HEALTHCARE PROFESSIONALS FORUM Tuesday 13 March 2018 Rhondda Room, Ynysmeurig House, Navigation Park, Abercynon 1pm-4pm AGENDA

1. Agenda HPF 13 March 2018 PART 1. PRELIMINARY MATTERS 1.1 Welcome and Introductions 1.2 Apologies for Absence 1.3 Declaration of Interests HEALTHCARE PROFESSIONALS FORUM Tuesday 13 March 2018 Rhondda Room, Ynysmeurig House, Navigation Park, Abercynon 1pm-4pm AGENDA Lead / Attachment 1.4 Unconfirmed Minutes of the meeting of the Healthcare Professionals Forum held on 14 November 2017 Chair Attachment PART 2. GOVERNANCE, PERFORMANCE AND ASSURANCE 2.1 Stay Well @ Home Assistant Director of Therapies and Health Sciences Presentation 2.2 Valleys LIFE Assistant Director of Operations Mental Health Presentation PART 3. FOR INFORMATION 3.1 Integrated Medium Term Plan 2018-2021 (latest version) Attachment 3.2 Organisational Chart (work in progress Version 3) Attachment 3.3 MSc Genomic Medicine, Swansea University Medical Attachment School 3.4 General Data Protection Regulations update Attachment PART 4. OTHER MATTERS 4.1 Any Other Urgent Business Chair 4.2 Forward Look what next for the HPF? 4.3 Dates of the Next Meetings to be held at Ynysmeurig House, Abercynon Thursday 12 July 1-4pm and Thursday 15 November 1-4pm. Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 1 of 72

1.4 Unconfirmed Minutes HPF 14 November 2018 MINUTES OF THE MEETING OF THE CWM TAF HEALTHCARE PROFESSIONALS FORUM HELD ON TUESDAY 14 NOVEMBER 2017 IN YNYSMEURIG HOUSE, NAVIGATION PARK, ABERCYNON PRESENT Mrs Collette Kiernan (Chair) Mr Jonathan Arthur Dr Sajitha Koratala Ms Suzanne Scott Thomas Dr Has Shah Mr Tim Palmer Ms Katrina Clarke Mr Steve Davies IN ATTENDANCE Mrs Lynda Williams Mr Chris White Mr Kamal Asaad Dr Kelechi Nnoaham Ms Gwenan Roberts Clare Williams Beth Winder Mrs Janet Barlow Therapies Representative Scientific Representative Medical Representative for Mental Health Clinical Director Medicines Management Primary & Community Care Medical representative Optometry representative Dental representative Community Pharmacists representative Director of Nursing, Midwifery and Patient Care Chief Operating Officer / Director of Therapies and Health Sciences Medical Director Director of Public Health Head of Corporate Services Assistant Director of Planning and Partnerships Workforce Redesign Secretariat HPF/17/17 WELCOME AND INTRODUCTIONS Mrs Collette Kiernan welcomed all to the meeting. All present introduced themselves. HPF/17/18 APOLOGIES FOR ABSENCE Apologies for absence were received from: Carolyn John; Penny Owen, Paul Crank and Robert Cragg. HPF/17/19 DECLARATIONS OF INTEREST There were no declarations of interest received. HPF/17/20 MINUTES OF PREVIOUS MEETING Members AGREED the notes of the meeting which took place on 2 October 2017. Minutes of the meeting of the Health Professionals Forum held on 14 November 2017 Page 1 of 5 Healthcare Professionals Forum Meeting 13 March 2018 1 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

1.4 Unconfirmed Minutes HPF 14 November 2018 HPF/17/21 MATTERS ARISING Mr Kamal Asaad confirmed that the Clinical Services Strategy had been delayed due to the announcement of the potential boundary changes with Bridgend. Members noted that the short term IMTP one year plan would still be developed. Mr Chris White and Dr Kelechi Nnoaham provided feedback to members on the recent Team Wales Event. The Chair explained that the National meetings of all healthcare professionals had recommenced and she had been invited. The forthcoming dates would be shared with members and papers shared as soon as possible. Mr Chris White updated the group on the ongoing work in relation to Imaging, Diagnostics & Pathology. Members noted that the statement of intent for Pathology services was in its final draft stage; the statement of intent for imaging statement had been circulated for final comments. Mr Chris White confirmed that once the final documents had been received they would be forwarded to the group. HPF/17/22 INTEGRATED MEDIUM TERM PLAN (IMTP) PRESENTATION Mrs Clare Williams gave an overview of the work undertaken on the Integrated Medium Term plan. Members were aware that Cwm Taf had an approved IMTP which was confirmed formally by the Cabinet Secretary. To progress the new plan, it was confirmed that the Local Planning Framework published end of October, would need to underpin the work and would be circulated to the group. During the presentation key areas were highlighted which included: The need to ensure and encourage the professional staff voice within Directorate IMTPs Commissioning training packages for staff, particularly for those professions with small number Opportunities for directorates and localities to work together to have invest to save schemes Clinical directorate plans would need to be in the final draft phase by 18 th December for inclusion in the corporate plan for submission to the Welsh Government by 31 January 2018. The Chair asked Members to raise key issues within directorates particularly in relation to work for improving, innovating or opportunities to develop services and joint working. The group felt that it would be helpful to have a view on directorate plans and particularly of the key messages and to not lose the opportunity for the smaller professions (in terms of numbers of staff). Minutes of the meeting of the Health Professionals Forum held on 14 November 2017 Page 2 of 5 Healthcare Professionals Forum Meeting 13 March 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 2 of 72

1.4 Unconfirmed Minutes HPF 14 November 2018 Members resolved to: Thank Clare for the informative presentation Receive key messages at the next meeting in relation to the content of the directorate plans Send any further comments via Gwenan Roberts for inclusion in the corporate process. HPF/17/23 WORKFORCE DEVELOPMENTS Members received update from Ms Beth Winder. Members noted the work being undertaken by the workforce team around the commissioning of training places for staff working within Primary Care. Mrs Suzanne Scott-Thomas informed Members that not all community Pharmacists were employed by Cwm Taf UHB and also raised awareness that a number who were employed by independent contractor pharmacies who are currently not included in the workforce planning numbers. Members felt it was important to take on board the numbers of staff in the independent sector when commissioning places Members resolved to: Invite Beth Winder to all future meetings to provide updates on workforce developments HPF/17/24 COMMUNITY PHARMACY WORKFORCE DEVELOPMENTS Mrs Suzanne Scott Thomas and Mr Steve Davies gave an informative presentation on the community pharmacy workforce developments. Key areas highlighted included: There are 77 community pharmacies in Cwm Taf The number of patient facing services provided by pharmacies Uptake of the flu vaccine 3% of the population vaccinated The Cwm Taf was the first area in Wales to commission the common ailments scheme in all pharmacies and were looking to expand the service in terms of test and treat for sore throats in Cwm Taf from April 2018 Cwm Taf were piloting a blood borne virus (BBV) screening service for people with Hepatitis B in relation to needle exchange; if a positive result was identified, the person would be referred into secondary care for specialist treatment Medicine use reviews & Discharge medicine reviews to ensure that the patient was able to take the medications prescribed safely with the ability to refer to the GP if any issues were identified The electronic discharge advice letter (e-dal) had been rolled out across the health board with the patient being asked about their preferred community pharmacist which was communicated to both pharmacy and GP. The aim would be to have a reduction in the number of errors on medications and GP updating patient records Minutes of the meeting of the Health Professionals Forum held on 14 November 2017 Page 3 of 5 Healthcare Professionals Forum Meeting 13 March 2018 3 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

