National Delivery Plans Progress Report 21 March 2018
Content Slide 2: Slide 3: Slide 4: Slide 5: Slide 6: Slide 7: Slide 8: Slide 9: Slide 10: Content Cancer Delivery Plan Diabetes Delivery Plan End of Life Delivery Plan Heart Disease Delivery Plan Stroke & Neurological Conditions Delivery Plan Respiratory Health Delivery Plan Liver Delivery Plan Critically Ill Delivery Plan
Cancer Delivery Plan The latest Cancer Delivery Plan for NHS Wales was published in 2016 http://gov.wales/docs/dhss/publications/161114cancerplanen.pdf. Cancer is the single biggest cause of premature death in Wales and the UK. The incidence of cancer is expected to rise by 2% per year for the next 15 years. Those born after 1960 now have a one in two chance of developing the disease during their lifetime. Changes to the age and sex structure in the population are the main driver of changes in cancer incidence and the number of people living with cancer is increasing. The plan covers prevention, detection, fast, effective treatment and care, meeting the needs of people with cancer, improving information, end of life care and research. There is a set of actions within these for NHS Wales, Health Boards, Cancer Centres and Research Centres, Public Health Wales, Cancer Networks and partners. The key statistics are collated at an all-wales level; the latest progress report can be found here http://gov.wales/docs/dhss/publications/171123cancer-annualstatementen.pdf. - Cancer is one of the Big Four causes in our Health and Care Strategy and IMTP, ensuring a continued focus on this area. - PTHB has a multi-agency Cancer Partnership Group which leads the work to improve cancer services for the people of Powys - The health board s team focusing on cancer services now includes a Macmillan Senior Lead Nurse for Cancer, a Patient Centred Care Manager, a newly appointed GP Facilitator for Cancer and a Community Cancer Specialist Nurse. - The 2017/18 work programme has included a pilot Community Cancer Specialist Nurse role in mid Powys to provide support for practice nurses, a cancer care review in primary care; skill development; the use of the National Cancer Survivorship risk stratification process; key worker role and signposting - A feasibility study of chemotherapy outreach services in Powys is being explored with Hywel Dda UHB and Shrewsbury and Telford NHS Trust to develop service options in North Powys. - Implementation of the Commissioning Assurance Framework continues to strengthen the performance management of commissioned cancer services. Key measures for cancer are routinely reported via the IPR and PTHB have established processes to review patient breaches with Welsh and English commissioned provides. PTHB have also developed a 100 Day Cancer Improvement Plan to strengthen performance reporting and review of pathways. - There is a collaborative scrutiny process led by PTHB in place for the Velindre Cancer Centre Transforming Cancer Services programme which is at Outline Business Case stage - The health board is making preparation for the implementation of the single cancer pathway, continuing into 2018/19. - Partnership work is underway with Macmillan and other Third Sector partners on an integrated model between health and social care which delivers a proactive community response to the needs of people with cancer. This will offer holistic needs assessment and an identified link officer to signpost or refer to local agencies and provide appropriate support 3
Diabetes Delivery Plan The Diabetes Delivery Plan for Wales 2016 2020 was published in December 2016, with a vision for a fully integrated primary and specialist service, designed around the needs and ability of the patient to manage their condition. There is an emphasis on coresponsibility, lifestyle choices and participation in education to minimise the risk of complications in the years to come, in addition to tackling preventable disease http://gov.wales/docs/dhss/publications/161212diabetes-delivery-planen.pdf. Diabetes affects a wide cross section of society from babies to pregnant women to the elderly and touches most areas of health and social care. There is a high prevalence rate for diabetes in Wales and prevention by reducing risk factors is a key goal and has an additional benefit of reducing the risk of other conditions such as cardiovascular and respiratory disease. The national diabetes implementation group decides its priority areas annually but three key strands are likely to be consistent: meeting national standards in primary and inpatient care; supporting people to manage their conditions through structured education programmes; and creating more integrated primary and specialist provision. - Assessment of population need and lifestyle risk factors is included as part of the Powys Wellbeing Assessment and this analysis has informed the Health and Care Strategy and IMTP. Diabetes is one of the major causes of life years lost and years of life spent with poorer health. It is included in as one of our Big Four in circulatory conditions and the health board has made a strategic commitment to improving clinical outcomes and patient experience. - PTHB aims to reduce the rise in rates of type two diabetes, in line with the National plan and continue to improve complication rates, through effective management of the condition and enabling self management - The Health and Care Strategy and IMTP both focus on improving health and wellbeing, which aligns to the core concept and interventional approach in the National Plan (for Diabetes and other chronic, long term conditions). - The future model of care supports the National plan and is based on integrated pathways of care and an emphasis on enabling the individual to better manage their own health, with care co-ordination for those with more complex needs - PTHB has a Diabetes Delivery Plan overseen by a Diabetes Planning and Delivery Group with links to the All Wales Diabetes Implementation Group and Structured Education Programme review - We are in regular liaison with Diabetes UK, for example co-ordinating and supporting Living with Diabetes Days, patient information and Patient Groups across our localities - The Plan reports to the Planned Care Board, ENT Project Board and National Delivery Plans Steering Group. 4
