QUALITY, SERVICE, WORKFORCE & FINANCIAL FRAMEWORK 2010-2015 Changing for the Better OUR FIVE YEAR PLAN January 2011
CONTENTS Section Page 1.0 Foreword 3 2.0 Our Values and Ambitions 4 3.0 How we developed this Plan 5 4.0 Inclusive and in Partnership 6 5.0 Context and Drivers for Change: 5.1 Demography and Population Health 5.2 Patient Expectations 5.3 Quality 5.4 Workforce 5.5 Finance 6.0 Aligning National and Local Priorities 6.1 Our Healthy Future 6.2 Setting the Direction 6.3 Saving 1,000 Lives Plus 6.4 Doing Well, Doing Better: Standards for Health Services in Wales 6.5 Better Outcomes for Tougher Times: The Next Phase in Public Service Improvement 6.6 Quality, Service, Workforce and Financial Framework 6.7 Griffiths Review into Non Emergency Patient Transport Across Wales 7.0 Our 5 Year Plan 7.1 Prevention and Promotion 7.2 Unscheduled Care 7.3 Mental Health 7.4 Long Term Conditions 7.5 Primary Care / Primary Care Assurance 7.6 Continuing Care 7.7 Medicines Management 7.8 Community and Voluntary Sector 7.9 Carers 7.10 Children and Young People 7.11Transport 7.12 Public Health Protection 7.13 Informatics 7.14 Workforce 7.15 Patient Engagement and Experience 7.16 Research, Development and Training 8.0 The Shape of NHS Services 8.1 Primary and Community Services 8.2 Hospital Services 8.3 Flows from Other Health Boards 9.0 Enablers 9.1 Procurement and Shared Services 9.2 Capital and Estates 10.0 Realising Financial Stability 10.1 Background 10.2 Likely Economic Context 10.3 Financial Planning Principles 10.4 Benchmarking Current Efficiency 10.5 Outline Financial Plan 10.6 Financial Engagement and Transformation Capability 11.0 Making it Happen 11.1 Integrated Planning 11.2 Corporate Objectives 11.3 Evaluation Criteria 11.4 Equality Impact Assessments 9 9 10 11 11 12 13 13 14 14 15 16 17 17 18 18 19 20 21 22 23 24 25 26 27 28 29 30 31 33 34 36 36 39 41 42 42 43 45 45 45 45 46 47 49 50 50 50 51 52
1.0 FOREWORD Local citizens and local communities deserve good health and have a right to expect responsive, high quality care from the NHS. This Framework sets out how Abertawe Bro Morgannwg University Health Board will rise to this challenge and consistently meet the needs and expectations of the public. It specifies ambitious objectives and goals and defines a wide range of priority action areas. The next few years will undoubtedly be characterised by large scale, complex change. The NHS will need to respond to unprecedented financial pressure, new medical technologies, a changing workforce and rising demand. Our plans acknowledge these drivers for change and anticipate the need to introduce new integrated models of care, to focus on prevention and health improvement and to utilise our considerable resources effectively and efficiently. The Framework has been produced following an extensive process of engagement with our partners, the public and our staff. As we implement our plans, this engagement will continue. At all times we want to ensure understanding of and support for our work. We look to the future with confidence. We are building on strong foundations there is excellence in many of our existing services, our partnerships and, above all, our staff. There is moreover a shared sense of ambition and an appetite for change. Our Framework Changing for the Better will harness this excellence, enthusiasm and ambition. It will enable a high quality, responsive and sustainable NHS across ABMU Health Board. Win Griffiths Chairman David Sissling Chief Executive 3
2.0 OUR VALUES AND AMBITIONS Underpinning all that we do is the One Wales ambition to transform Wales into a selfconfident, prosperous, healthy nation and society, which is fair to all. The Welsh Assembly Government is committed to improving the quality and length of life and to ensure that everyone in Wales has a fair chance to lead a healthy life adding life to years and years to life is our challenge. As part of this commitment, patient safety will be our number one priority. 2.1 Our Values Delivering Excellence: We will work to the best of our ability, be purposeful in what we do and focus upon delivering quality results. We will seek ways to improve what we do on a daily basis and innovate where we are confident in managing our risks. We will be flexible in our approach to working with others and adapt when circumstances require us to think or do things in a different way. We will learn from our experiences, the knowledge and insight of others and, in turn, share what we know and understand. Treating Others with Dignity and Respect: We will treat others fairly and demonstrate respect and dignity in our relationships. This will help to build trust and confidence in what we do and encourage others to follow our example. We will put the welfare and wellbeing of patients at the top of our agenda and be mindful, at all times, that meeting the needs of others is the reason we are here. It is a privilege and a responsibility. Working as a Community: We will strive to build relationships with our staff and others that are honest and open, even when our conversations are difficult and challenging. We will act with courage and compassion to make a difference and we will accept personal responsibility for our successes and failures. We will recognise the value we each bring to delivering better health for all and work collaboratively to achieve success. 2.2 Our Strategic Outcomes Improve performance, quality and financial stability by reducing harm, waste and variation: building on the solid foundations of the 1,000 Lives Campaign and intelligent targets to promote adoption of best practices that will efficiently deliver the best possible care. Capture the opportunity of integration: balancing health improvement and health care, creating integrated care, and aligning all support systems. Empower the frontline: providing clinical and non-clinical staff with the tools they need to lead change and deliver high quality care. Deliver excellent services through continuous improvement, good governance and strong partnerships: recognising the critical importance of effective, forwardlooking leadership throughout the organisation. Put local people and local communities at the centre of all our work: to ensure we can meet their expectations at all times. 4