1.4 Unconfirmed Minutes HPF 14 November 2018 Work was also continuing on gaining access by the community pharmacists to the GP record to inform the emergency medicine supply to a patient. An update on the work being undertaken by Pharmacists and Pharmacy technicians working within GP cluster practices and directly employed by GP practices was also discussed. Members welcomed the presentation and asked additional information if Community pharmacies could be used for more anti-microbial prescribing which Mrs Suzanne Scott Thomas responded had been commissioned from community pharmacy in Cwm Taf. The group were also updated on the developments of the Stay Well @ Home scheme and noted that patients would be assessed at home to manage their medications starting in December 2017. Anticoagulation services were also discussed in relation to the community pharmacy setting and Mrs Suzanne Scott-Thomas explained that the potential to develop many different services including anticoagulation was a distinct possibility in the community pharmacists. Another area of interest including whether there were systems to track the impact of the different schemes and the number of admissions into hospital due to adverse drug reactions. Members noted that currently this was not available. Members resolved to: note the presentation receive an update at a future meeting on community pharmacy services which might include the area What different professions are being accessed by patients via the community HPF/17/25 ENGAGEMENT ON THORACIC SERVICES / CONSULTATION ON MAJOR TRAUMA SERVICES Members noted the reports received on the engagement in relation to thoracic services and the consultation on major trauma. The Members agreed to provide any feedback to Gwenan Roberts by the end of November 2017. HPF/17/26 PROMOTING PROFESSIONALISM, REFORMING REGULATION PAPER FOR CONSULTATION Members noted the consultation on promoting professionalism, reforming regulation and were aware that the Chair (Prof Marcus Longley) was representing Wales on the host Authority. Members were invited as a collective to respond to the paper and it was agreed to send any comments to Gwenan Roberts as soon as possible. Minutes of the meeting of the Health Professionals Forum held on 14 November 2017 Page 4 of 5 Healthcare Professionals Forum Meeting 13 March 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 4 of 72

1.4 Unconfirmed Minutes HPF 14 November 2018 HPF/17/27 ITEMS RECEIVED FOR INFORMATION Safety Alerts Broadcast System Procedure Policy for the Management, Identification and Authorisation of Policies and Procedures Update on the General Data Protection Regulations Latest Version of the Organisational Chart for information HPF/17/28 ANY OTHER BUSINESS Mr Jonathan Arthur informed the group that concerns had been raised by the heads of service in Wales in relation to the lack of recruitment / training for cardiac and respiratory physiology roles and the lack of opportunity to influence the development of the workforce plan. Ms Beth Winder noted the information and agreed to raise with workforce colleagues. Mrs Suzanne Scott-Thomas raised an issue around the use of defibrillators in the community. Members discussed whether there was a policy for the use of defibrillators and Mrs Lynda Williams suggested that this matter be raised at the Resuscitation Committee meeting. HPF/17/29 NEXT MEETING Members noted that the next meeting would take place on Tuesday 13 March between 09:30am and 11:30 am in the Rhondda and Cynon Rooms, Ynysmeurig House, Abercynon. Chair. Date Minutes of the meeting of the Health Professionals Forum held on 14 November 2017 Page 5 of 5 Healthcare Professionals Forum Meeting 13 March 2018 5 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

2.1 Stay well @ home (to follow) Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Stay Well @home Service Six Month Progress Report 1 of 72

2.1 Stay well @ home (to follow) 2 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 What is different? Assessments are undertaken outside of core hours Care/support package agreed and established within the agreed 4 hour response 7 days a week, including bank holidays Information is shared across health & social care, using one record Discharge to assess model used Community review undertaken within the first 14 days An enabling approach is implemented to increase independence levels and reduce dependence on long term service provision. 2.1 Stay well @ home (to follow) 3 of 72

4 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Measures of Success The 3 main measures of success are: % reduction in people admitted to a hospital bed from A&E % increase in numbers admitted but returning home earlier % reduction for those transferred to a community hospital 2.1 Stay well @ home (to follow)

Activity SW@H Hospital Based Team 2.1 Stay well @ home (to follow) Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Total number of assessments completed 1076 (April Sept 2017) July to Sept 17 data demonstrates: 79% referrals responded to within 1 hour Following assessment/input by the SW@HT, admission avoidance and reduced length of stay figures remain positive, with each site having a successful turn around rate. 5 of 72

6 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Activity RCT Support @home Number of referrals 248 Number discharged home with a service 225 100% referrals responded to within 4 hours Outcome of Services 25 Independent of longer term services 108 Require ongoing longer term services 28 Readmitted to hospital Deceased/declined 2.1 Stay well @ home (to follow) 22 Currently ongoing 42

Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Activity MT Initial Response Service Number of referrals 25 Number discharged home with a service 24 5 8 1 Outcomes of Services 9 Independent of longer term service Require ongoing longer term services Readmitted to hospital Deceased /Declined 2.1 Stay well @ home (to follow) 7 of 72

8 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Activity Nursing @Home Service Total number of referrals 27 All referrals have been to the core @home service requiring a response within 3-7 days No referrals requiring a 4 hour nursing response Advanced Nurse Practitioners continue to work with staff based at the DGH to raise awareness around IV administration 2.1 Stay well @ home (to follow)

Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Activity Your Medicines @home Your Medicines @Home, planned implementation for: Rhondda area Dec 1 st 2017 Taf area February 2018 Merthyr and Cynon to follow in quarter 1 and 2 of 2018. Training provided to approximately 550 domiciliary care staff during Oct/Nov 2017 Undertook a pilot project with 12 patients currently on HMAS in Sept 17 2.1 Stay well @ home (to follow) 9 of 72

10 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Summary of first six months data The number of attendances at A&E for patients aged 61 and over, has continued to grow in 2017/18, with attendances increasing by over 5% for the periods April September when compared to 2016/17 Since the start of the SW@H service in April 17 there has been a slight change in overall admissions but it is too early in the year to make a full evaluation, the winter period needs to be included in the data. % reduction in people admitted to a hospital bed from A&E There has been measurable improvement for patients aged 61+ who have a zero length of stay (LOS) There has been encouraging improvement for patients aged over 75 who have a zero LOS There has been measurable improvement for patients aged over 75 who have a 1-2 day LOS 2.1 Stay well @ home (to follow)

Summary of first six months data cont. % increase in numbers admitted but returning home earlier 2.1 Stay well @ home (to follow) Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 (The following are the numbers of people who stay in hospital over 5 days) There has been measurable improvement for patients aged 61+ who have a 5+ day LOS There has been measurable improvement for patients aged over 75 who have a 5+ day LOS % reduction for those transferred to a community hospital There has been a reduction in the numbers of patients being placed on the transfer list for community hospitals. However, a total of 8 months below the average would be required to demonstrate a change in the overall performance and so this requires ongoing analysis 11 of 72

12 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Summary of first six months data cont. The findings of the recent Delivery Unit Audit 2017 (a repeat of the audit undertaken in 2016 prior to the start of the project), shows a reduction in the percentage of delayed discharges attributed to Community Pathways and the Interface with Social Care There has been an encouraging reduction in the hospital escalation levels ( 1 4) 60% being level 1 or 2 There has been a rebalancing of bed usage between medical and surgical beds leading to a reduction in cancellations of elective admissions. 2.1 Stay well @ home (to follow)

Value for money Potential bed days saved is as follows: 2.1 Stay well @ home (to follow) Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 13 of 72

