Candidate Information

Transcription

1 Candidate Information

2 Contents Section 1 The NHS in Wales 3 Section 2 Purpose, vision, aims and values 5 Section 3 How we are structured and overview of services Section 4 Strategic change, challenges and planning Section 5 Working in partnership with Universities Section 6 A very special and unique place to live and work

3 The NHS in Wales The most important role for the NHS in Wales is to improve health and reduce inequalities. The health of the people of Wales continues to improve. Significant progress has been made against the big killers of cancer and heart disease in the past 20 years. Male premature deaths from heart disease have reduced by 60 per cent since There has been considerable success in concerted efforts against smoking, alcohol and substance misuse and risk behaviours. This has resulted in year on year improvement in health outcomes as a nation. The recent Nuffield Report comparing the health systems in the UK provides a good overview please click on this link to view the report in full: Despite this progress, we are not satisfied and there remains a commitment and aspiration to work together to further reduce the impact of poor health decisions. There are however considerable challenges in levelling up the health status for the whole population. Traditional stubborn pockets of deprivation exist, largely in the South Wales Valleys, but also in dispersed communities across the country. It is the stated aim of the Welsh Government to tackle the inequalities that exist in Wales by pursuing a health economy policy approach, supported by coordinated and determined research and intelligence. The NHS in Wales has made a conscious decision to do things in a way that meets the needs of the Welsh community. It is more integrated and more community orientated than many other parts of the UK NHS. In 2009 the NHS in Wales was reconfigured with the formation of seven Health Boards taking responsibility for the planning and delivery of all services in their areas from primary to tertiary care. The reforms put into place are designed to guard jealously Bevan s legacy of a health service which is free at the point of delivery on the basis of need but to do so recognising the huge pace of change in health care, the rapidly changing nature and scale of demand, and the overriding desire to deliver a citizen focused service. Underpinning the NHS in Wales is: A desire to re-establish the key and close links between health service planning and delivery and the specialist public health function. The delivery of a high quality all-wales public health service focused on improvement of the health of the people in Wales and working seamlessly with the reconfigured National Health Service. Recognition that in a country of three million people it is possible to use a planning-based approach to the design and delivery of services. An absolute imperative to move services closer to people and by doing so rebalance the priorities afforded to acute, primary and community based care. The establishment of new accountabilities between health service organisations, the people who lead and work in them and the people they serve. The imperative of high quality performance and the need to manage that performance effectively and rigorously. The achievement of Prudent Healthcare which fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patient s benefit. The absolute requirement to build a health service which is sustainable into the future and supports the well-being of future generations. 3

4 ABMU Health Board ABMU Health Board is one of the largest NHS organisations in the UK, advancing clinical excellence and driving forward clinical research. The Health Board is responsible for the health of over 500,000 people. We have a budget of over 1 billion, and employ over 16,000 staff. As a Health Board in Wales, we provide integrated care for our patients. We deliver tertiary, acute, intermediate, mental health, community and primary care services to people in Swansea, Bridgend, Neath Port Talbot, and beyond. In addition, the Health Board provides a large range of regional and subregional services, including Cardiac Surgery, Forensic Mental Health and Learning Disability Services. Our Welsh Centre for Burns and Plastic Surgery is also responsible for patients in the South West of England. We are research-driven, working in close partnership with universities and the Institute of Life Science in Swansea (ILS). ILS is Wales premier purposebuilt medical research facility. It is a collaboration, between Swansea University and the Welsh Government, together with ABMU, IBM and industry and business partners. (See for more information.) We are passionate about delivering excellence in clinical services and taking early action to promote and protect health and independence. Our Changing for the Better programme will transform clinical models and develop and implement a sustainable long term clinical and service strategy. 4

5 Our purpose, vision, aims, clinical strategy and values The Health Board has engaged with staff, partners and stakeholders on its purpose, vision, aims and objectives to develop a shared strategic direction. Our Purpose To fulfil our civic responsibilities by improving the health of our communities, reducing health inequalities and delivering prudent healthcare in which patients and users always feel cared for, confident and safe. Our Vision To be an excellent healthcare, teaching and research organisation for ABMU and the wider region. Our Corporate Objectives Promoting and Enabling Healthier Communities Delivering Excellent Patient Outcomes, Experience and Access Demonstrating Value and Sustainability Securing a Fully Engaged and Skilled Workforce Embedding Effective Governance and Partnerships 5

6 Our Values Underpinning all the work we are doing is the need to transform the culture of ABMU Health Board by setting out how we will behave with patients, colleagues and partner organisations. To help us do this, we have been listening to our patients, their carers and relatives as well as our staff and stakeholders, to develop this shared set of values and behaviours. We spoke face to face with over 2,000 staff in a series of staff seminars. We also held staff In Our Shoes and patient In Your Shoes workshops throughout the summer and autumn. Staff were able to talk about what was a bad day in work for them and what a good day looked like. Patients and carers were able to talk about their experiences, good and bad, to staff who were not directly involved in their care. We also held leadership events involving senior managers and clinicians; and workshops with board members and executive directors. In addition we carried out staff and patient surveys which had over 3,100 responses. All of these activities have been designed for the Health Board to develop a culture and set of values which are owned by staff, patients, families, carers, the voluntary sector and our communities. These values are set out below and they will underpin all that the Health Board does, and the behaviours we expect from staff to achieve this. Our Values and Behaviours Framework was launched in February 2015, along with arrangements for embedding the values and monitoring their effectiveness once in place. 6

7 The Executive Team and Board Members Tracy Myhill Chief Executive 1st February 2018 Hamish Laing Medical Director Sian Harrop- Griffiths Director of Strategy Kate Lorenti Acting Director of Human Resources Lynne Hamilton Director of Finance Chris White Interim Chief Operating Officer Sandra Husbands Director of Public Health Christine Morrell Director of Therapies and Health Sciences Angela Hopkins Interim Director of Nursing and Patient Experience Pamela Wenger Director of Corporate Governance and Board Secretary Chairman: Andrew Davies Vice Chair: Emma Woollett Independent Members Local Authority Mark Child Third Sector - Vacant Finance Martin Sollis Legal - Martyn Waygood Trade Union Jackie Davies Community - Chantal Patel Swansea University - Professor Ceri Phillips Maggie Berry ICT Tom Crick 7