3.0 HOW WE DEVELOPED THIS PLAN In preparation for the creation of the Abertawe Bro Morgannwg University Health Board (the Health Board) a series of events were held to engage with stakeholders and gauge their views on the priorities for the new organisation. Alongside this a series of staff open forums were held to ensure staff were also engaged in this process. The purpose of these events was to ensure our staff and partners contributed to the vision, values and strategic direction of the new organisation. The themes emerging from these events were: A strong desire to commit to our clear consistent vision for the future; A commitment to integration: across the NHS and with partner organisations; An enthusiasm to emphasise communities and localities in our work; A requirement to focus on services not institutions and buildings; A sense of shared ambition and a desire to achieve excellence and continuous improvement in all that we do. In order to develop the clinical strategy and priorities for the next 5 years, we invited views from partners and stakeholders. Responses were received from: Local Authorities Localities Swansea University Clinical Directorates Each Clinical specialty Primary care contractors Community Health Councils Council of Voluntary Services Professional Staff Groups The responses provided a wealth of information and helped us clarify how services should be changed in the future and what the long-term direction of travel for the organisation should be. This lead to a workshop in December 2009 and a follow-up workshop in March 2010 where over 250 participants outlined their views on how services should develop over the next 5 years, and how the challenges facing the ABM area should be addressed. This framework has also been influenced by relevant evidence and acknowledged good practice. We have learnt from the experience of other health systems and particularly those successful in planning and implementing large scale transformational change. We have, moreover, adopted an analytical approach where necessary. We need to ensure our ambitions are combined with an appropriate sense of realism and pragmatism. The requirement is to translate our vision into reality to deliver better health and healthcare services to local communities. 5
4.0 INCLUSIVE AND IN PARTNERSHIP We will work in partnership with others to plan and secure the delivery of the best possible healthcare for local citizens. We will identify all key partners and establish clear mechanisms to involve them in the work of the Board through: The Health Board s own structures and operating arrangements. The new Locality Model will be particularly significant in this regard. It enables joint working with local Authorities and, over time, a focus on engagement with communities and citizens at a more local level. The involvement of Board members and Board officers in formal partnership arrangements. The Health Board will work with Local Authorities, the Third Sector, Swansea University, service users and carers to ensure that there is full commitment in the development and implementation of integrated plans. We will look forward together and search out opportunities for joint working. An example of this is the joint appointment of the Locality Director for Bridgend by the Health Board and Bridgend County Borough Council. We will enthusiastically play an active role in established processes of engagement and partnership. Currently identified areas of partnership working are: Community Plans/Strategies Local Service Boards Health, Social Care & Well Being Strategies Needs Assessments Children and Young People s Partnerships Community Safety Partnerships ABM Substance Misuse Area Planning Board Safeguarding Children Safeguarding Vulnerable Adults Spatial Plans / Local Development Plans Transport and Travel Planning Housing Plans Joint Planning Groups for specific care groups (e.g. Older People, Carers, Younger Disabled People) Strategies for Older People The Valleys Strategy City Centre Framework (Swansea) Convergence Programme In addition, we will develop closer working relationships with the new Community Health Councils to ensure that views from the public can be harnessed in the planning and development of new service models. 6
Community and Voluntary Sector The Health Board is also working in partnership with the third sector in line with Welsh Assembly Government s Designed to Add Value A strategic direction for the voluntary and community sector in supporting Health & Social Care. Delivering health and social care services will require stronger and coordinated partnership across the statutory, independent and voluntary sectors as well as with local people, carers and patients. The voluntary sector has a key role to play in health, social care and well being, particularly in preventing ill health; shifting the balance of provision closer to where people live; involving local people and delivering the type of responsive services and support people want. We will work with the third sector through the following eight key strategic themes: Stronger partnership working within the voluntary sector and between the sectors Better and consistent commissioning Supporting self care and independence Improving access to services for disadvantaged and rural communities Strengthening volunteering in health and social care Integrated workforce planning Reducing hospital admissions and improved discharge Research and development In addition to the joint working identified above, the Health Board is required to establish structures within its own governance arrangements to formally ensure joint working with key stakeholders on issues. Therefore it is establishing the following Advisory Groups: Stakeholder Reference Group Healthcare Professionals Forum Local Partnership Forum Stakeholder Reference Group (SRG) The SRG s role is to provide independent advice on any aspect of Health Board business. This may include: Early engagement and involvement in the determination of the Health Board s overall strategic direction Provision of advice on specific service proposals prior to formal consultations Feedback on the impact of the Board s operations on the communities it serves. The SRG provides a forum to facilitate full engagement and active debate with the aim of presenting a cohesive and balanced stakeholder perspective to the Board. The ABM SRG was established in late 2010 and focussed on discussing the 5 Year Plan Changing for the Better. 7