14 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Value for money cont. Using a direct annual cost per bed estimate of 41,522, this would equate to potential cost avoidance of 832k (reported expenditure of 560k) for the period April to September 2017 Initial indications would demonstrate that the implementation of the SW@W Service is promising, with potential value of benefits outweighing the cost of investment by over 48%. Note: Due to a growth in emergency admissions and a reduction in cancellations of elective admissions there has been a rebalancing of bed usage between medical and surgical beds. Therefore the actual difference between occupied beddays in April to September 2017/18 has reduced by a much lesser degree. 2.1 Stay well @ home (to follow)

Next Steps Continued monitoring of the Stay Well @home Service is undertaken throughout the winter period to provide further assurance of sustainability and deliverability. 2.1 Stay well @ home (to follow) Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Implement those elements of the original business case which are not yet fully operational: Initial Response MTCBC out of hours planned for quarter 4 2017 Medication Support @Home, planned implementation for Taf area February 2018, Merthyr and Cynon to follow in quarter 1 and 2 of 2018. Validate progress through further analysis of the re-admissions data, auditing any re-admissions directly linked to Stay Well @home. Establish a robust and repeatable service user feedback approach which can be used across the service. Commission an external more detailed review, including lessons learnt, of the entire Stay Well @home Service to commence in April 2018 following a years worth of operation. 15 of 72

16 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Valley LIFE 2.2 Valleys LIFE (background information)

Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 CWM RECOVERY MODEL IN MENTAL HEALTH Developing the Mental Health Model in Cwm Taf Investment approach Developing YGT through the VALLEY LIFE Project into a Dementia Hub What s next 2.2 Valleys LIFE (background information) 17 of 72

18 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 THE RECOVERY MODEL REMEMBER WHAT WE SAID.. Nobody receives mental healthcare in bed OUR AIM AT THE BEGINNING Where possible, everyone with a mental health problem can recover at home or in the community WHERE WE STARTED. First with children, then adults of working age and now those over 65 years of age HOW HAVE WE DONE IT Investing in community services and working with patients, families and professionals to achieve the best WHAT HAS IT MEANT. Better patient outcomes; less hospital admissions; shorter lengths of stay; needing less beds 2.2 Valleys LIFE (background information)

Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 INVESTMENT What have we done to prepare the ground? Expanded Community Mental Health Teams for over 65s Specialist Dementia Advisors & Dementia Support Nurses Natural Waking Project (National Patient Safety Award) Memory Assessment services Care Home Intervention Team in (shortlisted for national award) An Enhanced Care Unit in the RGH Enhanced rehabilitation in St David s Functional Unit, RGH From 5 to a 7 day hospital-based Psychiatric Liaison Services What else do we want to do? Expand our Memory Clinic Initiative Increase in-patient psychology Develop a Hospital Based Flexible Resource team to work with people with Dementia in a general hospital bed 2.2 Valleys LIFE (background information) 19 of 72

20 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 VALLEY LIFE Local Integrated services for the Frail and Elderly A new approach for people in the older years More care in the community and at home Reduce unnecessary hospital admissions Where admission is necessary, it will be shorter and discharge planning will be better 2.2 Valleys LIFE (background information)

Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 WHAT WILL IT DO? The aim is to provide a critical mass of expertise to support GP clusters in Rhondda and Taf Ely: Increase diagnostic rates and thus access to the right services Early access to cognitive assessment Choice in packages of support people at home as An alternative to admission Increase the quality of treatment and support in residential and care homes A critical support hub for carers and families Integration with other services such as District Nursing to address frailty and reduce risk in the home setting 2.2 Valleys LIFE (background information) 21 of 72

2.2 Valleys LIFE (background information) 22 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

2.2 Valleys LIFE (background information) Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 23 of 72

2.2 Valleys LIFE (background information) 24 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Q Phase 4 Proposed; W35 and W7 Dementia Hub at KHHP, Increase Day Care, NH in-reach, AHPs, Increase memory Assessment, residential unit Phase 3 Proposed; Fernhill and Cambrian Ward; Dementia Hub at YGT, Increase Day Care, NH in-reach, AHPs, increase memory Assessment, residential unit Phase 2 Dinas Ward (YGT); Increase in PLS to 7 days, new functional outreach team Phase 1 Ward 1 (DSH), single site assessment (Seren); Increase in CPNs to 7 day working (OPMH) 2.2.1 Appendix 1 Presentation 25 of 72

2.2.1 Appendix 1 Presentation 26 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

2.2.1 Appendix 1 Presentation Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 27 of 72

2.2.1 Appendix 1 Presentation 28 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.1 Integrated Medium Term Plan 2018-2021 AGENDA ITEM 3.1 31 JANUARY 2018 Health Board Report UPDATE ON DEVELOPMENT OF CWM TAF UNIVERSITY HEALTH BOARD S INTEGRATED MEDIUM TERM PLAN 2018 2021 Executive Lead: Deputy Chief Executive/Director of Planning & Performance, Director of Finance and Director of Workforce and Organisational Development. Author: Assistant Director of Planning and Partnerships Contact Details for further information: Clare Williams. Telephone 01443 744833 or email clare.williams11@wales.nhs.uk Purpose of the Health Board Report This report provides an update on the progress made in developing the UHB s Integrated Medium Term Plan (IMTP) for the period 2018-21 and invites members to approve the final draft IMTP prior to submission to Welsh Government for assessment and scrutiny. The final draft IMTP will be available to Board following scrutiny by both Executive Board and the Finance, Performance and Workforce Committee. Governance Link to Health Board Strategic Objective(s) Supporting evidence The Health Board s Integrated Medium Term Plan 2017-2020 is developed to deliver the related organisational objectives, aligned with the Institute of Healthcare Improvement's (IHI) Triple Aim : To improve quality, safety and patient experience. To protect and improve population health. To ensure that the services provided are accessible and sustainable into the future. To provide strong governance and assurance. To ensure good value based care and treatment for our patients in line with the resources made available to the Health Board. The report focuses mainly on improving quality, safety and patient experience and ensuring good value based care and treatment for our patients in line with the resources made available to the Health Board. A full version of the UHB s current Integrated Medium Term Plan 2017-2020 and supporting annexes are available electronically via the following web link: Update on Development of the IMTP 2018-21 Page 1 of 18 Health Board Meeting 31 January 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 1 of 72

