THE THREE-YEAR INTEGRATED PLAN 2014-2017 SUMMARY WE ARE CWM TAF Cwm Taf University Health Board is responsible for providing healthcare services to 289,400 people living in Merthyr Tydfil and Rhondda Cynon Taf. We also provide NHS services to people living in the neighbouring areas of the Upper Rhymney Valley, South Powys, North Cardiff and the Western Vale. We provide the full range of hospital and community-based services to people living in Rhondda Cynon Taf and Merthyr Tydfil. We employ around 7,000 whole time equivalent staff and are the second largest employer in the area. @cwmtaf
INTRODUCTION Welcome to this summary version of Cwm Taf University Health Board s first three-year integrated plan. The plan describes how we will maintain and improve the quality and safety of our services between 2014 and 2017 whilst also reducing costs by 5.5% in each of those years to meet the financial challenges we face. This challenge is faced by all Health Boards within NHS Wales, so each will have its own plan. Cwm Taf University Health Board was amongst the first Health Boards to have its plan approved by Welsh Government as being robust and fit for purpose. This is a high-level summary of the main points of the three-year plan. The Plan includes a chance to reflect on the achievements of the last year and on the opportunities and challenges ahead. The past 12 months have seen scrutiny and significant financial challenges in the NHS in Wales, and the UK as a whole, on an unprecedented scale. We will also face many challenges over the coming years with growth in our population need, increased costs and significant resource constraints. The next three years will be particularly challenging with further real terms reductions in resource allocations over this period. This will present the most significant challenge of this type that the University Health Board has faced to date. The achievement of a balanced financial plan over the three years of the plan assumes we will meet a savings requirement of 71m. At the same time, we must continue to ensure that we provide safe and efficient care in the most appropriate location, delivering the best possible outcomes for our patients, by well trained staff who feel supported and valued. The Plan looks to bring all of these complex and important factors into balance. Change is therefore inevitable, but we believe that although this won t be an easy journey, it brings with it the opportunity for development and improvement for our patients, our workforce and our partners. The publication of the Francis report (the review of Mid-Staffordshire NHS Trust) was a bleak and difficult time for each and every one of us working in the NHS. The challenge for people in leadership positions in Cwm Taf is to create a culture and a plan, which we can deliver for the benefit of our population, where compassionate care can flourish and where all staff feel cared for, no matter what budgetary and performance
challenges we face. In order to meet such a challenge, while also best addressing the healthcare needs of our local population, we are committed to radically redesigning both systems and services in order to ensure that the best value is achieved from our resources. Systems will be better developed to understand the key drivers that affect financial performance and deliver change that secures safety, clinical and financial sustainability for the future. We are determined that by implementing our transformation programme and by working closely with our partners that we will maximise the resources available to us to ensure that we can continue to deliver safe and effective services to the population of Merthyr Tydfil and Rhondda Cynon Taff. Working together has never been as important and is essential if we are to make our vision a reality. We will do this by: Preventing ill health, protecting good health and promoting better health Providing care as locally as possible wherever it is safe and sustainable Delivering services of the best quality and within efficient, affordable and effective models of care Delivering more care in primary and community-based settings, reducing the need for hospital inpatient care wherever possible Developing joined-up health and social care services by working with local authorities and the voluntary sector Working with our staff, partners and communities themselves, building on strong local relationships and the solid foundations of the past Paying due regard to equality, which will underpin everything we do To achieve our vision we have been, and will continue, to work on a range of initiatives. Our vision for Cwm Taf is to: Prevent ill health, protect good health and promote better health by providing services as locally as possible and reducing the need for hospital in-patient care wherever possible.