Healthcare Professionals Forum (HPF) The HPF s role is to provide a balanced, multidisciplinary professional advice to the Board on local strategy and delivery. The HPF will facilitate engagement and debate amongst the wide range of clinical interests within the Health Board s area of activity. Local Partnership Forum (LPF) The LPF s role is to provide a formal mechanism where the Health Board, as employer, and Trade Unions/professional bodies representing the Health Board employees work together to improve health services for the citizens of the ABM area. The University of Swansea The Health Board and the University of Swansea have agreed to establish a long term, strategic and operational partnership driven by a shared commitment to ensuring excellent health and medical care in the region. Both parties recognise that there are potential synergies between a University Health Board and its partner University far in excess of the Traditional University Hospital model which focussed primarily on training doctors and clinical medical research. The partnership will therefore involve multiple links covering education of professionals, continuous professional development, research and audit, innovation, modernisation and international benchmarking. 8
5.0 CONTEXT AND DRIVERS FOR CHANGE 5.1 Demography and Population Health The Health Board covers a population of approximately 600,000, serving one of the most densely populated areas in Wales with 466 persons per square km. Within the area there are almost twice as many people living per square km in Swansea compared with Neath Port Talbot. 45.7%, 27.5% and 26.8% of the population live in the local authority areas of Swansea, Neath Port Talbot and Bridgend respectively. With 17% of Wales population, the area s age and gender profile is very similar to that of Wales as a whole. There are, however, relatively fewer in the 5 to 19 and 55 to 64 year old age groups. Life expectancy in the ABM area is slightly lower than the average across Wales (76.3yrs for men and 80.7yrs for women compared with 76.8yrs and 81.2yrs respectively across Wales). Across Wales and the UK, the general fertility rate, the number of births per 1000 women of child bearing age, had been falling until 2001/02. However this has been slowly rising since. The ABM area s general fertility rate closely resembles the rate across Wales. In the ABM area the under 75 age standardised mortality rate dropped by 18% between 1998 and 2007 and has remained consistently close to the rate across Wales. This fall is likely to reflect not only the activities of health services, but also improvements in living standards during the latter part of the 20 th century. Figures for 2007 show the mortality rate in people less than 75 years old in the ABM area to be higher than, but consistent with, the rate for Wales as a whole. The rate in Swansea is lower than, but consistent with, the Wales rate and the rate in Neath Port Talbot is higher than, but consistent with, the Wales rate. The rate in Bridgend is substantially higher than the Wales rate and makes Bridgend the fourth highest of all the 22 local authorities in 2007. The greatest causes of death in people aged under 75 among Health Board residents are cancer, circulatory disease and respiratory disease, accounting for 39%, 26% and 9% of approximately 1900 deaths respectively during 2007. Deaths in the winter months rise sharply. There are 11,094 people registered on the Register of Physical/Sensory Disability in the ABM area. Almost half of those registered live in Neath Port Talbot. Within the ABM area there are areas of deprivation, particularly in the urban parts of Swansea, Neath Port Talbot and the valley communities in Bridgend. Research shows that unpaid carers, that is, family, friends and neighbours, provide around 70% of care in the community. Changes in marriage patterns, increases in single person households, lone parent families and mobility among family members are likely to reduce the availability of informal care. This is especially the case when older people become sick, disabled, frail or vulnerable. A decline in the number of informal carers is likely to increase the demand for statutory health and social services. As life expectancy increases there is a risk that carers may continue their caring roles for much longer periods. They may also be caring for people with multiple and increasingly complex needs. There were 3,229 9
identified carers in the ABM area between 1 st April 2007 and 31 st March 2008 (split between 37% each in Swansea and Neath Port Talbot, plus 26% in Bridgend). Living arrangements are important because older people living alone may place a greater demand on personal social services compared with older people having other living arrangements. Figures from the 2001 Census report that 43.1% of older people live alone in the ABM area. However, figures vary at Local Authority level from 42.6% in Swansea and Bridgend to 44.5% in Neath Port Talbot. Current projections are for a rise in the older population (75 years and over) of Health Board residents from 43,000 (9% of the total population) in 2006 to 72,000 (13% of the total population) in 2031. This is a significantly higher rate of growth than the 11% projected across Wales as a whole for this period. These estimates are based on assumptions about births, deaths and migration. The increase in the number of older people is likely to cause a rise in the number of people needing healthcare for chronic conditions such as circulatory and respiratory diseases and cancers. Meeting the needs of these individuals will be a key challenge for the Health Board. In the current economic climate, the relative (and absolute) increase in economically dependent and, in some cases, care-dependent populations will pose particular challenges to communities. 5.2 Patient Expectations Current performance in the health care system is mixed; health outcomes and service quality do not always meet the high aspirations of patients or the citizens of Wales. Patient expectations are ever increasing, in relation to access, the range of services available and the responsiveness of the services provided. Patients are moreover expecting to play a much more active role in the planning and delivery of their own care. Many want care to be available at home or local to where they live. We welcome this development in patient expectations and acknowledge the requirement to change our services to allow us to meet them as long as it is safe to do so. At the heart of our commitment to provide a safe, high quality experience is our relationship with patients and those who support them. We will become an organisation that meets not only the physical needs of patients, but personal and emotional ones too. This means: Getting good treatment in a comfortable, caring and safe environment, delivered in a calm reassuring way Our clinicians ensuring that patients understand their condition to be able to make informed choices, to feel confident and to feel in control Being listened to and spoken to as an equal, being treated with honesty, respect and dignity Ensuring that we can communicate effectively with patients, their carers and families in the language of their choice 10