3.1 Integrated Medium Term Plan 2018-2021 Update on Development of the IMTP 2018-21 http://cwmtaf.wales/how-we-work/plans-andreports/integrated-medium-term-plans/ Engagement Who has been involved in this work? The update of the IMTP for 2018 2021 is underpinned by an internal and external engagement process designed to initiate a genuine conversation with the organisation and its stakeholders about delivery of the UHB s strategic priorities. The engagement plan can be reviewed via the following hyperlink: IMTP Stakeholder Engagement Plan. Health Board Resolution To: APPROVE ENDORSE DISCUSS NOTE Recommendation The Health Board is asked to: NOTE the progress made to date in developing the UHB s IMTP for 2018-21. APPROVE the final draft IMTP (Appendix 1), prior to submission to Welsh Government on 31 January 2018. Summarise the Impact of the Health Board Report Equality and diversity Legal implications Population Health Quality, Safety & Patient Experience Resources An overarching Equality Impact Assessment of the updated IMTP will be completed and considered by the UHB s Equality Committee and the Health Board. The IMTP contains a number of indicators to monitor progress in relation to legislation, such as the compliance to national targets and measures and compliance to statutory duties. For 2018-21, particular consideration will be given to the implications for the UHB in continued implementation and compliance with the requirements of Social Services and Well-Being (Wales) Act 2014; the Well-Being of Future Generations (Wales) Act 2015 and the Nurse Staffing Levels (Wales) Act 2016. Assessment of Population Health including a range of actions to improve Population Health, predicated on the Health Needs Assessment is included in the updated Plan (Appendix 1, Chapter 4 and Appendix 1, Book A1) and developed in a number of supporting plans in further detail (Appendix 1, Chapter 5). Quality, Safety and Patient Experience is a major theme running throughout the IMTP and is based on the UHB s Quality Strategy and Delivery Plan. There are a range of resource implications for the delivery of the Plan, which are identified in the Page 2 of 18 Health Board Meeting 31 January 2018 2 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.1 Integrated Medium Term Plan 2018-2021 Risks and Assurance Health & Care Standards Workforce Freedom of information status Finance Chapter of the IMTP (Appendix 1, Chapter 7). These are being re-visited and revised as required and as part of the ongoing planning and risk management processes. Principal risks to delivery and mitigating actions are identified in the updated Plan. In terms of the planning process to develop the IMTP, the Health Board s Integrated Planning Group keep risks under review and develop mitigating actions accordingly. The 22 Health & Care Standards for NHS Wales are mapped into the 7 Quality Themes: Staying Healthy Safe Care Effective Care Dignified Care Timely Care Individual Care Staff & Resources http://www.wales.nhs.uk/sitesplus/documents/1 064/24729_Health%20Standards%20Framework _2015_E1.pdf The work reported in this summary and related annexes take into account many of the related quality themes. The updated IMTP identifies a range of areas that will impact on workforce which include developing the workforce, recruitment and retention, realigning staff numbers and using indicators to monitor progress in relation to Workforce, such as sickness and Personal Development Review rates. There is a specific chapter on workforce in the IMTP that brings these issues together (Appendix 1, Chapter 6). Open Update on Development of the IMTP 2018-21 Page 3 of 18 Health Board Meeting 31 January 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 3 of 72

3.1 Integrated Medium Term Plan 2018-2021 UPDATE ON THE DEVELOPMENT OF CWM TAF UNIVERSITY HEALTH BOARD S INTEGRATED MEDIUM TERM PLAN 2018 2021 1. SITUATION / PURPOSE OF REPORT This report provides the Health Board with an update on the development of the UHB s Integrated Medium Term Plan (IMTP) and highlights those chapters in particular pertaining to finance, performance and workforce. Subject to Health Board approval, the IMTP will be submitted to Welsh Government on 31 January 2018 for assessment and scrutiny. A final version IMTP then needs to be developed by 29 March 2018 for final approval by the Health Board and submission to the Welsh Government. 2. BACKGROUND / INTRODUCTION The Welsh Government published the NHS Planning Framework 2018-21 and the draft NHS Delivery Framework 2018/19 on 11 October 2017. The NHS Planning Framework requires each Health Board and NHS Trust in Wales to prepare and submit a Board approved final draft of the three-year IMTP to Welsh Government by 31 January 2018, with a final version to follow by 29 March 2018. Work has therefore been commissioned across the organisation to develop the UHB s IMTP for the period 2018-21 (attached as Appendix 1). 3. ASSESSMENT / GOVERNANCE AND RISK ISSUES The updated NHS Planning Framework for 2018-21 requires Health Boards and NHS Trusts to demonstrate efficiency and value for money in achieving the Triple Aim of improving outcomes, improving experience and achieving best value in the way we use our resources. It places greater emphasis upon the following areas: The Well-being of Future Generations (with a particular focus on how IMTPs are adopting the sustainable development principles and contributing to the well-being goals). Quality and safety. Prudent and value based healthcare. Integration. Collection working (including partnership working, regional planning and between health boards and trusts. Maturity and continued improvement across all service areas. Key delivery priorities include: Prevention. Reducing health inequalities. Primary and community care. Timely access to care. Mental health. Update on Development of the IMTP 2018-21 Page 4 of 18 Health Board Meeting 31 January 2018 4 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.1 Integrated Medium Term Plan 2018-2021 Overall, the National Planning Framework stipulates that plans should demonstrate traction and pace in delivery priorities, while maintaining a tangible commitment to improving population health. A key thrust of our IMTP is therefore about actualising the potential for our healthcare system to drive sustainable improvements to the population health of Cwm Taf, both directly and through leveraging public health, local partnerships and enabling policy and legislation (such as the Well-being of Future Generations Act). As a result, we will plan and commission services over the course of the next three years focusing on the following in order to improve population health: A reduction in ill health across our communities and an improvement in well-being. Fully embraced and demonstrated progress against delivery of the principles and ethos of the Well-Being of Future Generations (Wales) Act 2015. Embedded value and prudent healthcare in our service planning and delivery. Delivered truly integrated services with our partners across the health, social care and wider public sector community, particularly for children, young people, people with learning disabilities and older people. Build a recovery model of mental health, where all but the most acute episode of illness are treated and cared for within the community. Strengthened core primary care services through extending enhanced services across federated practices to improve equity of access. The development of Cluster Hubs to further drive locality working, thus facilitating a demonstrable shift of service from secondary to primary care. Implemented innovative and efficient workforce and service models in primary, community and acute services to support implementation of our clinical service strategy. Implemented redesigned secondary care service models across our fragile service areas, as part of local and where appropriate regional arrangements with our partner Health Boards and Trusts. Update on Development of the IMTP 2018-21 Page 5 of 18 Health Board Meeting 31 January 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 5 of 72

3.1 Integrated Medium Term Plan 2018-2021 Developed a strengthened approach to commissioning services through Welsh Health Specialised Services Committee (WHSSC) and Emergency Ambulance Services Committee (EASC), that are provided by others, including neighbouring health boards, Velindre NHS Trust and Welsh Ambulance Service Trust (WAST). As a consequence, the UHB commissioned the following streams of work across the organisation in early October: An organisational wide IMTP Engagement Event on 18 October 2017. Development and release, on 31 October 2017, of a Local Planning Framework 2018-21. An IMTP Stakeholder Engagement Plan to include Executive Director/ Assistant Director led IMTP discussions at both internal and external committees and groups. Participation in the All-Wales Winter Learning / IMTP Event on 23 November 2017. A working draft of the updated overarching, UHB IMTP to be made available by mid-december 2017. First draft updates of the Clinical Directorate Plans by 18 December 2017. First draft updates of the Corporate Directorate Plans by 8 January 2018. (Submission dates are staggered to free up corporate business partners to support the prioritisation of clinical directorate plans). Confirmation of the Cross-Cutting Themes for 2017-20 (see below). 3.1 Framing and Structure of the Integrated Medium Term Plan Key considerations for the UHB in updating its IMTP for 2018-21 include: Cwm Taf UHB is the only Health Board in Wales to have had its IMTP approved in four consecutive years. Cwm Taf should therefore be confident in its reputation as an organisation that can deliver. The UHB achieved financial balance in the first three years of its IMTP, and is predicted to do so again in 2017/18. The UHB has invested in an integrated Business Partner Model to support the Directorates in the development and delivery of their IMTPs. This model is embedded and maturing. As we move into year four of the Business Partner Model, support is in situ from Patient Care and Safety, Planning, Workforce and OD, Finance, Procurement, I.T. and Performance and Information. The UHB is adopting a system wide approach to well-being which weaves together the principles of: Prudent Healthcare; the IHI Triple Aim; Equitable Healthcare; Value-Based Health and prevention. In putting the system wide approach to well-being into practice, Cwm Taf has strengthened its golden thread integrated planning approach. As well as linking quality to population need, service planning, demand and capacity, workforce, capital and financial planning, now value, prevention, integration and collaboration are more prominent than ever before. Update on Development of the IMTP 2018-21 Page 6 of 18 Health Board Meeting 31 January 2018 6 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.1 Integrated Medium Term Plan 2018-2021 We await the outcome of the Welsh Government consultation on proposals to align the Bridgend Local Authority catchment population with that of Cwm Taf before final completion of the Clinical Services Strategy. This is not however, preventing us from making use of the rich information gathered to date as we begin to develop the services described in the IMTP, or to work towards the overarching aim of the strategy to provide a balanced system of care where people get the right care in the right place from people with the right skills, working across the artificial boundary of hospital and community services. In light of our system wide approach to well-being, as we develop our Clinical Services Strategy we are using the model of healthcare system outlined in the figure below. In turn, this informs our priorities for each area of service provision. Consequently, areas of importance and focus for the UHB to articulate in the 2018-21 IMTP include: The influence of the system wide approach to well-being on the further development and implementation of the UHB s Clinical Services Strategy. A stronger focus on population health and the well-being of future generations. Describing the contribution it will make to the Cwm Taf Public Service Board. Further identification of options and plans for health and social care integration. Improved alignment of the IMTP with the Primary Care Cluster Plans. Improved alignment with further regional and national service change plans. A strengthened workforce and OD approach, including innovation in recruitment, retention, career development (e.g. the HCSW skills escalator, a medical workforce strategy and recruitment plan, introduction of the Physician Assistants) and further building delivery capacity within the organisation. Update on Development of the IMTP 2018-21 Page 7 of 18 Health Board Meeting 31 January 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 7 of 72