8 Operational Management Structure In 2015 we developed organisational arrangement to reflect the current needs of our communities, patients and staff. These arrangements have recently been implemented. They are designed to be: Easier to understand for staff and patients does what is says on the tin A vehicle to accelerate progress on new models of primary and community care, shifting the balance Patient facing based on how patients experience our services rather than specialties or professions Visibility for staff - fewer layers, shorter lines of communication between senior management and front line teams Clarity about who is responsible and accountable at all levels and on all sites More devolution of responsibility and decision making to local teams Better framework for joined up working re service improvement, major operational challenges and performance issues More local ownership and clinical engagement Operational Delivery Units Primary Care and Community Services Mental Health and Learning Disability Services Morriston Hospital Princess of Wales Hospital Singleton Hospital Children's services & Pathology services Neath Port Talbot Hospital Therapies and Medicines Management The delivery units each have sufficient autonomy and accountability to determine how best to deliver the Health Board s plans and strategies. Each have substantial budgets (between 100 and 200m) and a sizeable workforce. The operational management structures within each of these delivery units are based upon the same principles as the overarching structure. Each of these delivery units is led by a team consisting of a Service Director, Medical /Clinical Director and Nurse Director. All three of these individuals are part of the Health Board s senior management team along with the Executive Team to ensure that there is robust clinical and professional leadership and advice. The Service Directors hold overall accountability for the effective running of the Delivery and report to the Chief Operating Officer. The Medical/Clinical Director and Nurse Director are also Associate Directors within the relevant corporate department and have specific accountabilities delegated to them from the Health Board s Executive Medical Director and Director of Nursing and Patient Experience. The senior management team for each of these delivery units also includes Finance, HR, information support as well as input from other professional groups as appropriate. 8

9 The Health Board is responsible for improving the health of our communities as well as the planning, commissioning and provision of both primary (General Practitioner, Optometry, Pharmacy and Dental services), and Hospital services. We are responsible for a range of community based services delivered within patients own homes, via community hospitals, health centres, and clinics. In addition we provide a range of tertiary services such as Burns and Plastic Surgery Services (for South Wales and the South West of England), Forensic Mental Health Services (for the whole of South Wales) and Learning Disability Services (Swansea, Cardiff and the Rhondda Cynon Taf and Merthyr Tydfil areas). The Health Board has four main acute hospitals providing a range of services; these are Singleton and Morriston hospitals in Swansea, Neath Port Talbot Hospital in Port Talbot and the Princess of Wales Hospital in Bridgend. There are a number of smaller community hospitals and primary care resource centres providing important clinical services to our residents outside of the four main acute hospital settings. There are also two mental health hospitals, Cefn Coed in Swansea and Glanrhyd in Bridgend, which provide inpatient care. Integrated Care HOME BASED SERVICES - A range of domiciliary services, including assessment and treatment, are provided by different professionals in people s own homes, for instance: An overview of ABMU Services District Nursing Services provide holistic assessment, planning and evaluation of care from engagement in the discharge planning to proactive health surveillance and health promotion for patients with long term conditions. District nurses support the management and treatment of many conditions such as diabetes, continence issues, immunisation and wound care. District Nurses also support medicines management through Nurse Prescribing and medication administration. They have a key role in End of Life Care and post bereavement support. Chronic Conditions Management Nurses are based within primary care, and support people with complex long term conditions who are at risk of episodes of frequent ill health to avoid hospital admission. Community Resource Teams (CRTs) are multi-disciplinary teams that provide a wide range of care including rapid response, personal care, re-ablement and specialist advice and support. Staff groups involved in the delivery of a comprehensive range of community services includes: Nursing, Therapists, Community Psychiatric Service, Community Drug and alcohol service, Wound care, continence, tissue viability, medicines management and specialist palliative care teams, Health Visitors and Flying Start Health Visitors, Looked After Children s Health teams, Child Disabilities Health Visiting Service, Child Community Nursing Services and Health Care Support Workers. PRIMARY CARE BASED SERVICES - We contract with independent practitioners to deliver primary care services, which are delivered by General Practitioners, Optometrists, Pharmacists and Dentists. The contracts are determined on a national basis. There are 77 General Practices across the Health Board. There are currently just over 300 GPs, nearly 60 Opticians, 125 Community Pharmacists and almost 300 Dentists in the area. Outside normal practice hours, the Health Board manages the provision of the GP Out-of-Hours Service. We also provide General Medical Services within Her Majesty s Prison (HMP) Swansea, and are responsible for commissioning all health care within HMP Swansea. We directly manage two practices in the Neath Port Talbot area: in the Afan Valley and Neath town centre and one in Bridgend: Nantyffyllon. All other practices are independent. Practice list sizes vary across the area, with the lowest approximately 1,000 patients and the highest 20,000 patients. COMMUNITY BASED SERVICES We provide community nursing through district nursing, Community Resource Teams, health visiting, community mental health, learning disabilities, therapy staff, as well as midwifery and school nursing services. There are a number of smaller community hospitals and primary care resource centres providing important clinical services to our residents outside of the four main acute hospital settings. Mental health services are essentially community based focused on supporting people through Community Mental 9 Health Teams which bring together health and social services personnel. There is also a primary mental health support service and a range of day services provided in the community in conjunction with the Local Authority and volunteer organisations.

10 Accident and Emergency and trauma services There are two main hospital Emergency Departments, at Morriston Hospital and the Princess of Wales Hospital. Plans are currently underway to finalise a major trauma service network for South Wales. Morriston Hospital will play a major part in this network. There are also Minor Injury Units at Singleton and Neath Port Talbot hospitals. Other Acute Care Paediatric acute in-patient care is provided at Morriston and the Princess of Wales hospitals. Neath Port Talbot and Singleton Hospitals have a children s development centre. Morriston Hospital provides acute general medical care and care of the elderly, a full range of general and specialist surgery, critical care, diagnostic and specialist services including a trauma and orthopaedic service and a range of urology specialties. It has a High Dependency Unit caring for children. Singleton Hospital s services include ophthalmology, dermatology, gynaecology services as well as oncology. It has a High Dependency Unit. It also provides general medical beds, care of the elderly and elective short stay surgery. Singleton Hospital is a regional centre for maternity and neonatal services. The Princess of Wales Hospital also has acute medicine, a consultant-led obstetric unit and has a neonatal unit, ITU and CCU. The hospital provides general surgery and has a palliative care service. It also has treatment centres for hernia, vein and cataract surgery. Neath Port Talbot Hospital provides rehabilitation medicine and has a urology service, provides elective orthopaedic surgery for shoulder, feet and ankle joints. It has a midwife-led birth unit and an elderly care day hospital. It also has a palliative care day unit, and provides some specific gynaecology services for the ABMU area. Tertiary services Morriston Hospital The Welsh Centre for Burns and Plastic Surgery, based at Morriston Hospital, provides a service for South and Mid Wales and the South West of England (North Wales patients go to Liverpool for treatment). The Welsh Institute of Metabolic and Obesity Surgery, which opened in 2011, is also based at Morriston Hospital. Morriston Hospital also carries out open-heart surgery at its Cardiac Centre, one of only two hospitals in Wales providing this service; (the other is Cardiff). Morriston also has a regional renal unit, and one of three regional artificial limb and appliance centres in Wales. It also has regional maxillofacial services, and provides rheumatology, critical care and palliative medicine to a wide catchment area. Complex and emergency surgery takes place on site. 10