5.3 Quality Our quest to improve quality will be a key driver for change. Getting it right first time is the most efficient way of delivering healthcare. There is variability at present and we need to move to a position where: Our patients receive the same standard of high quality care wherever they receive their treatment; Our patients are safe from harm arising from the healthcare system; Our system of care meets the most common types of needs, but has the capacity to respond to individual patient choices and preferences; Our patients are given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions affecting them; Our patients have access to their own medical information and to clinical knowledge; Our patients receive care based on the best available scientific knowledge; Our patients are directly involved in the development of healthcare services and the manner of their delivery; Our healthcare system makes information available to patients and their families that allows them to make informed decisions about their care; Our healthcare system anticipates patient needs, rather than simply reacting to events; Our healthcare system does not waste resources or patient time; Our clinicians and managers actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care; Our patients receive care when they need it and in many forms, not just face-to-face; Our healthcare system has robust processes of evaluation, monitoring and audit; Our patients have equity of access to services and are treated with equality irrespective of their race, gender, disability, sexual orientation or age. 5.4 Workforce In common with many others across Wales, the Health Board faces some key workforce challenges, including: Significant numbers of hospital middle grade and junior doctor vacancies across most specialties which are difficult to fill. This will require service redesign moving to a Consultant delivered service with senior nurses, therapists and healthcare scientists taking on extended roles to ensure the safe running and sustainability of services. Reductions in turnover due to the economic situation. An ageing workforce. There are 2,004 staff aged between 56 and 65. In total there are almost 9,500 staff aged over the age of 41. Whilst this offers opportunities for workforce redesign this could also mean that there could be significant skills shortages in a range of professions in the future. Delivering the Annual Operating Framework workforce targets which include a 10% shift of staff to a Community setting between 2010 and 2013 and a 3% reduction in staff in bands 5 to 9 and an increase in bands 4 and below each year between 2010 and 2013. 11
Meeting the requirements of the European Working Time Directive. Increasing integration of services with partners, particularly Social Services, requiring different skill sets and different roles. Meeting the requirements of the Empowering Ward Sisters agenda there is a need to ensure supernumerary status of the Ward Sister/Charge Nurse. Extending advanced practice for nurses, healthcare scientists and therapists. Developing shared skills across professions to maximise clinical opportunities for the patient and service. 5.5 Finances Providing quality services that are appropriately delivered in the right setting must be at the centre of the approach taken by the Health Board in planning and delivering services for the population we serve. This is not only the correct approach from a healthcare service and patient point of view, but is also the correct approach from a financial perspective. Financial pressures, whilst challenging, create an opportunity to transform the way services are delivered by reducing waste, harm and variation. Financial pressures are not and can never be an excuse for reducing quality or access. Whilst the Health Board in broad terms, compares favourably with regard to its cost efficiency, there are opportunities that exist to improve service productivity and efficiency within this position. The Health Board in line with NHS Wales overall faces significant and increasing financial challenges. The state of public finances means that funding will reduce in real terms over the coming years while cost pressures are likely to continue to increase. In addition, the total growth (cash) funding provided to NHS Wales over the last six years has been considerable but the service has experienced ever increasing demand and new developments. NHS organisations in Wales therefore enter a more challenging economic period with a clear need for major redesign and service change. 12
6.0 ALIGNING NATIONAL AND LOCAL PRIORITIES The Health Board with its partner organisations has an opportunity to break with the past and make a decisive shift in the balance of services away from a high cost model based on dealing with people whose health is already deteriorating to one based on local, early action to promote and protect health and independence. We can deliver a clear, compelling and exciting vision of the future, one in which we create a truly integrated healthcare system, designed to meet the needs and priorities of our citizens, and comparable with the best in the world. In doing this we will work within the context of the ministerial and national policies outlined below. 