3.1 Integrated Medium Term Plan 2018-2021 More sophisticated demand and capacity plans, and robust monitoring of their delivery. Planning for recurrent financial balance. Set out in the following way, the structure of our Plan is closely aligned to the Welsh Government s National Planning Framework and the Clinical Services Strategy. MESSAGE FROM THE CHAIR AND CHIEF EXECUTIVE A welcome to our updated IMTP EXECUTIVE SUMMARY Providing an overview and summary of key messages CHAPTER 1 INTRODUCTION An overview of our system wide approach to well-being, our services and approach to our Plan CHAPTER 2 STRATEGIC CONTEXT Values, vision and objectives, including the Clinical Services Strategy CHAPTER 3 PROGRESS IN DELIVERING OUR PLAN Outlining the journey travelled over the last three years and the achievements in 2017/18 CHAPTER 4 2018-21 DRIVERS FOR CHANGE An overview of our legislative and policy drivers and the key population challenges and the opportunities available over the next 3 years CHAPTER 5 SIGNIFICANT SERVICE CHANGE IN 2018-21 Reflecting on the progress made in 2017/18 and the challenges we continue to face, the key service change required to deliver the clinical services strategy CHAPTER 6 WORKFORCE AND ORGANISATIONAL DEVELOPMENT Detailing the main workforce challenges and opportunities CHAPTER 7 FINANCE 2018/19 TO 2020/21 Setting out the financial plan CHAPTER 8 - ENABLERS The priorities for Innovation, ICT and Capital and Estates CHAPTER 9 DELIVERY, STEWARDSHIP AND GOVERNANCE The governance and assurance framework which wraps around our Plan BOOK A1 LOCAL POPULATION & HEALTH NEEDS CHALLENGES LOCAL ANNEXES BOOKS A1 TO A3 BOOK A2 QUALITY ASSURANCE & IMPROVEMENT (including Research & Development) BOOK A3 SERVICE CHANGE PLANS (including service delivery plans and commissioning priorities) SUPPLEMENTARY INFORMATION ANNEXES B1 TO B11 WELSH GOVERNMENT ANNEXES C1 TO C21 3.2 Service Change and Performance/Quality The service change plans have been developed both corporately and at directorate level, following submission of Directorate Plans on 18 December 2017. All service change is focused on delivering the following objectives. Update on Development of the IMTP 2018-21 Page 8 of 18 Health Board Meeting 31 January 2018 8 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.1 Integrated Medium Term Plan 2018-2021 As a University Health Board, our priorities for 2018-21 are to: 1. Embrace the prevention agenda, for example by encouraging our patients and staff to adopt one more healthy behaviour and supporting the well-being of our communities with our partners, including the development of community zones. 2. Demonstrate greater integration across health and social care, particularly in the way in which services are provided to our more vulnerable client groups i.e. older people with complex needs, people with learning disabilities, children with complex needs and all age carers, with increased joint commissioning arrangements, pooled budgets and making better use of our estate in partnership. 3. Implementation of our next step mental health service improvements, including the next phase of older adult mental health service redesign and new approaches to dementia care. 4. Implement our updated primary and community care plans including improving the sustainability of primary care; further development of our Clusters and Cluster Plans, improved demand management and evidencing the shift of service from secondary to primary care. 5. Development of local and regional hospital service planning and delivery where appropriate in areas such as diagnostics, ophthalmology and orthopaedics, as well as vascular and ENT service redesign. 6. Continue to improve scheduled and unscheduled patient care, patient flow and urgent care processes including: maintaining and improving upon the target of no patients waiting for treatment over 36 weeks; maintaining and improving upon the target of no patients waiting over 8 weeks for diagnostics; continuing to work on the 95% 4 hour target (maintaining wherever possible at least 90% performance) and having no patients waiting over 12 hours. 7. Continue work to meet the 31 day target and work to meeting the 62 day cancer target, maintaining at least a 90% position. 8. Continue our strong involvement and approach to the commissioning of specialist services working with partners such as WHSSC, EASC and Velindre NHS Trust. Update on Development of the IMTP 2018-21 Page 9 of 18 Health Board Meeting 31 January 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 9 of 72

