POWYS thb ANNUAL PLAN 2013-14 Aim Improvement Action Measure Lead Standards for IMPROVING HEALTH AND WELL-BEING OF COMMUNITIES 1. Improve the opportunities and life chances for children Increase uptake of childhood vaccinations to 95% target through the implementation of the Powys Immunisation Action Plan. 95% uptake of scheduled immunisations for children under 4 years. Public 2. Implement the Children s Integrated Services Plan (including co-location) 3. Implement the Baby Friendly Initiative Programme 4. Undertake the specific Board actions relating to multi-agency working for children (Youth Offending; Corporate Parenting; Stable Lives/Brighter Futures; Integrated Family Support Services; Child Poverty Programme; Flying Start Child and family satisfaction measures Increase in breastfeeding rates by 10% in year at both 10 days and 28 days (outcomes as indicated in the LSB framework) 5. Reduce preventable death and disability due to chronic disease Reduce prevalence of smoking through the implementation of the Powys Tobacco Control Action Plan and increase access o smoking cessation services for Powys residents Year on year reduction in smoking prevalence from 2010/11 = 21%, to 16% by 2020. Reduction in non-smoking adults' exposure to passive smoke indoors (2010/11 baseline 18%) 5% of Powys smokers to be treated by smoking cessation services (baseline 3.5%, 2012-13) Public Annual Plan Page 1 of 12 2013-14
6. Reduce the prevalence of overweight and obesity through the development and implementation of the y Weights Action Plan Year on year reduction in prevalence of obesity from 2010/11 24% baseline Year on year increase in the proportion of adults who report being physically active on 5 or more days in the past week (baseline 39%, WHS 2010/11) Year on year increase in the proportion of adults who reported eating five or more portions of fruit and vegetables the previous day (baseline 40%, WHS 2010/11) Public 7. Support the development and delivery of the Substance Misuse Strategy, as led by the Area Board 8. Develop a Community Champion approach Reduction in adults who reported drinking above guidelines on at least one day in the past week (baseline 41%, WHS 2010/11). Adults who reported binge drinking on at least one day in the past week (baseline 25%, WHS 2010/11). Alcohol attributable mortality Community Champion approach to be in place in 2013-14 Public Public 9. Contribute to the development of a neighbourhood management approach with partners in the Local Service Board Neighbourhood Management to be established in 2013-14 Public / Annual Plan Page 2 of 12 2013-14
10. Reduce illness, death and healthcare utilisation due to flu Increase uptake of flu vaccination amongst at risk population to 75% and health care workers to 50% through the implementation of the Powys Flu Action Plan 75% uptake of influenza vaccination among Over 65s Under 65s in at risk groups Pregnant women 50% uptake of influenza vaccine among care workers Public 11. Optimise the health, well-being and public health skills of the workforce Increase the proportion of Powys thb staff who have undergone Alcohol Brief Intervention and Smoking Brief Intervention training, and assess skills requirements as part of training needs assessment Alcohol - Baseline 2 staff 2012/13. Smoking - Baseline 22 staff 2012/13 (Awaiting final figures). Public 12. Implement the recommendations of the Welsh Government review of Visiting, strengthening the public health role of the health visiting team Recommendations implemented 13. Implement staff health and well-being strategy and introduce reporting framework based on line manager reports Assessed against a baseline of 1/4/14 achieve reduction in sickness absence of 0.5% in each department Annual Plan Page 3 of 12 2013-14
ENSURING THE RIGHT ACCESS 14. Deliver local integrated health and social care system Develop and deliver unscheduled care plan and maturity matrix in each locality area, and for children, and Powys wide actions including communications hub Joint indicators for maturity: Emergency medical admissions Bed days utilised Discharges to care homes Deaths at home Delayed transfer of care Medical GP access: appointments after 5pm 4 hour A&E performance Ambulance response times 15. Develop and implement strengthened commissioning arrangements for complex care jointly with the Local Authority where possible (Funded Nursing Care, Joint Care Packages, and Continuing care) Improved value for money demonstrated; Clear quality assurance process in place and audited 16. Fully implement and assess benefits realisation of integrated health and social care model in Builth Wells and social care utilisation indicators 17. Implement year one of the carers strategy to deliver the carers measure Key performance indicators within plan Annual Plan Page 4 of 12 2013-14