6.1 Our Healthy Future Our Healthy Future renews and affirms the Welsh Assembly Government s commitment to improve the quality and length of life and to ensure that everyone in Wales has a chance to lead a healthy life. It sets a long-term vision in which: Children and young people are given a good start in life that supports their long-term health and wellbeing. Everyone aspires to, and is supported to achieve, a healthy and fulfilling working life. Older people have the knowledge, skills or support to make informed choices about living independent and fulfilled lives. The health of individuals experiencing greatest disadvantage is improving to the levels found among the more advantaged. Healthy sustainable communities places where people want to live, work, play and flourish are sought for all. Health and social services place greater emphasis on prevention and early intervention. Health and wellbeing is a shared goal for all. Our public health policies and interventions are based on good evidence and monitored. To realise this vision, Our Healthy Future aims to: Increase the pace of change in improving health in Wales. Increase years of healthy life. Achieve fairer health outcomes. Reduce (or eliminate) barriers to leading a healthy life. Provide the strategic direction for national and local public health. Unhealthy environments and behaviours, and the illnesses they cause, place a considerable and avoidable burden on individuals, communities and organisations, including the NHS. For individuals research has shown that taking exercise, eating a healthy balanced diet, not smoking and drinking below the recommended limits can potentially add 14 years to life. For the NHS, the financial cost of avoidable ill health is huge, continues to grow and is unsustainable in the future. 13
As part of Our Healthy Future, ten high level actions have been identified for the next 3-5 years: Reducing smoking prevalence Increasing participation rates in physical activity Reducing unhealthy eating Stopping the growth in harm from alcohol and drugs Reducing teenage pregnancy rates Reducing accident and injury rates Improving mental wellbeing Improving health at work Increasing vaccination and immunisation rates to target levels Reducing health inequalities 6.2 Setting the Direction The key purpose of this policy is to set out a framework aimed at assisting Health Boards in the development and delivery of improved primary care and community services for their local populations. The implementation of the models of care described in Setting the Direction will enable a step change in the volume and range of care provided nearer to home or at home. This will be enabled by: A Communications Hub providing accurate real time information about public sector services to patients, citizens and staff. Development of Community Networks on a localised basis delivering accessible and integrated services to small populations based around established communities. Accelerated development of Specialist Community Teams to provide more intensive support to people outside hospital. The proposed way forward will be enabled by our workforce, enhanced Information Technology capabilities, appropriate governance arrangements and a focus on standardised care pathways. 6.3 Saving 1,000 lives Plus Through 2009 and 2010 the 1,000 Lives Campaign focused on the reduction of harm, waste and variation. This two year patient safety initiative enabled frontline staff to implement new ways of working which made a real difference to patient care. As part of the 1,000 Lives Campaign, the Health Board worked on six key areas: Improving leadership for quality Reducing healthcare associated infections Improved critical care Improving medicines management Reducing surgical complications Improving general medical and surgical care 14
The programme has been effective in rolling out best practice across Wales. In May 2010 the Welsh Assembly Government launched 1,000 Lives Plus to continue and surpass the positive achievements of the original campaign. There will be a strong focus on accelerating the scale and pace of these improvements so that all patients in all settings can expect to receive the highest levels of care, given reliably all of the time. The programme therefore has a number of mandatory interventions which the Health Board will adopt. We will also sustain existing improvements and develop new clinical interventions and priorities. In addition to the priorities identified above, 1,000 Lives Plus will introduce new ways of working for healthcare organisations to adopt, including: Providing better rehabilitation following a stroke Preventing Acute Coronary Syndrome Speedier recovery from surgery Reducing falls in the community Better treatment for depression Improving care for dementia sufferers Improving maternity services 6.4 Doing Well, Doing Better: Standards for Health Services in Wales The Healthcare Standards for Wales, which were published in 2005, have been updated to ensure that they are fit for purpose. The new standards Doing Well, Doing Better provide the framework to enable organisations to look across the range of their services in an integrated way to ensure that all they do is of the highest quality. They set out the requirements of all health care services in all settings and are at the centre of our drive for continuous improvement in the quality of services that citizens of Wales have a reasonable right to expect. These new standards came into effect from 1 st April 2010. Services and Teams within the Health Board will use the standards to: Assess compliance; Benchmark with others to improve further; Identify what they do well and should be shared; Identify what they do less well and need to put right; Map against their professional standards and show how they complement and sit alongside them; Make changes which contribute to overall quality improvement within their services. The standards will continue to be used by Healthcare Inspectorate Wales to undertake a level of testing and validation against the standards each year as part of their public assurance role. There are 26 standards, each of which has a varying number of actions contained within them. The standards are: Governance and accountability framework Equality, diversity and human rights Health Promotion, Protection and Improvement Civil Contingency and Emergency Planning Arrangements 15