11 Singleton Hospital The South West Wales Cancer Centre is located in Singleton Hospital and the Health Board is very proud to have a new Maggie s Centre built in its grounds. The Maggie s Centre offers free practical, emotional and social support to people with cancer and their family and friends. The Centre in Singleton Hospital was designed by Japanese architect Kisho Kurokowa (see picture). Singleton Hospital provides regional neonatal intensive care. Singleton Hospital also has a consultant-led obstetrics which deals with the most complex cases from across South West Wales. The Maggie s Centre The Princess of Wales Hospital (Bridgend) The Princess of Wales Hospital provides a regional Cochlear Implant programme. Neath Port Talbot Hospital ABMU manages the NHS IVF service for South Wales, and earlier this year the new IVF clinic was opened. Neath Port Talbot also has the regional Neuro Rehabilitation Service. Mental Health, Substance Misuse and Learning Disability Services We provide Mental Health Services, Substance Misuse and Learning Disabilities Services. Learning Disability services are provided across three Health Boards and seven Local Authorities. Mental Health Services have changed significantly over the last 10 years or so and the Health Board now provides Mental Health services across a strong community service base complemented by modernised, fit for purpose hospital based care. We also provide Mental Health and Forensic Mental Health Services to a wider population base. Substance Misuse Services are planned and commissioned for the ABMU area by the Western Bay Substance Misuse Area Planning Board which took over responsibility for these services with the move by Welsh Government to regional commissioning from The Health Board has worked with partners in the 3 Local Authorities, South Wales Police, the Police & Crime Commissioners Office, Criminal Justice Agencies, Prisons, third sector organisations, service users and carers. The majority of Child and Adolescent Mental Health Services are provided by Cwm Taf Health Board. The planning of these services is taken forward by the ABMU Children's and Young People Mental Health Planning Group. Cwm Taf Health Board, the Local Authorities and the third sector are members of this Planning Group which has an agreed action plan to address key issues. Forensic/Secure Mental Health Services Regional medium secure mental health services are provided by ABMU HB on behalf of HB s in south, west and mid Wales. These services are based in Glanrhyd Hospital alongside low secure mental health services. This hub of secure services offers inpatient and community based treatment and care to mental health service users with complex needs. Many of the service users are transferred from local prisons as well as high secure hospitals and courts. ABMU HB are also responsible for providing prison in-reach services to HMP Parc and Swansea and criminal justice liaison services to main police stations in Bridgend and Swansea. 11

12 Strategic Change The Health Board alongside the NHS in Wales faces a period of unprecedented large scale, complex change. The new Welsh Government has made very clear its commitment to improve the health and wellbeing of people in Wales, to create 21st century healthcare and to take tough action on health inequalities over the next 5 years. A Regional Collaboration for Health (ARCH): ABMU is a partner in the ARCH portfolio. ARCH (A Regional Collaboration for Health) is a unique collaboration between ABMU Health Board, Swansea University and Hywel Dda University Health Board which aims to improve health, wealth and wellbeing of South West Wales. The ARCH partners are working together to revolutionise the way healthcare is delivered in this region, create an effective and sustainable workforce and drive investment to boost the local economy. ARCH is also ensuring that prevention and improving people s wellness is at the front and centre of all of its aims. The ARCH region spans the six local authority areas of Ceredigion, Pembrokeshire, Carmarthenshire, Bridgend, Neath Port Talbot and Swansea and will benefit 1 million people. ARCH embraces service delivery transformation, education, skills and talent development, research, innovation, translation and economic development within one regional health ecosystem. Such a radical innovation would truly break the mould allowing new solutions to challenges that are proving insurmountable with traditional approaches. ARCH builds on the priorities already established through the clinical strategies set out by both health boards. ABMU s Changing for the Better and Hywel Dda s Your Health, Your Future engagement programmes. Projects are already underway as part of ARCH range from the creation of a Health and Wellbeing Academy on the Singleton Campus, to a multi-million pound Wellness and Life Science Village in Delta Lakes, Llanelli, to the launch of the Talent Bank, bespoke Further Education programme designed to encourage more year olds into STEM subjects and the start of Swansea University s Medical School s Physician Associate qualification which begins this month and The Bevan Commission s move to be hosted by Swansea University at the new Bay Campus. The first phase of ARCH will also see the rollout of a network of health and wellbeing villages and centres, delivered in partnership with Public Service Boards, local authorities, Government, the third sector and private sector. ARCH wants to help establish a regional approach to tackling health challenges. The NHS is facing rising costs, increasing demand and an ageing population, by working across all sectors we aim to tackle these issues by putting prevention and improved health and wellbeing in a joined up way. The villages and centres will form part of a wider regional health and wellbeing model aimed to support the long-term wellbeing of the population, address the sustainability of healthcare services and the increasing pressure on primary care. For further information on ARCH visit: or on twitter 12