18. Ensure adults and children receive timely access to scheduled care Implement year one of three year repatriation project for adult services and Year 2 of the Scheduled Care Repatriation Project for children s services (paediatrics) and maternity services Increase level of in-county paediatric work by 20% for Year 2 DGHs (Wales) and a further 10% for Year 1 DGHs (England) Increase level of in-house adult service provision by 30% Increase to 80% of all low risk women giving birth in Powys Public 19. Deliver timely access to scheduled care services, and risk assess services for fragility and ensure business continuity plans in place 26 and 36 week waiting times; therapies waiting times Risk 7 20. Develop and implement commissioning strategy for orthopaedics Orthopaedic waiting times Shift in resource from secondary to primary care Reduced in overall activity 21. Ensure people have access to clearly defined and co-ordinated pathways of care Deliver together for health service change plans: implement cancer plan implement stroke plan Prepare plans in response to WG planning and delivery plan due for publication during 2013-14 31 and 62 cancer targets achieved Increase in chemotherapy services provided in-county Quality indicators for stroke care 22. Influence delivery of service change plans in neighbouring health boards (South Wales Programme; Hywel Dda and Betsi Cadwalladr) to reduce risk of fragile services to Powys residents Approval of plans Risk 8 Annual Plan Page 5 of 12 2013-14
23. Improve emotional well-being and mental health of the population Implement Year 1 of the Together for Mental Strategy, specifically: - Test current governance arrangements - Develop and implement Powys Five Ways to Wellbeing - Evaluate Mental Measure and compliance - Develop, agree and implement the adult services modelling (including out of hours services and potential for technology in mental health care); - Implement key milestones of Suicide Prevention Action plan; - Develop, agree and implement a Community Intensive Service solution for children and young people Reduction in suicide levels Increase in mental wellbeing, as measured by the SF36 Mental Component Summary Score (Baseline 51, WHS 2010/11) Key milestones of the plan met (including evidence of measurement of user experience in mental health) 24. Develop and implement the Assurance Framework for the Mental Act to demonstrate compliance 25. Finalise and implement the Learning Disabilities Joint Commissioning Plan Implemented Assurance Framework Milestones in the LD Strategy met; Improved value for money demonstrated 26. Implement the sustainability and improvement plan for specialist Child and Adolescent Mental services Improvement Plan implemented 27. Develop and implement the Joint Dementia Plan with Local Authority and Third sector partners that meets intelligent targets for dementia care Key miles implemented; Intelligent targets met Annual Plan Page 6 of 12 2013-14
STRIVING FOR EXCELLENCE 28. Embed a culture of continuous improvement in safety, quality and patient experience in all settings Implement the Improving Quality Together programme 29. Develop internal quality system: Identify and implement changes following review of governance framework and reporting/assurance mechanisms around quality and safety 30. Develop and implement clinical audit programme focussed on learning, access and implementation of evidence-based practice across all services 25% of directly employed and contractor workforce trained in quality improvement methodology by April 2014 Reduction in healthcare acquired infections, pressure damage and inpatient falls HAT; discharge letters, sepsis Inspection reports and audit reports demonstrate evidencebased practice Public Science Medical SHS 3:6 Quality triggers; fundamentals of care audit; nursing dashboard and complaints 31. Establish effective and transparent approach to staff and organisational learning, training and development linked to learning from incidents and complaints, concerns, patients stories, coroners ombudsman and national reports Evidence of improvements in place in response to incidents and complaints. 100% mandatory and statutory training Science 32. Deliver medicines management improvement plan Prescribing indicators Medical 33. Develop and Implement a Protecting Vulnerable People Strategy (2013 2015) Milestones implemented 10 Annual Plan Page 7 of 12 2013-14
34. Create a culture that places the patient first in everything that is done Increase transparency of patient experience and health outcomes and patient related quality and safety data at Board level Board and committee papers to include impact assessment on quality of patient experience and health outcomes Data on quality and patient safety published in Annual Quality Statement, Service Reports and Annual Report Integrated performance report Science SHS 3.4 35. Ensure absolute compliance with fundamental standards, professional conduct and competence across all disciplines Implement Clinical Professions Strategies (nursing, medical, therapies and health Science) including attention to safe staffing levels 36. All teams to participate in Aston Team approach and robust personal and professional development and career framework in place Milestones met Medical re-validation and appraisal milestones met 100% identified home team by 1/7/13; all teams agreed purpose by 1/9/2013; PDR 75% compliance at 1/7/13 and 85% by year end Medical Science SHS 2.6 (clinical engagement) SHS 1:2 SHS 3:9 2 37. Implement quality assurance framework for receiving, evaluating and taking action where quality triggers or measures highlight potential for substandard care/problems 38. Support providers to improve quality of services Evidence of intervention where indicators of quality standards not met Evidence of training and development implemented for care homes, GP practices. Science Science Annual Plan Page 8 of 12 2013-14
