,255 1,281 (69) 4,037 46,996 (2,115) 481 1,052 (2,047) (1,206) (1,065) (141) (120) Delegated Expenditure Control Limits Div Savings Income Staff Non Staff Required DECL VCC (24,828) 25,112 26,241 (1,533) 24,992 WBS (10,717) 10,581 18,926 (823) 17,967 Corp (430) 3,364 1,169 (66) 4,037 46,996 Depreciation 3,855 Depreciation 3, P age

157 VELINDRE NHS TRUST POTENTIAL COST PRESSURES 2014/ / / 7 National Pressures VCC WBS CORP Total 000 VCC WBS CORP Total 000 VCC WBS CORP Total 000 Staff increments Staff wage 1% Non Pay inflation % 0.68% 0.51% % 0.66% 0.40% % 0.67% 0.40% Sub Totals , % , % % Local Pressures Service Modernisation Pressures 1, , % 1.14% % 0.79% % 0.86% Total Cost Pressures 2,149 1, , % 1, , % 1, , % Less identified savings identified (2,149) (1,112) (116) (3,377) (1,403) (873) (69) (2,345) -3.86% (1,533) (823) (66) (2,422) -3.99% Further savings required to balance plan % % % 157 P age

158 Velindre Cancer Centre Plan VCC-wide TOTAL 1 Pay pressures absorbed by Depts savings Vacancy turnover Managed vacancy savings Recognise activity income Senior management staffing opportunity 60 6 Electronic referral project (WCCG) 20 7 Travel costs (10% reduction) 15 8 SLA review (incl anaesthetics) 10 9 Sickness management (spend to save) 8 SACT 10 Dispense & deliver service Increase private income (drugs margin) SACT review of delivery clinics Temporary funding opportunity 20 Outpatient & Imaging 14 SLA negotiation (Nuc Med) MRI capacity sales 10 Radiotherapy 16 Increase private income for advanced RT New service income stream (1) New service income stream (2) 10 Medical & Palliative Medicine 19 Staffing opportunity (Med) Staffing opportunity (Pall Med) 60 Facilities Management 21 Improve rental stream from property 15 TOTAL SAVINGS IDENTIFIED 2,149 Recurrent Grn Amb Red , ,789 Non-recurrent Grn Amb Red Welsh Blood Service WBS Plan TOTAL 1 Staff Inflation to be managed at department level HPC Income Stream increases increased services provided to Screening Microbiology testing procurement initiative Budget setting departmental savings found Service Improvement Programme 265 Recurrent Grn Amb Red Non-recurrent Grn Amb Red TOTAL SAVINGS IDENTIFIED 1, Corporate WBS Plan TOTAL 1 Staff Vacancies 80 2 Miscellaneous Non Pay Cost improvements 36 Recurrent Grn Amb Red 36 Non-recurrent Grn Amb Red 80 TOTAL SAVINGS IDENTIFIED P age

159 159 P age Section 9: Managing the delivery of our plan

160 Commissioning Arrangements The Local Health Boards are responsible for commissioning cancer and blood services from the Trust to meet the needs of their population. This process is currently managed by the Welsh Health Specialised Services Committee (WHSSC) on behalf of the LHBs, with strategic advice provided by the Cancer Networks. There is a common view across Wales that the commissioning process could be strengthened and the Trust will seek to work with LHBs to improve the current arrangements to ensure that the people of Wales continue to receive services of high quality. Integrated Performance, Risk and Assurance Framework We utilise an Integrated Risk Management Assurance Framework to manage the delivery of services and strategic plans. This ensures that there is a golden thread that links all organisational plans and priorities, risk, delivery and measurement into an overall system of assurance. This is illustrated in Fig. 24. Fig.24 Integrated Performance, Risk and Assurance Framework 160 P age