End of Life Delivery Plan The most recent NHS Wales Palliative Care and End of Life Delivery Plan was published in March 2017. http://gov.wales/docs/dhss/publications/170327end-of-lifeen.pdf. This builds on work to improve care which began with the Sugar Report in 2009. The aim is for People in Wales to have a healthy, realistic approach to dying, and to be able to plan appropriately, to end their days in the location of their choice. It promotes access to high quality care wherever someone lives and dies, whatever their underlying disease or disability. The National Plan is overseen by an End of Life Care Board supported by a well-established Adult Palliative Care Clinical Implementation Group and an all-wales Paediatric Palliative Care Network and Implementation Group, providing peer support and acting as an effective information sharing platform. The all-wales Paediatric Palliative Care Network and Implementation Group was developed to ensure improvements in care for those with life limiting conditions from birth, through childhood and into teenage years. This is delivered by working with the children s hospices, Tŷ Hafan and Tŷ Gobaith/Hope House, to find service solutions in each health board area. - There is a rolling work programme in place to deliver the PTHB End of Life Delivery Plan, highlights include: - Development of a palliative care standard for Primary Care and support to practice managers - Support for primary care actions including palliative care registers and MDTs - Development of an electronic record to support advance care planning - Education programme being further developed to support clinical teams with symptom control, ACP, communication skills, care decisions guidance, anticipatory prescribing and JIC box - Two Macmillan GP End of Life Facilitators have been appointed to support the work above - There is a rolling events and education programme for the public, care homes and clinical staff. There is a wider reach planned for 2018 with primary care involvement and support for Advanced Care Planning - Recruitment is underway enabled by a successful bid to Macmillan for two Advance Care Planning nursing posts - PTHB are working in partnership with the University of South Wales to deliver the degree module in palliative care in Powys - There are also actions underway for children and young people which are picked up within paediatrics - The model of care in the Health and Care Strategy and IMTP support the aims of the national and local plans for palliative and end of life care, with a focus on care closer to home, care co-ordination and care planning for complex needs 5
Heart Disease Delivery Plan The refreshed Heart Conditions Delivery Plan was published in January 2017 http://gov.wales/docs/dhss/publications/170106heart-reporten.pdf. This notes the progress made in improving the care of people with a heart condition in Wales. There has been a steady decline in the rate of people in Wales dying from all cardiovascular disease and the rate of hospital admissions for coronary heart disease has fallen considerably over the last five years. It notes developments in cardiac care across NHS Wales and key challenges remaining in workforce, benchmarking, variations in practice and clinical audit and the delivery of services. It highlights the issues relating to an ageing population. The prevention of premature coronary disease is significantly influenced by poverty and socio-economic determinants - as well as family history, smoking, alcohol consumption above recommended guidelines, obesity, lack of physical exercise eand untreated hypertension. The Plan acknowledges the crossover with prevention sections in other Welsh Government Delivery Plans, such as the Stroke and Diabetes Delivery Plans. For some people with heart conditions it will also be appropriate to refer to the Delivering End of Life Care Plan and the Delivery Plan for the Critically ill. - Assessment of population need is included as part of the Powys Wellbeing Assessment and Cardio vascular / circulatory disease features prominently as a cause of life years lost and is one of the Big Four which we are addressing in our Health and Care Strategy and IMTP, giving this area an enhanced focus for 2018 / 2019 - As one of the Big Four PTHB have made a commitment to improving clinical outcomes and patient experience - We aim to reduce the incidence of circulatory conditions through the wider work to improve health and wellbeing; timely detection through increasing awareness and working with primary care services, effective treatment through robust commissioning and strengthening of community services and the wider model of care - The future model of care developed jointly by PTHB and PCC supports the National plan aims for more integrated pathways of care and an emphasis on enabling the individual to better manage their own health - The model of care also emphasises early help, targeted support and care co-ordination for those with more complex needs - The development of Community Cardiology services have been a focus for 2017/18 and this work is ongoing - There is a partnership group in place for heart disease and circulatory condition services for the people of Powys 6