13 Our Health Challenges A key part to the integrated approach to healthcare is our Public Health responsibility. As well as treating ill health, the Health Board focuses on promoting healthier lifestyles for our citizens, to avoid future ill health as much as possible. In common with England and Wales, life expectancy at birth across the ABMU Health Board area has continued to increase over the last two decades although we are slightly below the EU27 countries average for both males and females. Despite the overall increase in life-expectancy at birth across the ABMU Health Board area not all our communities share the same life chances. Male babies born into our 20% most deprived communities can expect to live around ten years less than those born into our 20 per cent least deprived communities. Whilst the life expectancy gap is smaller for female babies it is still sizeable, being about seven years. Whilst we are strengthening our support in the early years and giving every child the best start, we need to improve the life chances of our adult population across the ABMU Health Board area, with a proportionate focus on the most disadvantaged. This can only be done by helping our communities access employment, good quality housing and continuing educational opportunities and by developing environments which support their emotional health, promote physical activity and a healthy diet. Increasingly we are not only looking at the problems or deficits in our communities but also what assets they have including skills, knowledge, passions, networks and connections which can support health and wellbeing. Through harnessing and mobilising these assets we can start to build community resilience, developing capacity and tackling persistent inequities. The Health Board has refreshed its local Public Health Strategic Framework using a life course approach and making the case for a strong focus on prevention and early intervention in the early years. Our five key priority areas are: Smoking Cessation Tackling Obesity Increasing Immunisation Uptake Health Protection Oral Health These issues have been selected as priorities based on their unequal distribution, their adverse impact on our communities health and wellbeing and NHS services, and because there is evidence of effective interventions. Quick links: Director of Public Health Annual Report Chief Medical Officer for Wales Annual Report : Healthier, Happier, Fairer 13

14 The Health Board s Annual Plan Our Annual Plan sets out the Health Board s robust approach to meeting the considerable recovery and sustainability challenges that ABMU Health Board faces. The Health Board will not be able to deliver a balanced financial plan for 2016/17 and our Plan for 2017/18 is very firmly focussed on a year in recovery to enable ongoing sustainability. To enable the Board to deliver these rapid improvements, a Recovery and Sustainability Programme Board has been established to lead this major change programme and to embed sustainability of services within the Health Board. The Board s priorities are clear: Patient safety and quality of care; Financial recovery; and, Sustaining and, where possible, improving performance. Our previous Plans have described our strategic vision, our Clinical Strategy Changing for the Better and our values which influence everything that we do. The Annual Plan includes an assessment of our progress and achievements in 2016/17, and we have made some notable improvements, particularly in smoking reduction, mental health, stroke services and our rates of healthcare associated infections. This Plan describes a summary of the hospital system demand and capacity work that we developed this year and we know that we have more to do to meet our performance expectations. We have developed a clear set of corporate objectives to frame the implementation of our Plan and to ensure clear performance and risk management of our detailed plans. These corporate objectives and the detailed actions underpinning them form the basis of our Plan for 2017/18. A considerable amount of work has been undertaken to develop a three to five year service plan for the Health Board and the Plan sets out, by service area, our strategic intentions, our medium term aims for the next three years and our detailed plans for the next year. Most importantly, we have clearly linked our service improvement plans, quality plans, workforce plans and Recovery and Sustainability Programme to our financial plan. These plans are integrated at Delivery Unit level to ensure that our financial plan is robust and deliverable. Many of our detailed service plans will be enabled through the innovative partnership programme; A Regional Collaboration for Health (ARCH), which includes our Health Board, Swansea University and Hywel Dda Health Board. The Portfolio Delivery Plan for ARCH was submitted to Welsh Government in February 2017 and will be key to unlocking many of our service transformation and sustainability plans. We are also developing a strategy for the future configuration of clinical services to be provided at the Princess of Wales Hospital which recognises its important role in the South Wales healthcare system. In common with all other NHS bodies across the UK, we are facing serious challenges with regard to the availability of qualified nursing and medical staff and this is contributing to the financial and performance challenges that we face. The Plan also describes our workforce delivery plans, and the opportunities afforded by our other enablers of digital health, infrastructure investment and research, development and innovation to meet these challenges. 14

15 Building for the Future The Health Board is making significant investment in its estate to modernise the facilities and the environment, for patients, visitors and staff. The fifth and largest phase of the Health Vision Swansea project at Morriston Hospital was completed during July This 60m phase provides a new Out-patients department (including Phlebotomy, Radiology support, Lung Function and General Out-patients), a new renal Dialysis Unit, a redeveloped Head and Neck Unit (including Maxillofacial, Cleft Lip and Palate, Audiology, ENT, and Ophthalmology), a dedicated Paediatric Outpatients, a Pre- Operative Assessment Unit, Fracture Clinic and an Integrated Education Centre to support the Health Boards needs for ongoing clinical and non-clinical training. It is part of a massive 102m redevelopment of the hospital. Integral to the clinical facilities will be a new main entrance, retail and patient support services delivered in a modern environment that support the provision of high quality clinical services as well as providing an improved environment for patients and staff. This ambitious project supports the Health Board s 5-Year Plan Changing for the Better. It is our aim to become a centre of excellence and a leader in the use of cutting-edge technology. For example, the Maxillofacial Unit based at Morriston Hospital are using a revolutionary 3D printing technology to improve patient outcomes during complex reconstructive surgery. This project is the work of the Centre of Applied Reconstructive Technologies in Surgery (CARTIS - established in 2006 as a partnership between the Health Board and the National Centre for Product Design and Development Research (PDR) based at Cardiff Metropolitan University. This pioneering work enables surgeons to create mirror images of unaffected areas to design guides to cut and position the bones with pinpoint accuracy, as well as implants tailor-made for the patient. The guides and implants are produced in medical-grade titanium in Belgium, at one of the world s few specialist 3D printing facilities. Other completed phases at Morriston include a 8.5m Combined Rehabilitation Centre for patients with artificial limbs and for patients requiring rehabilitation support, a 3.2m Mortuary redevelopment, 6m redevelopment of the Accident and Emergency Unit and 3.3m upgrade in Estates accommodation to better support our clinical needs. At Singleton Hospital we have recently completed a 3m major refurbishment of the South West Wales Tertiary Neonatal Unit and have built a 1.9m Children s Development Centre. The Beacon Centre for Health, the new primary care centre in Swansea s SA1 waterfront opened to patients in The 7.25 million centre provides purpose built accommodation for primary and community healthcare services. The centre also includes dedicated training rooms for Swansea University s College of Medicine, providing medical students with appropriate training and learning opportunities. The centre enables the Health Board to provide a range services to closer to patients homes, instead of them travelling to hospitals. As part of the modernisation of mental health services within the Health Board we have already made significant investments in mental health services in Swansea and Bridgend, including a new 10m Adult Rehabilitation Unit and an award winning 16m Older Person s Intermediate Care Beds Unit for patients with dementia at Cefn Coed Hospital. We have also invested nearly 10 million in community mental health schemes, 12 million in a new Children s and Young Adults Mental Health (CAMHS) Unit at Princess of Wales Hospital and 10m an Older Persons Continuing Care Unit and are planning to invest 16m in a new Low Secure Unit at Glanrhyd Hospital. 15