3.1 Integrated Medium Term Plan 2018-2021 9. Continue to improve patient experience throughout the University Health Board. 10 Further develop our Clinical Service Strategy. 11. Address recruitment and retention challenges with a priority on workforce planning and redesign and development of new roles such as Physician Associates. Overarching Enablers 12. Further developing leadership and delivery capacity across the organisation. 13. Engage with an increasing number of members of the public and staff in Cwm Taf through a variety of accessible platforms to involve people in the design and development of new clinically led and patient focused services, both in and out of hospital. 14. Improve data quality, including reporting and transparency. 15. Ensure compliance with legislation. 16. Achieve financial balance In developing plans for this service change, we have given consideration to the Tier 1 performance targets within each of the domains and projected a position for the end of this financial year. Whilst not all targets will be fully met, the UHB has committed to meeting the Referral To Treatment (RTT) target for 36 weeks and the 8 week diagnostic target. In addition the non-urgent suspect cancer target will be met, as will the Mental Health Measure, with a commitment to deliver better compliance for patients waiting less than 26 weeks than was the case for March 2017. There is evidence of further improvement in terms of unscheduled care also, with the UHB s IMTP commitment of 90% of patients admitted, transferred or discharged within 4 hours of arrival at A&E being a realistic achievement before the end of this year. There will need to be some refinement of the levels expected to be achieved throughout the lifetime of the IMTP, prior to its submission in March, though the work carried out to date is a realistic platform on which to base discussions. 3.3 Workforce Cwm Taf continues to strengthen its organisational development approach to our maturing Health Board and this is demonstrated in the new Plan. We understand the need to continuously build capacity and capability from within, enabling staff to change, empowering them to take responsibility to improve the quality of service delivery and continuously enhance performance in our services for patients and the population. Update on Development of the IMTP 2018-21 Page 10 of 18 Health Board Meeting 31 January 2018 10 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.1 Integrated Medium Term Plan 2018-2021 Some of our greatest risks to transformation however are our workforce fragility and recruitment difficulties in both Primary and Secondary care and areas of priority are described in the Plan. However, these are also some of our biggest opportunities for innovation and workforce re-designs. The Plan sets out three core organisational development frameworks addressing Engagement, Education and Leadership. The transformation articulated in Cwm Taf s IMTP becomes possible when staff are fully engaged and learning together influenced by credible management and leadership distributed throughout the organisation, and across our external partnerships. We have received positive feedback from the staff survey and medical engagement survey and this is enabling us to focus interventions to further support and develop this approach. The focus of our workforce agenda in the Plan will therefore be to: Build upon organisational development capacity. Build on the staff engagement work undertaken over the past 5 years. Support Primary Care with workforce innovation and the development of the multi-disciplinary team. continue to address our recruitment & retention and corresponding pay bill pressures. Support innovative workforce modernisation, competency based workforce planning that supports service change; optimize the use of e-systems to drive efficiency and the delivery of safe patient care. Based on our corporate and directorate plans, the net impact of our workforce profile is projected in the Plan at a reduction of circa 509 paid WTE over three years. Provision for investment in new service and delivery models has been made within the finance plan and this reduction will be offset by a projected increase over the three years of 258 paid WTE. This investment in new service delivery models and other quality and safety investments are dependent upon the assumed funding set out in the financial plan, which requires confirmation with the Welsh Government. The net decrease of 251 paid WTE over three years of current workforce is shown in table below: Workforce Plan 2017-18 to 2019-20 Savings Plans Cost Pressures and investment Net Movement 2018/19-211 80-121 2019/20-174 84-90 2020/21-124 94-30 Total -509 258-251 Further details of the year one impact by staff group and the expected model of workforce reduction is shown in the following table. The table below reflects this position for both financial and workforce plan movements: Update on Development of the IMTP 2018-21 Page 11 of 18 Health Board Meeting 31 January 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 11 of 72

3.1 Integrated Medium Term Plan 2018-2021 Workforce Plan 2017-18 Staff Group Savings plans Investments and Cost Pressures Total Board Members 0 0 0 Medical and Dental -15 8 23 Nursing and Midwifery 33 30 63 Registered Additional Prof, Scientific and 1 2 3 Tech Healthcare Scientists -17 1-16 Allied Health Professionals -11 4-7 Additional Clinical Services -141 14-127 Administrative and Clerical -69 14-56 Estates and Ancillary -22 7-14 Students 0 0 0 Total -211 80-131 It should be noted however, that the estimated WTE referred to above, does not in all cases mean a real reduction in employed staff. This WTE reduction will be released through skill mix change, reduce usage of bank staff and efficiencies. The biggest challenge to the UHB s financial position is the overspend on Medical and Dental and Nursing Locum, Bank and Agency expenditure from which we plan to reduce by circa 8.8m next year. The focus for workforce approach to rebalancing the workforce will be based around three key strategies set out in the Plan and which are summarised below: Workforce redesign, skill mix change and new roles We will continue to develop a multi-disciplinary approach across acute, community and primary care settings, developing alternative and new roles to both compliment and develop different workforce models which will address the recruitment challenges the organisation is facing. This will significantly influence the shape of our future workforce. Our key priorities for 2018 2021 will be: Further development of Advanced and Extended roles within the Secondary and Primary Care settings. Trialling and introduction of alternative practitioners including Physicians Associates, Surgical Care Practitioners etc. Development of the HCSW and apprenticeship roles within the Secondary and Primary Care settings. Support and encourage the appropriate use of delegation, ensuring a competent and prudent workforce. Update on Development of the IMTP 2018-21 Page 12 of 18 Health Board Meeting 31 January 2018 12 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.1 Integrated Medium Term Plan 2018-2021 Maximising workforce efficiency Alongside improving general workforce productivity, the Health Board has two key identified workforce productivity themes which are underpinned by e- systems development: Medical Workforce Productivity - e.g. targeted medical recruitment strategy for permanent posts coupled with control and reduction of our expenditure on locum agency staff. Introduction of targeted interventions to support the introduction of Caps on Medical Agency & Locum expenditure. Nursing Workforce Productivity - e.g. targeted nursing recruitment strategy for permanent posts coupled with control and reduction of our expenditure on premium agency staff. Introduction of new care pathways for patients requiring enhanced personal care. In support of these cross cutting themes - E-systems Workforce Productivity - e.g. roll out and implementation of our e-systems ESR self service, medical and dental e-rostering and job planning, nursing e-rostering and bank modules. All of these e-systems compliment and enable the two productivity strands above. Flexing the size and location of the workforce Delivering the scale of workforce change identified will continue to be challenging and will require a co-ordinated and staged change programme. We will ensure alternative workforce models are considered as part of patient pathway redesign and change. We will underpin this with the use of a competency based approach to Workforce Planning. Additionally we will accelerate and actively utilize retire and return to facilitate skill mix change and flexible retirement to support workforce stability and retention of experience. Enabling work will support the rationalization of the Health Board accommodation portfolio through the development of agile working principles. We anticipate that there will be modest access to VERs in the event that we are unable to redeploy staff to suitable alternative posts via the Organisational Change Policy process. However we do not expect that we will need to utilize any compulsory exit mechanisms to facilitate change. This would only be utilized as a last resort. The main workforce risks/limitations to the transformation of services being delivered are also set out in the Plan and include. Our ability to recruit within a challenging UK and international labour market. Ability to engage Locum and Agency at the capped rate. Delays in delivering the service and workforce change in the earlier part of the year will necessitate greater levels of workforce savings in the latter part and may require blunter measures to be utilised, e.g. vacancy freeze, etc. Risk of not achieving the changes in service provision and workforce modernisation to enable safe and sustainable services to be provided. Breakdown in partnership working. Update on Development of the IMTP 2018-21 Page 13 of 18 Health Board Meeting 31 January 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 13 of 72