Over the last two years the South Wales Programme has been examining options for some of the more specialised hospital services (namely acute medicine, neonatal care, consultant-led obstetric care and paediatric care). As the population ages, the underlying demand for healthcare will increase. We are already successfully preventing people with less complex conditions from being admitted to hospital by meeting their needs in primary care or the community. As a result unscheduled care (otherwise known as emergency care) activity has not been growing significantly over recent years thanks to schemes we have put in place, including community-based services such as our @home service which enables patients to be assessed and supported in their own homes. However, this means that demand is increasing across primary care, community services and diagnostic services and we need to continue to address this in order to reduce unnecessary or avoidable admissions to hospital. It also means that those people who are admitted to hospital tend to have more complex care needs. So the Plan is not just about saving money. In some areas investment will be required. New service models will be vital to sustaining high quality care. At least 2m will be invested in each of the years 2014-15, 2015-16 and 2016-17 in new models to provide better patient care at lower cost. Following the recent completion of this planning work, new alliances of networked hospitals are to be formed which will enable us to determine the most appropriate pattern of services for our local population, which will include the Royal Glamorgan Hospital becoming a beacon site for emergency medicine. For the alliance to succeed significantly, improved primary and community care is needed to compliment and reduce demands upon hospital services. To do this 5m has been built into the Plan from 2016/17 to improve services. Details of our plans for 2014-2017 are available in the full three-year integrated plan, which is available on our website. As a University Health Board, our key priorities are to: Reduce health inequities Continue to improve patient experience throughout Cwm Taf Develop a clinical service strategy, which includes the outcomes of the South Wales Programme and its next phase of work in developing local alliances Continue to improve primary care and community services
Continue to improve unscheduled patient care, patient flow and urgent care processes Continue to focus attention on improving waiting times Continue work to meet the 62-day cancer target Improve data quality, including reporting, openness and transparency Improve the health and wellbeing of the workforce and reduce sickness rates Continue to develop our staff engagement Ensure compliance with legislation Achieve financial balance SERVICE CHANGE PLANS We are committed to putting patients and carers at the centre of all our work, engaging and listening to everyone who uses our services to inform our quality improvement priorities and to address any concerns. Our philosophy is Cwm Taf Cares, which is embraced in our Quality Strategy and Delivery Plan, and will ensure we deliver safe and effective services by staff who deliver care with compassion. Like all Health Boards in Wales, Cwm Taf is facing significant challenges to manage changes in the population and the associated growth in health expenditure. In this context, we recognise that demographic changes alone will compel us to reform health care. Keeping pace with this increasing demand and the rising costs of health care will require a very different approach. Cutting health care is unlikely to be the solution to this challenge because health need would simply move from one setting to another, potentially costing more. We will need to take an approach that delivers transformation through innovation and it is more important than ever that we understand the way our population is changing and that we renew the focus on improving population health overall. Working in partnership with Local Authorities, Third Sector partners and our local community will be a key component of this approach. Examples of some of the major service redesign plans within the plan include: Building on the successful improvements already made to reduce delays in the way patients flow through the healthcare system, we now plan to extend this work and add additional improvements to pathways of care to further reduce unnecessary delays. By making sure that patients can move through the system more smoothly our requirement for acute in-patient and community beds will also reduce. Examples include increasing the acute physician service in A&E and introducing a liaison psychiatry service, for which we have been successful in receiving Welsh Government funding.
We have also been talking to service users, carers and the public about ideas to redesign older people s mental health services, shifting the focus of delivery from hospital to the community. This would mean that older people with mental health conditions could be better supported in the community for longer with less reliance on inpatient hospital stays. Key to this would be enhanced services in the community and increased support to carers, which were areas that service users and carers highlighted as being particularly important to them. These changes would result in the remodelling of our older people s mental health beds, with the development of more services to support patients in the community. Linked to this work will be the opportunity to review and remodel the wider service provision at Dewi Sant Hospital. The ambition is to develop a Health Park which builds upon the success of the Keir Hardie University Health Park in Merthyr Tydfil. Conversations about the opportunities this presents will commence with staff and the public in the coming months. We have also been reviewing our palliative care services at Pontypridd & District Cottage Hospital, which we will look to remodel and improve further in the coming year by transferring provision to the Royal Glamorgan Hospital. This would bring a range of benefits, including co-location with diagnostic services. This review has already involved extensive discussions with staff, service users, carers, voluntary organisations and the Community Health Council and these conversa-
tions will continue. We are also exploring options of transfer Child & Adolescent Mental Health Services (CAMHS) from Tonteg Hospital to the Royal Glamorgan Hospital. Cwm Taf University Health Board is also developing ambitious plans for a long-term programme to address health inequalities and to increase healthy life expectancy by five years by 2023. The programme will target health inequalities by tackling disease and unhealthy lifestyle choices. The health board will work with statutory and third sector partners to implement local action plans targeted at: Reducing population smoking rates Reducing levels of obesity Reducing unplanned teenage pregnancy rates Improving mental health and wellbeing Reducing the harm from alcohol and drugs Increasing vaccination and immunisation rates Reducing accident and injury rates Improving health at work Key to our success in implementing these service plans is the significance of achieving University Health Board status in 2013. This is important because it will enable us to work with academic partners at the University of South Wales and Cardiff University to research and evaluate models of care, to develop new and innovative service solutions and to develop our staff, as well as training and nurturing our workforce of the future.