16 Partnership with Swansea University The Health Board and Swansea University have agreed a long term strategic and operational partnership driven by a shared commitment to ensuring excellent health and medical care in the region. A significant number of consultants share their time between research at the University and clinical duties within the Health Board. ABMU Health Board is an active member of the Association of UK University Hospitals. Both the Health Board and Swansea University recognise that there are synergies between a University Health Board and its partner University far in excess of the traditional University Hospital model, which focused primarily on training doctors and clinical medical research. The partnership involves multiple links covering education of professionals, continuous professional development, research and audit, innovation, modernisation and international bench-marking. Established in 1920, the main seafront campus of the university is adjacent to Singleton Hospital. There is also a new 450m Bay Campus currently being constructed on the Eastern approach into Swansea and this will provide academic, student accommodation and research space for Engineering, the latter being in a series of agreements with international and national companies. Research-led and ambitious institution within the UK Top 30 as indicated by the Research Excellence Framework (REF) 2014, which places Swansea amongst the UK s leading universities for research excellence in Medicine, Science, Engineering and Arts and Humanities World Top 200 (QS World University Subject Rankings) A global reach into North and South America, Europe, Africa, the Middle and Far East, and collaborations with leading global universities 5-Star rated for Teaching Excellence 2014 University of the Year (WhatUni.com Student Choice Awards) The College of Human and Health Sciences draws together the disciplines of health, nursing, midwifery, social care, social policy and psychology and is the largest provider of health care education in Wales, providing an exciting and dynamic environment in which to study and further an academic or professional career. The College s mission is to conduct high quality international research that meets the needs of the people of south-west Wales and beyond. For further information visit: The College of Medicine has three main activities: learning and teaching, research, and business and innovation. From the creation of the Graduate Entry Medicine (GEM) programme in 2004, opening of the Institute of Life Science phase one (ILS1) in 2007 and phase two (ILS2) and the Centre for NanoHealth in 2011, to earning the right to award Primary Medical Qualifications (PMQ) independent of any other institution in 2014; the College of Medicine is now acknowledged as one of the fastest growing medical schools in the UK. Research council centres: EPSRC UK National Mass Spectrometry Facility (NMSF) CIPHER health informatics centre (cross council funded) One biomedical research unit (BRU). This is NISCHR funded researching haemostasis and blood clotting biomarker development. 16

17 The College of Medicine The College of Medicine has had spectacular success in the Research Excellence Framework (REF) The College s achievements include: Joint 1st in the UK for research environment rated as 100% world-leading 2nd in the UK on research quality in our unit of assessment* with a grade point average of 3.49 That research scored 100% world-leading in terms of impact 95 % of the research submitted was assessed as worldleading (54%) or internationally excellent (41%) All research and innovation of the College of Medicine is housed in the Institute of Life Science (ILS), which is one of Wales premier purpose-built medical research and business incubation facilities. This is a partnership between Swansea University, Welsh Government, the NHS and industry. The ILS is an exceptional research facility that currently spans two buildings that straddle University and Health Board land, adjacent to the College s teaching centre and within 100m of Singleton Hospital. It incorporates four floors of biomedical research laboratories together with high performance computing facilities, the Centre for NanoHealth a 22million facility that combines nanotechnology with medical science to provide opportunities to benefit patients, healthcare providers and the healthcare industry and a Joint Clinical Research Facility (JCRF). JCRF is home to clinical research facilities including a clinical trials unit and medical imaging centre and is the second such centre for ABMU, complementing the Clinical Research Unit (CRU) based at Morriston Hospital. Research studies at both centres are co-ordinated with patients seen in the facility, or as in-patients on the wards. Swansea is a preferred partner for several major pharmaceutical companies and medical staff are encouraged to take on the role of Principle and Chief Investigator for multicentre and multinational studies. All studies are supported by dedicated Research Nursing Staff and Managers who deal with permissions and ethics in a smooth and efficient manner. The Data Science Building is the College of Medicine s newest venture which opened in summer It has two exciting Centres of Excellence together under one roof the 9.3 million MRC Farr Institute of Health Informatics Research and the new 8 million Administrative Data Research Centre Wales (ADRC Wales), enabling researchers to work together to unleash the potential of large scale data to conduct powerful new research. This preeminent interdisciplinary building will act as a hive of innovation, allowing researchers and staff from the NHS and industry to work together on cutting edge data science, whilst protecting privacy. The College of Medicine is also home to the EPSRC UK National Mass Spectrometry Facility (NMSF) situated on the University campus and a purpose built Haemostasis Biomedical Research Unit funded by NISCHR at Morriston Hospital. The NMSF provides a comprehensive mass spectrometry service to university research groups throughout the UK. The Haemostasis Biomedical Research Unit was formed to investigate a new biomarker that could have the potential to give clinicians an improved method of screening patients at risk of getting fatal abnormal blood clots. * Unit of Assessment 3 - Allied Health Professions, Dentistry, Nursing and Pharmacy 17