Stroke & Neurological Conditions Delivery Plans The Neurological Conditions Delivery Plan Annual Report for NHS Wales and its partners was first published in 2014 and updated in 2017 http://gov.wales/docs/dhss/publications/170727neurological-planen.pdf. A refreshed Delivery Plan for Stroke was published in February 2017 http://gov.wales/docs/dhss/publications/170209stroke-dplan1720en.pdf. It is estimated more than 500,000 people in Wales are affected by a neurological condition, including migraine, dementia and stroke. Of those people affected by a neurological condition, around 100,000 will have a long-term condition, resulting from disease, injury or damage to the body s nervous system, affecting the individual and their family for the rest of their life. The National Plan for Neurological Conditions sets out seven themes: raising awareness; timely diagnosis; fast, effective, safe care and rehabilitation; living with a neurological condition; children and young people; improving Information; targeting research. The National Plan for Stroke focuses in more detail on the Stroke Pathway, Outcomes and Patient Experience. Actions are outlined in each theme for partners including Health Boards. Outcome indicators and assurance measures are monitored at an all Wales level. - PTHB Stroke and Neurological Conditions Action Plan (2017-2020) sets out in detail the actions in key areas including: - Rehabilitation and Recovery; Living with Stroke / a Neurological Condition; Fast and Effective Care; Living Well and Stroke Prevention - Actions are aligned to the National Plan requirements and local need - The breadth of actions include work on self care, awareness raising, education and training, skill development, rehabilitation and recovery, patient pathways and flow, service development and evaluation, workforce, user involvement and a set of actions to reduce the number of strokes - There is a rolling programme of education for users, carers and professionals which is tracked with the action plan - There is a schedule of pathway developments and engagement with all Wales proposals - The Plan also includes Evaluation, linked to NICE Guideline audits and research opportunities - The Wellbeing Assessment for Powys also considered long term conditions more broadly and this has informed the Health and Care Strategy and the IMTP - The development of the PTHB future model of care, developed jointly between health and care, promotes a way of working that enables the individual to better manage long term aspects of neurological conditions - There is a summary plan within the IMTP for 2018/2019 which includes a set of proposed key measures for both Stroke and Neurological Conditions (this will form part 7
Respiratory Health Delivery Plan The National Respiratory Health Delivery Plan was first published in 2014 and recently refreshed for 2018-2020. http://gov.wales/docs/dhss/publications/180119respiratory-planen.pdf. One in twelve people in Wales have a respiratory illness and Wales also has the highest prevalence of asthma in Europe. Respiratory disease is ranked fifth in terms of spend of all disease categories. Tobacco smoking remains the single biggest preventable cause of death although smoking rates in Wales have been declining with the prevalence being 19% in 2016 better than the target of 20% set by Welsh Government. The Plan notes progress on workstream areas nationally and key themes of prevention, children and young people, early diagnosis, fast effective care and research, with case studies to highlight good practice and innovation. The Plan also notes the national work on metric development and collation of updates and key measures at an all Wales level is ongoing. There are crossovers with sections in other Welsh Government Delivery Plans, for example in relation to prevention, smoking, lifestyle factors and end of life care. - Assessment of population need is included as part of the Powys Wellbeing Assessment and the impact on ill health and disability is tracked as part of both the Health and Care Strategy and IMTP development. - Respiratory health features prominently in local needs and is one of the Big Four which we are addressing in our Health and Care Strategy and IMTP, giving this area an enhanced focus for 2018 / 2019 - As one of the Big Four PTHB have made a commitment to improving clinical outcomes and patient experience, supporting activities which will prevent respiratory diseases through health and well-being improvement and work with at risk groups - We will continue to strengthen local diagnostics services and support those with conditions with self management programmes, rehabilitiation, pathway development and crisis management packs - The Tobacco Control Steering Group and Smoking Cessation Services will continue to tackle and reduce smoking - The PTHB model of care supports each of the National Delivery Plans with an emphasis on enabling the individual to better manage their own health, with care co-ordination for those with more complex needs - There is a partnership group in place for respiratory health for the people of Powys - A stakeholder workshop is being held on 16 March to confirm the focus for 2018/19 - Areas under consideration for 2018/ 2019 include pulmonary rehabilitation, sleep, oxygen and spirometry 8