Citizen Engagement and Feedback Participating in Quality Improvement Activities Safe and Clinically Effective Care Care Planning and Provision Patient Information and Consent Dignity and respect Safeguarding Children and Safeguarding Vulnerable Adults Environment Infection Prevention and Control and Decontamination Nutrition Medicines Management Medical Devices, Equipment and Diagnostic Systems Blood Management Communicating Effectively Information Management & Communications Technology Records Management Research, Development and Innovation Managing Risk and Health & Safety Dealing with concerns and managing incidents Workforce Planning Workforce Recruitment and Employment Practices Workforce Training and Organisational Development 6.5 Better Outcomes For Tougher Times: The Next Phase in Public Service Improvement The Welsh Assembly Government has recently published Better Outcomes for Tougher Times to deliver on efficiency and innovation so that public services can use its resources funding, workforce, estates and information more efficiently. This identifies the following areas for focus: Lining up around outcomes for citizens and communities by concentrating resources and energy on those actions that will make a difference, aligning public services round commonly agreed priorities to achieve better outcomes. Offer public services that are more responsive to citizens by using the voice and experiences of citizens to drive change. Greater operational efficiency through improved procurement and commissioning, re-engineering business processes, asset and property management and exploiting the potential of ICT. Collaborating locally and regionally by developing the role of Local Service Boards, regional consortia and Spatial Plan Groups. Improving performance by moving away from targets to focus more on outcomes. Better information and evidence by using an enhanced Living in Wales survey and other measures to tell us how services in Wales are performing and improving. Incentivising and enabling improvement across public services by establishing an Efficiency and Innovation Board and developing a stronger Wales Social Partnership. 16
6.6 Quality, Service, Workforce & Financial Framework A 5 year Quality, Service, Workforce and Financial Framework has been produced for the Welsh NHS. This sets out an ambitious vision of transformational change which will drive up quality within a constrained financial environment. It identifies 11 national programmes focusing on key high value opportunities. Each of the programmes has a similar overriding end point patient safety and quality outcomes. These programmes are: Prevention and Promotion Unscheduled Care Mental Health Long Term Conditions/Primary Care/Primary Care Assurance Continuing Health Care Acute Care Medicines Management Informatics Workforce Social Services/Partnership Patient Engagement/Experience In addition two Task and Finish Groups are being established at an All Wales level supporting the vision underpinned by the Service, Workforce and Financial Framework: Capital and Estates Procurement and Shared Services In order to ensure leadership and performance accountability for these programmes, a lead Executive Director has been identified for each one. In addition the Health Board has identified one other local programme Research, Development and Training which is of sufficient importance to be given an Executive lead. 6.7 Griffiths Review into Non Emergency Patient Transport Across Wales In 2010 the Welsh Assembly Government issued the Griffiths Review into Non Emergency Patient Transport (NEPT) across Wales, on behalf of the Health Minister. The aim of the Griffiths Review was to investigate reports of poor performance and a lack of patient centred service delivery. The review highlighted the following recommendations for all Health Boards. Development of robust Service Level Agreements Greater utilisation of Community and Voluntary Organisations Enhanced cross sector co-operation Pilots are now being implemented across Wales to enable, in due course, the adoption of proven models and delivery arrangements 17
7.0 OUR 5 YEAR PLAN 7.1 PREVENTION AND PROMOTION 7.1.1 Our Objectives and Goals To make significant progress in relation to the six national theme areas identified nationally as part of the Our Healthy Future framework. Reduced Inequities in Health Health through the Life Course Improved quality and length of life Healthy & Sustainable Communities Prevention & early intervention and fairer outcomes for all Health as a Shared goal Strengthening evidence & monitoring progress To specifically address the health inequalities which exist within the ABM area. There is currently significant variation in life expectancy and in the prevalence of disease within and between communities. To foster partnerships with relevant organisations which allow us to address the determinants of ill health. 7.1.2 Priorities for Action In line with Welsh Assembly Strategy the ten key priorities for the Health Board are: o Reducing smoking prevalence; o Increasing participation rates in physical activity; o Reducing unhealthy eating; o Stopping the growth in harm from alcohol and drugs; o Reducing teenage pregnancy rates; o Reducing accident and injury rates; o Improving mental wellbeing; o Improving health at work; o Increasing vaccination and immunisation rates to target levels; o Reducing health inequities. We will utilise our Setting the Direction work to develop an active focus on prevention and health improvement in primary and community care. We will pay particular attention to the potential role of the primary care workforce in this regard. 18
One important new initiative is the decision of the Health Board, the City and County of Swansea and other partners to make a formal application to WHO for Swansea to be designated as a World Health Organisation Healthy City. 7.2 UNSCHEDULED CARE 7.2.1 Our Objectives and Goals Development of 24/7 capability and capacity to enable significant shift in unscheduled care activity from hospital to community and primary care settings. Listening and responding to the views of the front-line staff and patients on how unscheduled care services need to change. Ensuring all four acute hospitals within the ABM area continue to accept emergency medical patients, with protocols to define the range of patients which will be admitted. Delivery of timely and quality patient care in the Accident and Emergency Departments at Princess of Wales and Morriston Hospitals, supporting improved handover times from the ambulance service. Maintenance of high quality care standards evidenced by utilisation of audit, evaluation and patient feedback. 7.2.2 Priorities for Action Enhanced information for citizens and patients so they can access the most appropriate unscheduled care options. Specification of clear roles for each of the hospitals within the Unscheduled Care Network. Development of alternative pathways for short stay emergency conditions. Ensuring that access to primary care is robust throughout the Health Board, considering innovative models to extend access where appropriate. Exploring provision of relevant services into evenings and weekends. Increasing impact of admissions avoidance schemes and support into care homes. Breaking down barriers between primary, community and secondary care services so that services are seamless for patients. Development of new workforce models that reduce reliance on trainee doctors and maximise roles of nurses and therapists. Developing dedicated majors and minors streams within the Emergency Departments to provide timely assessment and treatment. Implementing modern service models for acute medicine including rapid access clinics. Improve discharge planning for both simple and complex discharges, based on effective multi disciplinary team working. Development of a range of monitoring indicators focussing on quality and outcomes. 19