18 The College s administrative and teaching centre is the Grove Building on the University s Singleton Park campus where there are lecture theatres and classrooms, an information technology suite, a suite of seminar rooms, state-of-the-art clinical skills and human biology teaching laboratories and the College s administration section. It is home to the Graduate Entry Medicine programme, a fast-track graduate entry programme for training doctors. In addition there are purpose-built and extensive clinical teaching buildings at each of the three Swansea Hospitals, Morriston, Singleton and Cefn Coed, which include libraries, clinical skills laboratories and seminar rooms. The Professorship of the College includes: Charles Archer (Regenerative Medicine) Stephen Bain (Diabetes) Damon Berridge (Chair in Applied Statistics) Gareth Brenton (Mass Spectrometry) Sinead Brophy (CIPHER) Marc Clement (Medical Innovation) Steve Conlan (NanoHealth) Michael Dennis (Psychiatry for Older People) Shareen Doak (Nano (geno) toxicology) Paul Dyson (Microbial Genetics) Adrian Evans (Emergency Medicine and Haemostasis) David Ford (Health Informatics) Belinda Gabbe (Trauma/Emergency Medicine) Andrew Grant (Clinical Education) Michael Gravenor (Mathematical Biology) Huw Griffiths (Medical Physics) William Griffiths (Mass Spectrometry/Experimental Biochemistry) Julian Halcox (Cardiology) Julian Hopkin (Experimental Medicine) Thomas Humphrey (Bacteriology and Food Safety) Gareth Jenkins (DNA Damage) Venkateswarlu Kamarmarlapudi (Molecular Cell Biology and Pharmacology) Diane Kelly (Pharmacogenetics) Steven Kelly (Microbiology, P450 Biochemistry) David Lamb (Structural Biology) Keith Lloyd (Clinical Psychiatry, Dean and Head of College) Stephen Luzio (Diabetes) Ronan Lyons (Public Health) Judith McKimm (Medical Education) David Owens (Diabetes) Ian Pallister (Trauma and Orthopaedics) Frances Rapport (Qualitative Health Research) Mark Rees (Molecular Neuroscience) Ian Russell (Clinical Trials) Samuel Sheppard (Microbiology and Infectious Disease) Martin Sheldon (Reproductive Immuno-Biology) David Skibinski (Evolutionary Biology) Helen Snooks (Health Services) Jeffrey Stephens (Diabetes and Metabolic Medicine) Roger Taylor (Clinical Oncology) Catherine Thornton (Human Immunology) John Wagstaff (Medical Oncology) Iain Whitaker (Burns and Plastic Surgery) Rhys Williams (Clinical Epidemiology) John Williams (Health Services) Medical student teaching is led by Professor Andrew Grant (Dean of Medical Education) together with Dr Phil Newton (Chair of Learning and Teaching), Mr Paul Jones (Programme Director) and Mr Tim Brown (Director of Clinical Teaching) and Marguerite Hill is Director of Clinic Placements. They have outstanding support from some 50 Senior Clinical Tutors from hospital, public health and general practice, as well as human biology lecturers, senior lecturers and other tutors. Along with GEM, the College also has a number of undergraduate genetics and biochemistry programmes and a growing range of postgraduate opportunities. BSc provision is led by Professor Paul Dyson with thriving programmes in Biochemistry, Medical Biochemistry, Genetics and Medical Genetics. There are also MSc programmes in Applied Analytical Science, Autism and Related Conditions, Health Informatics, Leadership for the Health Professions, Nanomedicine and Trauma Surgery (with a Military pathway) under the leadership of Dr Gareth Noble plus active research training programmes leading to MPhil, MRes, MD, MS and PhD awards. The College hosts several all-wales research networks in epilepsy, diabetes, asthma, unscheduled treatment care and mental health and looks forward in particular to the development of a new Outpatient and Ambulatory Medical Centre at the Singleton campus. There is great potential of that development to transform clinical care by drawing together clinicians from the Morriston and Singleton hospital sites and from primary care. Over the next 10 years the College s plans are equally ambitious. As part of its continued investment in the development of the Singleton campus, the College of Medicine will be creating a cutting-edge Medi-Park. 18

19 College of Human and Health Science Collaborating to deliver education, skills and research for a sustainable workforce What we do The College of Human and Health Sciences draws together the disciplines of children and young people, education, health, healthcare science, gerontology, nursing, midwifery, osteopathy, social care, social policy, and psychology. We are the largest provider of health care education in Wales, and the only provider of the Welsh paramedic science programme in collaboration with the Welsh Ambulance Service Trust (WAST). We offer an exciting and dynamic environment in which to study and to further an academic or professional career. The College offers undergraduate and postgraduate courses, research degrees, and continuing professional development and workbased learning opportunities. Our mission is to conduct high quality international research that meets the needs of the people of south-west Wales and beyond and underpins our learning and teaching to create an excellent student experience and drive innovation in health and social care provision. We strive to support excellence in service delivery through research and development, education underpinned by strong collaborative relationships that support the local and regional economy. Fast Facts The College of Human and Health Sciences performed exceptionally well in the last Research Excellence Framework (2014): Across the whole College our research was consistently rated as being of the highest quality, with almost 80% of papers and articles capturing world-leading or internationally excellent research. We are one of only four psychology departments in the UK to achieve a 100% 4* rating (maximum score possible) for the reach and significance of its work. We are rated 15th in the UK for our research in Social Work and Social Policy Examples of some of the world-class research submitted by Swansea University for the REF 2014 included: o The development of an approach to designing food items to facilitate psychological functioning by Professor David Benton and colleagues o Research on the economics of pain and pain management and how this impacts on policy, practice and patients by Professor Ceri Phillips The College has also achieved recognition and success in relation to the professional programmes it delivers: Winners at the Student Nursing Times Awards in 2014 and 2015, and shortlisted in several categories in Ranked 1st in the Complementary Medicine League Table in the Complete University Guide 2017 for the M.Ost Osteopathy degree, which has a unique partnership with Abertawe Bro Morgannwg University Health Board. 2nd place for Social Policy, 12th for Social Work and 14th for Nursing and Midwifery in the Guardian League Table % student satisfaction rates in Midwifery and Cardiac Physiology in the National Student Survey 2016 BSc (Hons) Healthcare Science (Audiology) degree ranked as the third best Aural and Oral Sciences degree in the UK by The Complete University Guide

20 The College of Human and Health Sciences How we deliver The College of Human and Health Sciences has state-of-the-art facilities for realistic workplace experiences in two campus locations; Saint David s Park, Carmarthen and Singleton Park Campus, Swansea University. The College's learning resources include: Clinical and technical skills resource centre Simulated clinical practice facilities Bioscience practice rooms Specialised psychology laboratories The Swansea University Osteopathic Clinic Health and Wellbeing Academy We have approximately 20 professorial staff from a variety of professional backgrounds who are leading experts in their fields. Our research also plays a vital part in informing our teaching and courses through textbooks and publications in professional journals to ensure future and current practitioners receive high-quality training throughout their studies. Research Innovation and Impact The College has a successful track record with skills in grant capture, research funding and an internationally recognised Research Excellence Framework (REF) accredited research portfolio. We have numerous research partners - regionally, nationally and internationally - with whom we undertake joint research projects. The College has a number of clinically relevant research centres: Swansea Centre for Health Economics This Centre is well established and has particular expertise in economic modelling, process evaluation, process budgeting marginal analysis and can support the evaluation of established services. The centre also provides research consultancy and support for partners to deliver cost effective health care whist using resources prudently. Improvement Science Research Group This group was recently established within the College and is an important source of support to drive practice improvement, develop joint funding bids for high level translational research and increasing the evidence base for improvement science. Centre for Innovative Ageing (CIA) The Centre is the only one of its kind in Wales, identifying gaps in ageing research and generating new interdisciplinary knowledge in the field of ageing. The CIA has achieved international recognition for its work in social gerontology as a collaborating centre of excellence and a global leader in research by the International Association of Gerontology and Geriatrics (IAGG). Wales Centre for Social Care Research The focus of this centre is on the investigation of final outcomes and the ways in which services impact upon service users lives, in terms of social capital, social inclusion and quality of life. This has led to the creation and development of validated outcome measures for operational use. Swansea Nutrition, Appetite and Cognition (SNAC) Research Group, This group researches the effect of nutrition and hydration on cognition (e.g., mood and attention).there is a strong focus on psychological aspects of weight-loss surgery; strategies for successful dieting; effects of dehydration; emotional eating; food variety in our environment. 20