3.1 Integrated Medium Term Plan 2018-2021 Fragility of medical and nursing workforce. Management capacity and capability to deliver. Ability to release staff for development and lead in time to develop new roles and extended skills. Lower staff turnover levels than predicted will reduce our capacity to deliver pay savings. Implications of BREXIT and potential loss of /inability to recruit from a European market. Changes to Pension and Taxation regulations which may affect retirement decision particularly senior professional and management staff. 3.4 Overview of the Financial Plan for 2018-21 The key assumptions driving our underpinning financial plan in the IMTP for the next three years are summarised below: A forecast underlying deficit at the end of 2017/18 of 6.0m. Additional recurring allocations from Welsh Government of 22.9m in 2018/19 and a further 28.1m in 2019/20 and 22.2m in 2020/21. Provision for recurring inflation, cost and service pressures of 23.5m in 2018/19, 28.5m in 2019/20 and 22.6m in 2020/21. These figures include provision for an annual pay award of 1% per annum plus incremental drift and non-pay increases from 2018/19 in line with projected inflation. The higher cost in 2019/20 includes 5.9m resulting from NI and pension changes. The Plan includes 3.6m for investment in new All Wales initiatives in 2018/19. The Plan also includes 2.3m for local discretionary investment in new service and delivery models plus 0.8m earmarked investment for Mental Health services. The local discretionary investment increases to 4.5m per annum in 2019/20 and 5.0m 2020/21. The plan includes provision for a number of non recurring costs and benefits with a breakeven position in 2018/19 followed by net costs of 3.0m per annum for each of the next two years. This includes 1.5m for Invest to Save schemes in 2018/19 followed by 1m per annum for the next two years. Recurring efficiency and redesign savings of 13.6m are required in order to deliver a balanced budget in 2018/19. This is 2.7% of the controllable budget of circa 500m. The recurring savings requirement reduces to 11.2m (2.2%) in 2019/20 and 8.0m (1.6%) in 2020/21. The total recurring savings over three years is 32.8m (6.6%). Availability of Welsh Government strategic capital funding to support the capital costs of the key changes included in the plan. Our three year capital plan includes a number of schemes which are critical to deliver key service changes within our Plan, many of which are key enablers for saving included in the Plan. It is assumed that the depreciation costs of all future capital schemes are fully funded by the Welsh Government, in line with current policy. These additional costs and consequent non-cash backed allocation changes are not included in the financial schedules pending clarity on approvals. Update on Development of the IMTP 2018-21 Page 14 of 18 Health Board Meeting 31 January 2018 14 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.1 Integrated Medium Term Plan 2018-2021 The financial plan is shown in the table below, with costs and deficits shown as positive numbers and income and surpluses as negative numbers. Based on the assumptions outlined above, this IMTP aims to deliver a break even position over the three year period. 2018/19 2019/20 2020/21 Total R = recurring NR = non recurring R NR Total R NR Total R NR Total m m m m m m m m m Brought forward recurring deficit/-surplus 6.0 6.0 2.0 2.0-2.3-2.3 Income changes Share of core un-earmarked growth monies -22.1-22.1-22.2-22.2-22.2-22.2-66.5 Share of earmarked growth monies -0.8-0.8 0.0 0.0-0.8 Return of 17/18 Brokerage -3.0-3.0 0.0 0.0 0.0 Invest to save repayments 0.2 0.2 0.4 0.4 0.4 0.4 0.0 Estimated repayment of 17/18 AME funding for retrospective CHC claims which crystallise in 18/19 1.3 1.3 0.9 0.9 0.7 0.7 0.0 Estimated new AME funding for new retrospective CHC claims provided for in 18/19 Estimated repayment of any 17/18 AME funding for NHSFNC Judicial review costs which crystallise in 18/19 Assumed Consequentials funding for UK national NI and pension changes -0.5-0.5-0.5-0.5-0.5-0.5 0.0 tbc tbc tbc tbc tbc tbc 0.0 0.0-5.9-5.9 0.0-5.9 Sub total income changes -22.9-2.1-24.9-28.1 0.8-27.3-22.2 0.6-21.6-67.3 Cost pressures and investments Pay rises, incremental drift and inflation 9.9 9.9 9.9 9.9 9.9 9.9 29.7 UK national NI and pension changes 0.1 0.1 5.9 5.9 0.0 0.0 6.0 Service and demand pressures 13.5 13.5 12.7 12.7 12.7 12.7 38.9 Service improvement - All Wales initiatives 3.6 3.6 0.0 0.0 3.6 Service improvement - locally determined 2.3 2.3 4.5 4.5 5.0 5.0 11.8 Service improvement - earmarked WG growth monies 0.8 0.8 0.0 0.0 0.8 Slippage on cost pressures and investments -0.8-0.8-1.5-1.5-1.5-1.5 0.0 Other Non-recurring costs & benefits 0.0 0.0 3.0 3.0 3.4 3.4 Contingency 2.3 0.9 3.2 2.0 2.0 2.4 2.4 6.7 Sub total cost pressures and investments 32.5 0.1 32.6 35.0 1.5 36.5 30.0 1.9 31.9 97.5 Efficiency and re-design savings -13.6-13.6-11.2-11.2-8.0-8.0-32.8 Sub total -13.6 0.0-13.6-11.2 0.0-11.2-8.0 0.0-8.0-32.8 Total change on previous year -4.0-2.0-6.0-4.3 2.3-2.0-0.2 2.5 2.3-2.6 Revised surplus/deficit 2.0-2.0 0.0-2.3 2.3 0.0-2.5 2.5 0.0 0.0 Update on Development of the IMTP 2018-21 Page 15 of 18 Health Board Meeting 31 January 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 15 of 72

3.1 Integrated Medium Term Plan 2018-2021 Medium Term Savings Plan 2018-21 Recurring efficiency and redesign savings 2018/19 2019/20 2020/21 Total m m m m (13.6) (11.2) (8.0) (32.8) Total (13.6) (11.2) (8.0) (32.8) The total recurring savings over the three year period is 32.8m which is around 6.6% of the Health Board s controllable expenditure (excluding capital charges and primary care contracts) of circa 500m. Recurring Efficiency and Re-Design Savings 2018-21 Our 2018/19 savings plan has been constructed over the following key categories: Savings Categories 2018/19 'm Addressing savings shortfalls and 8.8 recurrent overspends from 2017/18 Improved Controls and Cost Reduction 2.9 Net Income Generation - Staffing Models., Workforce 3.1 Management, Recruitment and Retention Efficiency And Productivity - Value; Pathways; Referral and Treatment 3.4 Thresholds; Clinical Decision Making Service Reconfiguration and Premises 1.1 Rationalisation Transitional funding (2.2) Sub Total 17.1 Contingency (3.5) TOTAL 13.6 Key Risks to the 2018-21 Financial Plan The following sets out risks to be managed by the University Health Board during the lifetime of the IMTP: Recurring deficit brought forward from 2017/18. Shortfall in savings delivery. Non pay inflation exceeding the 2m (2%) provision in the financial plan. Efficiency shortfalls to meet elective demands. Update on Development of the IMTP 2018-21 Page 16 of 18 Health Board Meeting 31 January 2018 16 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.1 Integrated Medium Term Plan 2018-2021 Other unavoidable cost pressures exceeding the 3m provision in the financial plan. WHSSC demand pressures exceeding plan provision of 2m. NICE costs greater than plan provision of 2.5m. Risks that require further discussion with Welsh Government (WG) Our income assumptions are set out in Section 7.4 which include an additional funding requirement of 9m. The potential impact of any changes to these assumptions would require discussion with WG. The final cost of the 2018/19 annual pay award could exceed the 1% plan assumption of 3.0m. Securing approval for capital funding to deliver the schemes which are key to the achievement of re-design and productivity savings over the three year period. Financial Risk Management Plans for 2018/19 Further development of the capability and capacity to plan and deliver service improvement and change. Further development of demand and capacity planning, reflecting both improved pathways and improved productivity in the delivery of services. Further increasing the rigour of requiring clear expected outcomes to be demonstrated before investment in re-designed services is approved. Development of more detailed options and plans for reconfiguration of services within the South Wales Programme and further work planned by the South East Regional Planning Forum, ensuring that value for money is maximised in those plans, including more detailed clinical models, patient flow predictions, staffing models and resultant financial plans. As regards the second category of risks which the Health Board cannot manage alone, the key actions regarding the 2018/19 risks are as follows: To engage with the Welsh Government regarding the assumptions the Health Board is making regarding additional allocations and slippage. To continue working with other Health Boards to develop a single integrated plan for service reconfiguration under the South Wales programme, and to liaise with the Welsh Government regarding the service and capital and revenue consequences of that plan. To continue working with other Health Boards through the Management Group and the Joint Committee to improve the effectiveness of WHSCC commissioning. To progress capital business cases and seek approval decisions from Welsh Government in a timely way. The key risks for years two and three are similar to those in 2018/19: Welsh Government income assumptions. Delivery of savings in line with the plan. Update on Development of the IMTP 2018-21 Page 17 of 18 Health Board Meeting 31 January 2018 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 17 of 72