7.3 MENTAL HEALTH Mental health services are entering a period of significant change, including the implications of the following: Significant capital investment to improve facilities across the Health Board Implementing National Service Framework action plans Integration of services with Local Authority, housing and voluntary sector partners Impact on Community Mental Health Teams of establishment of community Networks Delivering the National Dementia Plan Taking forward the recommendations contained within the All Wales Secure Services Review Implementing the Improving Futures Suicide Retention Strategy for Bridgend and Neath Port Talbot Addressing continuing health care challenges Introducing the National Assembly for Wales Legislative Competency Order Mental Health Measure 7.3.1 Our Objectives and Goals We will provide services which are:- Community focused helping people to stay in their own homes for as long as possible Provided in the least restrictive of environments Integrated with Local Authority, Housing and Voluntary Sector partners Supportive and which engage with patients and carers Evidence-based and effective 7.3.2 Priorities for Action Ensuring effective joint working between primary care and mental health services to ensure the needs of people with mental health problems are met. Ensuring an appropriate and enhanced capacity and capability in primary care to manage non-complex mental health patient needs. Implementing an effective and coordinated programme of care and treatment through the Care Programme Approach (CPA) for service users referred to specialist mental health services. Providing effective gate-keeping to ensure all admissions onto Mental Health admission wards are appropriate. Ensuring that patients who live near borders between the ABM area and other Health Boards do not experience difficulties accessing services due to their geographic locations. Implementing upstream prevention and wellbeing initiatives aimed at helping prevent people coming into secondary care services. 20
Implementing the Improving Futures Suicide Reduction Strategy for Bridgend and Neath Port. Ensuring coordination between Child & Adolescent Mental Health Services and adult services to ensure the needs of children and young people are met appropriately. Working closely with the All Wales Secure Services Committee to help take forward the recommendations contained within the All Wales Secure Services Review. Delivering the national dementia plan with focus in particular on: o Education and training o Primary care development o Access to specialist treatment and carer support Progressing the implementation of the National Intelligence Targets relating to depression and dementia. Introducing the National Assembly for Wales Legislative Competency Order (LCO) Mental Health Measure. This initiative will place an obligation on Health Boards and Local Authorities to provide: o Primary care mental health services o Assessment in care planning o Self-referral for those previously discharged from mental health services o Improved mental health advocacy Addressing Continuing Health Care challenges. The number of adult and older patients being transferred to Continuing Health Care funded placements has grown sharply in recent years. The future management of this process is a significant challenge. A comprehensive plan which addresses the priorities set out above will be produced in Spring 2011. 7.4 LONG TERM CONDITIONS 7.4.1 Our Objectives and Goals Improving the services for people with, or at risk of developing long-term conditions. Promoting wellness, rather than treating illness and supporting self care, independence and social inclusion. Integrating the development of community networks, specialist community resource teams and signposting of services to improve the care for individuals with long-term conditions. Reducing the demand placed on hospital services. Maintenance of high quality services evidenced by audit, evaluation and patient feedback. 7.4.2 Priorities for Action Effective utilisation of information to provide a sound evidence base for future decision making; Establishment of risk stratification systems which enable proactive management and intervention for those with developing chronic disease; 21
Implementation of Setting the Direction policy to create the capacity and capability to effectively manage relevant patients in primary and community care settings; Reconfiguration of existing services, with a shift of resources where appropriate from secondary to primary care; Provision of timely, responsive and anticipatory care that is comprehensive, consistent and preventative; Development and strengthening of partnerships with the third sector, where appropriate, to contribute towards providing better services; Simplifying access to coordinated services for promotion of health, social and emotional wellbeing; Developing further Expert Patient programmes to support people in the management of their own conditions; Streamlining and coordinating delivery of services for diabetes, musculoskeletal, neuromuscular, chronic pain, cardiac and respiratory conditions, using appropriate care pathways; Utilising technology and maximising effective use of telecare and telehealth; Increasing uptake of preventative measures e.g. smoking cessation, weight management that will minimise susceptibility to developing long term conditions and reduce the risks associated with living with a chronic condition. 