QUALITY AND PATIENT EXPERIENCE The plan has been informed by listening to and learning from our patients, services users and carers. Strengthening patient engagement to learn from their experiences is important to us. We are committed to creating a culture which welcomes and facilitates the involvement of patients, service users and carers from all communities we serve in the development, improvement and monitoring of patient care and services we deliver. We are committed to being open and transparent with the public, patients, service users and carers about the quality of the services we provide, sharing good practice, achievements and identifying areas for improvement. We aim to build upon this further by continuing to collect and learn from stories for improvement (real patient stories), to recruiting more carers champions, further promoting volunteering and extending the Have Your Say scheme. As part of the 2013-14 planning process, our board underlined its commitment to quality, safety and patient experience. This means that the will to improve quality and performance, as well as reducing cost, drives everything we do. As you would expect, we use a range of measures to assess quality and performance. Examples include: Patient/user feedback Risk adjusted mortality index (RAMI), Welsh RAMI, mortality reviews and mortality rates Learning from coroner s inquests Healthcare associated infections (otherwise known as hospital bugs ) Staff feedback WalkRounds - board members carry out patient safety checks on wards, in clinics and in GP Practices Clinical audits where learning outcomes are identified Concerns (incidents, complaints, claims, inquests) Compliance with National Institute for Health and Care Excellence (Nice) guidance and alerts Research and development findings
In monitoring progress against these measures, the questions we ask ourselves are: Are we providing safe care? Are we meeting required standards of effective care? Are we improving user experience? Are we providing efficient services within our resources? Are we engaging with the workforce? Are we providing accessible and equitable services? Are we improving population health? WORKFORCE Our workforce is our largest asset. However, the workforce challenges facing the organisation over the next 3 years can not be underestimated. To meet these challenges we need to continue our strong engagement with our workforce by sharing our plans at the earliest opportunities, listening to their ideas or concerns and supporting them through any changes. Our staff are the people who will translate this plan into action. example we have experienced difficulties recruiting to trauma and orthopaedics and surgery rotas) and as a result we have had to overly rely on locum doctors. The need for service change and new models of working. Examples include the move towards 24/7 working; more care provision in the community and in patients own homes; and the centralisation and the remodelling of hospital beds associated with new service models. The implications of such changes are that some of our staff will need to adapt to different working patterns, in different locations and in different roles. This will require significant change management programmes, underpinned by effective staff engagement and partnership working. Some of the key challenges facing Cwm Taf University Health Board over the next three years include: The sustainability of junior doctor rotas. This has been exacerbated by the reduction of training places provided by the Wales Deanery. We have specific problems in recruiting to some areas (for
Implementing the chief nursing officer s nursing workforce recommendations and safer care tools to make sure we have adequate and safe staffing levels. This will require a rebalancing of the nursing workforce across our wards and hospitals and a reduction in temporary bank and agency staff use. The age profile of the workforce poses its own challenges. There are several areas where an aging workforce could present service sustainability issues, for example in community nursing where 38% of the workforce is over 51. We anticipate that the remodelling of some service areas will result in a phased reduction in the number of beds required and the associated numbers of staff. Reductions would be achieved through not recruiting to vacancies that are no longer required, the use of voluntary early release schemes where appropriate and by reducing the use of bank and agency staff. FINANCE In developing our financial plan for the next three years, our key assumptions are: Repayments and deficits A deficit of 9m carried forward in to 2014/15 Repay a deficit of 3.9m from 2013/14 Additional income An additional 8.0m income in 2014/15 (of which 5m will be repayable in 2015/16) An additional recurring 6.0m income granted in 2015/16 and a further 6m in 2016/17 2.7m invest to save income in 2014/15, repayable in 2016/17 or later where agreed with Welsh Government Introducing new roles and career opportunities. We have applied for Welsh Government funding to support the development of 15 additional advanced nurse practitioner (ANP) posts by 2015 to improve the quality and safety of care. This will address the problem of shortages in the supply of junior doctors, where a substantial proportion of junior doctor posts are currently being filled by short-term locum staff. The key clinical specialties where this would be introduced would be paediatrics, neonates, accident and emergency, surgery and mental health.
Additional spending Recurring inflation, cost and service pressures of 18.8m (4.3%) in 2014/15, 16.6m (3.8%) in 2015/16 and 24.3m (5.5%) in 2016/17 Capital funding from Welsh Government to support the key changes included in the three year plan Recurring investment in new service and delivery models of 2.2m in 2014/15 with an additional 2.0m in 2015/16 and 2016/17 Investment in improvement programmes of 3.7m for 2014/15 and 2m in 2015/16 and 2016/17 Efficiencies and savings 53.2m of re-design and efficiency savings over 3 years (12.2% of controllable expenditure) 18.0m of savings from all Wales changes to terms and conditions, in line with advice from the Welsh Government No direct account has yet been taken on the outcome of the South Wales Programme. CAPITAL AND ESTATES Our estate is made up of a range of facilities and services which support all our activities in the delivery of healthcare for our population. Developments over recent years mean that we now have the most modern healthcare estate in Wales, but we still have some work left to do to ensure services are always provided in up to date, safe environments. A business case for the refurbishment of the ground and first floors at Prince Charles Hospital was approved by the Welsh Government in 2013. The final business case required to allow these works to proceed will be submitted to Welsh Government later this year. We are also developing exciting plans with Cardiff University for an undergraduate medical education centre at Keir Hardie University Health Park, in Merthyr Tydfil, to train the doctors of the future. This will be completed in January 2015. Other capital and estates plans include: Palliative care remodelling Stroke services redesign A&E redesign at Royal Glamorgan Hospital, including moving the acute assessment unit and medical day unit next to the A&E department A review of services at Dewi Sant Hospital Development of a diagnostic hub A major radiology and catheter laboratory modernisation programme
OUR 3-YEAR PLAN Full details about Cwm Taf University Health Board s plans for the next three years, including more information about all the initiatives mentioned in this summary, can be found in the main three-year integrated plan. If you have any comments or questions please write to: Cwm Taf University Health Board Ynysmeurig House Navigation Park Abercynon CF45 4SN www.cwmtafuhb.wales.nhs.uk @cwmtaf