Liver Delivery Plan The Liver Disease Delivery Plan for NHS Wales and its partners was published in 2015 file://cymru.nhs.uk/pow_dfs/north/newtown/private/sa095785/desktop/liver%20disease%20plan%202015.pdf. The three most common causes of liver disease in the UK are obesity, excess alcohol consumption and blood borne viral hepatitis. These underlying causes of liver disease are linked to social deprivation and can therefore disproportionally affect the poorest communities. Areas of focus in the National plan include lifestyle risks and variation in outcomes; reducing the average length of time spent in hospital; reducing emergency admissions; reducing alcohol related admissions and reducing the increasing incidence of liver cancer. Health Boards have responsibilities to assess need and take forward actions to improve outcomes in relation to lifestyle factors including obesity and alcohol factors. Specific responsibilities are also assigned to Trusts responsible for acute and specialist service delivery. The position against the measures in the National Plan are collated at an all-wales level; the latest progress report can be found here http://gov.wales/docs/dhss/publications/170630liver-diseaseen.pdf - The Wellbeing Assessment for Powys included lifestyle factors and risks and key measures of our local position are tracked via the Public Health Outcome Framework and reported in the Integrated Performance Report (IPR) - Key outcomes being tracked including alcohol use, healthy weight and lifestyle factors - The IMTP for 2018/2019 sets out the local priorities against Liver Disease these are: - Public and professional awareness raising - Primary care management and liaison - Primary preventation programme - Substance Misuse Strategy - The Area Planning Board oversees partnership actions on alcohol misuse and harm - The Health and Care Strategy and IMTP has enabled the development of the PTHB future model of care developed jointly between health and care, for care organised around the individual and the family, with a focus on prevention based outcomes, lifestyle factors and reduction of the burden of disease, which will support work to tackle liver disease - The PTHB model aims to provide care closer to home and reduced admissions, with early help and support. - The ongoing development of the care co-ordination approach will increase targeted support and care planning suited to the complexity of need, with appropriate, planned and timely access to diagnostics and acute and specialist services - The IMTP identifies that a clinical leader is being sought for this area of work, to lead further review and assessment of services and pathways in Powys against the Liver Delivery Plan. 9
Critically ill Delivery Plan The Delivery Plan for the Critically Ill for NHS Wales was first published in 2013 and a refreshed version in February 2017. Patients requiring critical care are relatively low in number (around 9,600 per annum) but, when critical care is required, access needs to be timely and often rapid. By the very nature of the intensive therapy provided, critical care beds are amongst the most costly resource within the health service. NHS Wales has historically had a lower number of critical care beds for the size of the population than the rest of the UK and a need to both maximize efficiency and increase capacity which minimizing avoidable admissions. The National Plan acknowledges that there is some common ground with other Welsh Government Delivery Plans, such as those for cancer, stroke, diabetes, liver, respiratory health, heart and neurological conditions. For some people, for whom critical care is not in their best interests, it may be appropriate to refer to the Delivering End of Life Care Plan. Additionally, there are specific guidelines for those Trusts who are delivering critical care including the Provision of Intensive Care Services (2015). The National Delivery Plan primarily focuses on the service delivery of critical care and supporting research. There is a national implementation group for the once for Wales solutions and Network Clinical Leads are working with the delivery Health Boards. - PTHB commissions critical care services from NHS provider organisations through its Long Term Agreements (LTA) in both England and Wales. The Welsh Health Specialised Services Committee (WHSSC) is delegated to commission specialised services for the population of Wales. This includes paediatric intensive care and the critical care episodes which form part of a specialised admission for adults - A key local priority for Powys is to work with the WHSSC to ensure there is clarity about the interface between secondary and tertiary service commissioning with regard to intensive care for adults. Through the WHSSC Integrated Commissioning Plan and the interface group with Powys, PTHB is seeking more detailed information - PTHB also has a role in relation to minimizing avoidable critical illness and admissions. The development of the PTHB future model of care, developed jointly between health and care, promotes a way of working that improves the management of conditions and diseases through joined up support and care co-ordination, which is known to help prevent avoidable exacerbations and admissions 10