21 The College of Human and Health Sciences Research Innovation and Impact (Cont d) Neuropsychological Research Group We have a number of internationally renowned researchers and professors within the area of neuropsychology with research interests in understanding the consequences of brain damage on various forms of cognitive function. This research seeks to better understand the patterns of patient impairment as well as provide clues to better remediation of those impairments; most notably, the development of the internationally accepted Saint Andrews-Swansea neurobehavioural scale. In addition the College has expertise with regards to functional magnetic resonance imaging (FMRI) and its clinical application. A series of animated films that showcase our research have been promoted within print and social media, notably Dr Amy Brown s baby feeding research, Professor Phil Reed s internet addiction studies, and Dr Yamni Nigam s research into medicinal maggots. These films, and more, can be viewed on the College s YouTube channel here: Workforce and Organisational Development The College works closely with partners to ensure a seamless approach to workforce development, training and continuing professional development so that both organisations are able to respond to changing service demands, recruitment pressures and a strategic direction requiring a more social model of health, congruent with prudent healthcare principles. Our undergraduate, postgraduate and continuing professional development programmes are designed to meet changing service needs, address recruitment gaps in the medical and technical workforce and support the development of a richer skill mix to deliver new models of care. The College is collaborating with Swansea University Medical School to deliver the new two year Physician s Associate PGCert. Collaborative Partnerships There is a strong tradition of collaboration and alignment of strategic priorities between ABMUHB, the College of Human and Health Sciences and other regional partners to deliver prudent healthcare, ensure workforce flexibility and promote the fluidity of staff across regions and organisational boundaries. This is demonstrated via a number of key collaborative endeavours. An example of collaboration with global reach is the innovative and transformative partnership between the College and Interburns UK to establish the Welsh Research Centre for Global Burns Policy and Strategy. Interburns UK is an international network of expert burn care professionals and the Centre will be a focus of excellence for Global Burns research, strategy, policy, teaching and excellence in practice. It will utilise the expertise locally, within Interburns and that that of Swansea University to drive research, learning, teaching and global engagement. There is also a wide portfolio of collaborative work between the College and regional partners as indicated below. The College has worked with Health Boards and Trusts to establish a Regional HR Policy that provides the respective partner organisations with a platform to drive further collaboration and innovation in the area of workforce and skills. This has supported the creation of joint and honorary appointments that optimise utilisation of specialist skills and deliver tangible benefits to patients, staff and students. The College is a key partner in the development of The Llanelli Wellness and Life Science Enterprise Village concept that has emerged from discussions between Carmarthenshire County Council, University Health Boards of Hywel Dda and Abertawe Bro Morgannwg, and Swansea University. This unique partnership seeks to explore an economic development opportunity based around wellness and life science economy and is in alignment with ARCH (A Regional Collaboration for Health) aspirations. 21

22 The College of Human and Health Sciences Collaborative Partnerships (cont d) Also in support of the ARCH vision, Gower College Swansea, the ABMUHB and HDUHB, are collaborating to establish an exciting initiative, the Talent Bank. Development work is underway in designing job roles suitable for Talent Bank learners as part of their work placement programme: Talent Bank aims to provide innovative education and training solutions for those aged 16 years and over who are interested in future careers in medical, healthcare and scientific professions. The College has forged a strategic alliance with the Swansea University Medical School and the School of Management (SOM) to provide a comprehensive range of leadership and management programmes including a bespoke postgraduate leadership development module for very senior managers. There is also a successful collaboration with Academi Wales delivering postgraduate leadership/innovation and management modules for healthcare staff from a wide range of professional backgrounds. Future Direction The College will continue to work closely with all of its partners and stakeholders in order to meet mutually beneficial objectives of: Excellence in service delivery, Promotion of research and development, Delivery of education, training and skills Supporting sustainable economic development. Exciting new developments such as the Health and Wellbeing Academy at the College of Human and Health Sciences, on the Singleton Campus, seek to provide a platform to do this whilst offering opportunities to support and enhance current methods of service provision in accordance with prudent healthcare and wellbeing principles. 22