7.5 PRIMARY CARE/PRIMARY CARE ASSURANCE 7.5.1 Our Objectives and Goals Improving the interface between primary and secondary care services; Ensuring the efficiency and accessibility of core primary care services; Developing and expanding primary care services to meet local need; Developing the governance arrangements to underpin new models of service delivery; Effectively engaging Independent Contractors to make changes to the range of services available; Ensuring that primary care is supported through modern infrastructure and premises. 7.5.2 Priorities for Action Continuing work on monitoring access to GP services and improving appointment systems and service delivery mechanisms. Working closely with GP practices and the Local Medical Committee to ensure a consistent approach to access and achievement of the Annual Operating Framework targets. Identifying opportunities for clinicians to deliver services in primary care facilities rather than hospitals. Prioritising estate developments to ensure they move forward in a managed way and so deliver a modern and fit for purpose base for services into the future. Continuing to work with our partners to make the best use of all premises and to ensure that developments that have already begun are progressed efficiently. Making best use of skill mix within primary care. 22
Implementing new models and patterns of care for dental services based on opportunities to develop these in community settings. Continuing to develop new and improved care pathways for patients. Ensuring that education and training for primary care clinicians is at the centre of delivery programmes and the development of a new and more integrated approach. Identifying how out of hours services can work more closely with other unscheduled care services. A review of all out of hours services will begin with the intention of providing new, more integrated models of care in the future. Continuing to develop the interface between NHS services and all contractor professions and the contribution each can make to the patient pathway, (e.g. extending the range of services within community pharmacy). Developing primary mental health services in line with the proposed Mental Health Measure. Ensuring effective referral and discharge information processes, increasingly supported by electronic communication and information systems. Identifying opportunities to develop enhanced services in light of the above priorities and as part of the development of local Community Networks. Stengthening and developing partnerships with the third sector, to enhance services. 7.6 CONTINUING CARE 7.6.1 Our Objectives and Goals Ensuring patients and their carers receive high quality care in an environment which best suits their needs and which supports their right to care provided and funded by the appropriate organisations. Ensuring we listen and respond to patients and carers views. Ensuring a collaborative approach to continuing care between Local Authorities, the Health Board, the Independent Care sector, Third Sector and patients and carers. Delivering continuing care as close to the individual s home as possible, or in the majority of cases, in the patient s own home, supported by robust care planning and coordination. Ensuring effective implementation of the Carer s Measure for carers of continuing care patients including meeting their training needs. Repatriating individuals whose care is currently provided out of area, to care which is delivered within localities, based on robust assessment of need and innovative care planning. 7.6.2 Priorities for Action Establishing a Continuing Care Programme Board to monitor and co-ordinate progress against development plan. Enhancing self care initiatives for Chronic Disease Condition Management to prevent client deterioration. Developing rapid/ early response / CISS Teams (the CISS Team is an intensive support team based in the community) to intervene in supporting clients in their home, thereby preventing hospital admission. 23
Establishing active rehabilitation in slow stream Rehabilitation Wards or in joint schemes with Local Authority colleagues. Training of staff who undertake CHC Multi Disciplinary training assessments and review of the documentation used. Creating community based CHC Teams (including Physiotherapy and OT staff) to reduce the need to admit to private sector placements. Ensuring appropriate schemes, such as respite services, are in place to support carers, particularly at crisis times. Maximising opportunities available through joint working with the voluntary sector providers such as Marie Curie, Crossroads. Establishing Intervention Teams in-reaching into private sector residential, nursing homes and patients own homes in areas such as EMI and Palliative care. Developing the role of community hospitals to optimise contribution to Continuing Health Care; Accelerating processes to enable repatriation of relevant patients from private or remote NHS sites. 7.7 MEDICINES MANAGEMENT 7.7.1 Our Objectives and Goals Extending the role of pharmacists to make an active contribution in preventative and chronic condition management programmes; Effective, evidence-based medicine management practices; Enhancing patient involvement in the planning and management of their medicines; Effective monitoring and evaluation of medicine management practice; Reducing spend on medicines in appropriate areas; Ensuring continuation of prescribing which is appropriate, evidence based and cost effective. 7.7.2 Priorities for Action Developing a new model of medicines management teams utilising the skills of pharmacy teams across all sectors of care, integrating with community networks and resource teams. Developing good practice in interface arrangements with social services and the voluntary sector for example with regard to medicines storage and administration. Implementing IM&T solutions to enhance cross sector communication. We will ensure that national IMT programmes identified through Informing Healthcare are implemented appropriately. Promoting the development of non medical prescribing within the Health Board. Ensuring appropriate utilisation of patient s own drugs whilst in hospital. Continuing to manage the Primary and Secondary Care Drug spend ensuring value for money. Ensuring appropriate mechanism for the introduction of new and high cost drugs which supports the AWMSG and NICE agenda. Improving junior doctor prescribing competences in line with Tomorrow s Doctors. 24