INVOLVING THE PEOPLE OF POWYS 39. Systematic, open, active engagement with residents and stakeholders in service planning and decision making Strengthen engagement mechanisms through development and delivery of locality strategies, joint Powys wide approach through LSB and review role of SRG and develop reporting mechanisms Measures to be developed SHS 1:1 40. Strengthen strategic joint planning through a review of partnership arrangements under the Local Service Board Joint LSB performance indicators SHS 1:5 41. Embedding values of equality and diversity through implementation of Equality Impact Assessment and monitoring impact on all stakeholders including patients and staff Increase number of EIA s undertaken SHS 1:3 42. Further develop an internal communications strategy, to systematically gain, record and act on the views of staff Improvements in staff survey indicators SHS 3:5 43. Improve citizen experience of care through listening and learning All directly provided services to have a formal service user feedback mechanism in place and develop methodologies for gaining patient feedback on externally provided services Consistent approach to patient survey and feedback measures across services I want great care survey for end of life care Mental health user and carer measures Therapies SHS 3:8 Annual Plan Page 9 of 12 2013-14
MAKING EVERY POUND COUNT 44. Achieve the statutory duty for financial balance in each financial year Secure external planning support to confirm the current position and identify further opportunities for cost reductions, and review financial strategy in light of outcomes of external review Reduction in Financial gap identified for 2013/14 and beyond Finance 1 45. Embed the 3 year service and workforce plan that demonstrates the future service model that delivers recurrent financial balance within the resource allocation from Welsh Government All home teams to have discussed and fed back on Plan 46. Implement year 2 of the all-wales CHC retrospective claims project Meet 2013-14 target cases resolved Nursing 3 47. Build an organisation with effective planning and financial management capacity and capability Strengthen planning and commissioning processes, development of a 3 year rolling plan to incorporate national planning priorities, demonstrate the views of citizens considered and includes a Quality Assurance Framework and performance monitoring process across all providers. 48. Implement the recommendations arising from planning and financial reviews undertaken by external support and Wales Audit Office 49. Implement an improved platform of information data and analysis to inform both financial and non financial variance analysis, planning and performance management Service specification and service level agreements to reflect expectation of high quality patient experience and health outcomes Recommendations completed in year Measured increases in range, scope and analysis of information available on desktop Finance SHS 1:4 SHS 2:8 SHS 3:2 11 Annual Plan Page 10 of 12 2013-14
MAKING IT HAPPEN Enabling Strategies Enabler Improvement Action Measure Lead Reference 50. Organisational development programme Complete implementation of Programme Office to support Transformation Programmes such as Information Services and the clinical change programmes Programme processes and tools embedded in organisation Project outcomes achieved SHS 2:3 6 51. Conclude review and implantation of change programme for HQ and locality functions WTE and financial neutrality of changes Productivity improvements SHS 2:1 52. Development of an integrated multiprofessional education, innovation, research and clinical effectiveness/quality improvement function Plan in place and milestones achieved SHS 3:3 4 53. Workforce Ensure that the workforce is recruited, developed and managed through the lens of the user 100% of appointments involve service users 50% of training courses have a user/carer component included 54. Maximise benefits of ESR through continued implementation of WfIS national and local priorities All agreed posts identified on ESR Cessation of paper systems capable of being managed through ESR Relevant policies to have been undated Scoping completed by 1/7/13 55. Develop and introduce multi professional education and training strategy using best practice methodology based on a holistic training needs assessment Training needs assessment complete by 1/7/13 6 Annual Plan Page 11 of 12 2013-14
56. Estates Develop a long term estates strategy Strategy in place approved by Board Key estates performance indicators improving SHS 2:2 5 57. IM&T Define IT business requirements of the organisation to inform IT strategy from 2014 Reviewed strategy in place Medical 9 58. Further develop and deliver Digital Powys programme Number and scope of pilot schemes in place Medical 59. Implement action plans to achieve key audit recommendations to be overseen by reestablished Information Governance Committee Delivery of key actions Science SHS 2:4 60. Governance To adopt an integrated governance approach which continuously reviews and develops the annual governance statement, linking more closely to corporate priorities Annual Report Annual Governance Statement Board Secretary SHS 2.5 61. Strengthen the approach for management of Board level risk. 62. Development of a Board Assurance Framework which will determine all risks of achieving the Board s strategic objectives (which will include legal and other requirements placed upon the teaching Board) and outline the sources of assurance available to the Board in satisfying itself that all are delivered. Risk register and audit of process Approved framework Science Board Secretary SHS 2.7 SHS 3.1 63. Implement Board Business Cycle to determine reporting requirements of the Board Approved cycle Board secretary SHS 3:7 Annual Plan Page 12 of 12 2013-14