23 A very special and unique place to live and work Above: Three Cliffs Bay Gower, Swansea, one of Britain's best views as voted by Visit Britain.com, Katherine Jenkins (in a celebrity poll by the Guardian) and readers of Country Life magazine Above: Three Cliffs Bay Gower, Swansea, one of Britain's best views as voted by Visit Britain.com, Katherine Jenkins (in a celebrity poll by the Guardian) and readers of Country Life magazine When you choose to come and work in ABMU Health Board, you not only become part of an ambitious, excellence driven organisation, but you also benefit from living in the one of the UK's most naturally beautiful regions. The moment you arrive, you will notice a real sense of community and you can easily access all the benefits of city life in Swansea and Cardiff combined with a superb seaside and countryside location. Swansea - Swansea is Wales second largest city and the regional capital of South West Wales. It is a University City with a rich history, and a flourishing cultural scene. As a waterfront city it has access to some of the most beautiful beaches in the UK on the Gower Peninsula (the UK s first Area of Outstanding Natural Beauty) and it also benefits from being able to offer outstanding leisure and recreational opportunities. Neath Port Talbot - Neath Port Talbot is a vibrant part of South Wales, set in the Hills and valleys alongside Swansea Bay. Approaching Neath Port Talbot via the M4 you are greeted by one of Britain's industrial titans - the Steel works. Beyond this, the area benefits from outstanding natural, heritage and cultural assets and is well known for Margam Castle, Neath Abbey and the impressive mountains, waterfalls and beaches. Bridgend - Bridgend is a market town with medieval origins and grew up around the crossing point on the confluence of three rivers. Just north of the town is the M4 motorway and nearby is the picture postcard village of Merthyr Mawr with its collection of thatched cottages surrounded by meadows and woodlands at the edge of the largest sand dune system in Britain and one of the largest in Europe. There are so many ways to enjoy the fantastic natural environment Water sports Swansea Bay and the Gower Peninsula experience the second greatest tidal range in the world which provides great conditions for surfing, wind surfing, sailing and kite surfing. Gower is well known for its world class surfing. Swansea has Sailing and Yacht clubs together with a large marina which is a great base for those wanting to sail the beautiful coast. Swansea Bay has hosted round one of the British Kite Surfing Championships. The Wales National Pool based in Swansea, is one of the facilities used to train Wales world class aquatic athletes and was used to train swimmers for the 2012 Olympic Games. Golf There are many Golf course options including cliff top courses with stunning views and the world famous Royal Porthcawl Golf Club which was described as being one of the twelve finest courses in the world. Machynys Golf Course is a Nicklaus designed 7121 yard modern links golf course that has already hosted an unprecedented eight championships, including two R & A Open Championships and four Ryder Cup Wales LET Championships of Europe. Walking Walkers are spoilt for choice in the area. Across Swansea and Gower, there is everything from smooth promenades, Botanical gardens and parkland to hikes over the Gower beaches and moorland. Keen walkers will love the 14 mile long Heritage Coast Path which offers unparalleled coastal views, while the Ogwr Ridgeway Walk will reward you with some of the most awe inspiring mountain and countryside views anywhere in Wales. For a bigger challenge there is the 72-mile Millennium Heritage Trail. Cycling and Mountain Biking Swansea has a range of safe cycle routes that are ideal for families, from disused railways lines to peaceful canal towpaths. Swansea is bounded by two National Cycle Network Routes. Bridgend has dozens of community paths that link up with the Celtic Trail national cycle route, or just meander through the beautiful country lanes and villages of the Vale. Afan in the Neath Port Talbot area has a mountain biking experience that is 23 described as second to none and it is the fastest growing mountain bike area in Britain and located minutes from the M4.

24 We are well connected! We re easily accessible by road, rail, sea and air. Swansea, Neath Port Talbot and Bridgend are all located alongside the M4 motorway and just a few hours by road and rail from the UK s main cities. "I moved to work in the NHS in Wales because I was impressed by the potential for delivering excellent joined up health care. There is a huge respect for the NHS in Welsh communities and a great public service ethos in the NHS. Wales is also the friendliest place that I have ever worked." Paul Roberts, Chief Executive Heathrow Bristol Birmingham Approximately 2 ½ hours Approximately 1 ½ hours Just over 2 hours You can travel to London from Swansea or Bridgend on a direct train in 3 hours. You can travel to Cardiff and be sat in the Millennium Stadium watching international Rugby or football or in the Wales Millennium Centre enjoying some of the world s best performing arts in around 45minutes. You can travel to Cardiff International Airport in 45 minutes and fly direct to locations such as Amsterdam (Schiphol), Paris (Charles De Gaulle), Barcelona and many other international destinations including the USA and the Middle East via on-going flights. Housing There is diverse range of living options in Swansea, Neath Port Talbot and Bridgend from city living, to countryside properties to waterside properties situated by the sea, the marina or by the river. Average house price for a 4 bedroom detached home Average house price for a 5 bedroom detached home Swansea 271, ,618 Bridgend 271, ,197 Schools / Education There are many excellent schools and colleges in and around the area. For schools in South Wales, the local Council websites have a vast amount of information and relevant contact details for each school in the locality: For Further education visit: Swansea College Neath Port Talbot College Gorseinon College Bridgend College For Higher education visit: Swansea University University of Wales Trinity Saint David Cardiff University Glamorgan University 24

25 Culture and events The area has a strong cultural history and was home to many famous composers, poets, writers, and artists. For those wanting to experience the cultured side of the area, there are a wide range of museums, galleries and inspirational attractions, including the award-winning National Waterfront Museum, the Victorian Swansea Grand Theatre and the Dylan Thomas Centre celebrating the life of one of Swansea Bay s most famous poet and writer. Swansea hosts a Festival of Music and the Arts, when international orchestras and soloists visit the Brangwyn Hall. The Brangwyn Hall is praised for its acoustics for recitals, orchestral pieces and chamber music alike. Throughout the region there are annual festivals in its many Art Centers and Theatres catering to a range of tastes. Messiah at the Brangwyn Hall, Swansea There are many other activities and events that can help you to enjoy your leisure time: Outdoor theatre at Oystermouth Castle, Mumbles, Swansea Premier League Football - Swansea City AFC Swansea City AFC was the winner of the Football League Cup and qualified for the UEFA Europa League. Professional Rugby - The Ospreys The Ospreys are one of the four professional rugby teams in Wales. The Ospreys are the most successful team in the history of the Celtic League or Pro 12 tournament, having won the competition four times. They also became the first and only Welsh regional team to beat a major touring side, defeating Australia in Cricket St Helen s Cricket Ground It was in this ground in 1968 that Sir Garfield Sobers hit the first ever six sixes in one over in first class cricket. Sobers was playing as captain of Nottinghamshire against Glamorgan. As part of their commitment to the entire country of Wales, Glamorgan County Cricket Club play some of their home matches at St. Helen's. Cardiff Cardiff is synonymous with sport and the Millennium Stadium, which is recognisable across the world, has been instrumental in elevating Cardiff to one of the most popular locations in the UK for major events and conferences. The SWALEC Stadium hosted the first Ashes test match in 2009, a first for Cardiff and a resounding success. In October 2010 the Celtic Manor Resort hosted The Ryder Cup, which elevated the city-region onto the world stage. Cardiff is also designated as a Centre of Culture, reflected in the iconic Wales Millennium Centre. The annual Creative Cardiff showcase promotes the city s creative economy to UK and international audiences and promotes the numerous creative festivals and events that take place in Cardiff during the year, including the biennial international Artes Mundi Prize and the World Music Expo in October Cardiff has recently been named as one of the best shopping destinations in the UK with retailers including John Lewis. 25