3.1 Integrated Medium Term Plan 2018-2021 Managing cost and demand pressures in line with the plan. This particularly applies to the assumption of the 1% public sector pay policy continuing during a period of potential higher inflation. In addition, the plan also assumes that there will be no adverse financial impact from the introduction of the new fair funding formula or the new IFRS16- Accounting for finance leases. 3.5 Next Steps Work will continue in order to further develop the final IMTP including: A review of the Welsh Government feedback, due in February 2018, on the final draft IMTP, with appropriate amendments made. Feedback and further development of Directorate and Corporate IMTPs, prior to their final Plan submissions, 12 March 2018. Submission, on 29 March 2018, to Welsh Government of a final version IMTP following Health Board approval. 4. RECOMMENDATION The Health Board is asked to: NOTE the progress made to date in developing the UHB s IMTP for 2018-21. APPROVE the final draft IMTP (Appendix 1), prior to submission to Welsh Government on 31 January 2018. Freedom of information status Open Update on Development of the IMTP 2018-21 Page 18 of 18 Health Board Meeting 31 January 2018 18 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

Chief Executive Mrs Allison Williams Cwm Taf University Health Board Chair Professor Marcus Longley Vice Chair Mrs Maria Thomas Community Community IT & Info Governance Mr Keiron Mr Mel Dr Chris Montague Jehu Turner Version 3: February 2018 Please note: the following organisations are also hosted by Cwm Taf: Welsh Health Specialised Services Committee WHSSC http://www.whssc.wales.nhs.uk/home Emergency Ambulance Services Committee EASC http://www.wales.nhs.uk/easc/home (From April 2018 - The National Imaging Academy - NIA Independent Members Legal Finance University Third Sector Mr James Mr Paul Mrs Jayne Vacancy Hehir Griffiths Sadgrove Local Authority Cllr Robert Smith Trade Union Ms Gaynor Jones Associate Members Social Stakeholder Healthcare Services Reference Professionals Mr Gio Ms Clare Ms Collette Isingrini Llewellyn Kiernan 3.2 Organisational Chart Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 19 of 72 Chief Operating Officer (Interim) Mr John Palmer Deputy Chief Operating Officer & Assistant Director (AD) AD Medicine Kath McGrath AD Surgery Deb Lewis AD Therapies and Health Science Alyson Davies AD Operational Support Services Russell Hoare (Acting) Head of Business Support Amanda Powell AD Information Technology Richard Cahn Head of: Clinical Systems Karen Winder IT Infrastructure Chris Ball Software Development Liam Morrissey Pathology and Radiology Clinical Directors: Dr Esther Youd (Pathology) Dr Balan Palaniappan (Radiology) Directorate Manager: Alan Lewis Deputy Chief Executive Director of Planning and Performance / Ms Ruth Treharne Assistant Directors (AD): AD Planning and Partnerships Clare Williams AD Capital and Estates Tim Burns AD Performance & Information Alan Roderick AD Innovation and Service Improvement / Programme Management Office Rachel Marsh AD Commissioning Julie Keegan Surgery. Urology, Trauma & Orthopaedics (T&O), Obstetrics & Gynaecology and Sexual Health Clinical Directors: Mr Xavier Escofet (Surgery and Urology) Ms Lisa Williams (T&O) Mr Jonathan Pembridge (Obs &Gynae) Directorate Manager: Director of Nursing, Midwifery and Patient Care Mrs Lynda Williams Assistant Directors (AD) AD Nursing Lesley Bevan AD Quality and Clinical Governance Andrea Gristock Head of Safeguarding Jane Randall Paula Pearce Head of Midwifery, Gynaecology & Sexual Health: Debbie Griffiths (Interim), starting April - Kerri Eilertson-Feeney Chief Operating Officer Medicine (including medical records, Outpatients, Acute Medicine, Accident & Emergency) Clinical Director: Dr Anthony Gibson Directorate Manager: Director of Public Health (including University Status) Dr Kelechi Nnoaham AD Research and Development John Geen Public Health Consultants (Public Health Wales) Sara Thomas Collette Kiernan Head of Nursing: Prince Charles Hospital Deborah Harris EXECUTIVE DIRECTORS Angela Jones Health Promotion Specialists Margaret Munkley Diane Gibbons Director of Workforce and Organisational Development Mrs Jo Davies Assistant Directors (AD): AD Workforce Gareth Hardacre AD Organisational Development, Learning & Development, Education and Clinical Education Robert Cragg Equality, Welsh Language & Sensory Loss Manager Liz Jenkins Anaesthetics, Critical Care and Theatres (ACT) / Head and Neck (H&N) Director of Finance & Procurement (Interim) Mr Mark Thomas Clinical Directors: Dr Vikram Sinha (ACT) Mr Sandeep Berry (H&N and Clinical Lead for Cancer) Directorate Manager: Neil Cooper Head of Nursing: Royal Glamorgan Hospital Amanda Cassidy Deputy Director of Finance Mark Thomas Assistant Director of Finance Scheduled Care Sue Holroyd Head of Finance for: Unscheduled Care Neil Mahoney Primary, Community & Mental Health Ana Riley Planning and Reporting Andrew Jones Financial Accounting Capital and Systems Huw Evans Corporate Directorates Shane Evans (Procurement provided by NHS Wales Shared Services Partnership) Head of Procurement Esther Price Director of Primary Community and Mental Health Therapies Localities and Primary Care Children and Young People (CYP) & CAMHS Directorate Manager: Jo Williams Medical Director Mr Kamal Asaad Deputy Medical Director & AMD Innovation /Service Transformation and Role Redesign Dr Ruth Alcolado Assistant Medical Directors (AMD): AMD Clinical Operational Performance and Productivity Mr Vijay Singh AMD Primary Care Innovation and Service Transformation Dr Stuart Hackwell AMD Professional Standards, Regulation and Organisational Learning Dr Richard Quirke AMD Strategic Lead Medical Education Professional Lead Appraisal & Revalidation Dr Anthony Gibson AMD Quality and Safety & Strategic Lead Mortality reviews Dr Lynne Millar-Jones Clinical / Locality Directors: Dr David Miller Rhondda Dr Gareth Jordan Cynon Dr Kurt Burkhardt Taff Ely Dr Nicola Lewis Merthyr Tydfil Directorate /Locality Managers: Community Services (including hospitals) Alison Lagier Primary Care Sarah Bradley Head of Nursing Director of Primary Community and Mental Health (Interim) Lesley Lewis Clinical Directors: Dr David Deekollu Children and Young People Dr Tracy Gardiner CAMHS Directorate Manager: how we do things here.leading compassionate care...looking after you, looking after others...developing you to be the best you can be Cwm Taf Cares Our staff and patients are at the heart of everything we do Mr Alan Lawrie Assistant Directors (AD): AD Primary Care, Children & Community Services Craige Wilson AD Mental Health and Learning Disabilities Julie Denley AD Valley LIFE / other projects Paul Davies Clinical Director /Head of Medicines Management Suzanne Scott Thomas BOARD DIRECTORS Director of Corporate Board Director Services & Governance / Board Secretary Mr Robert Williams Head of: Corporate Services Gwenan Roberts (includes Civil Contingencies) Communications & Media Felicity Waters Health, Safety and Fire Chris Beadle Christopher Coslett Heads of Nursing Julie Cude ( for CAMHS) Meryl Wiltshire (interim for CYP) Mr Stephen Harrhy Hosted by Cwm Taf Chief Ambulance Services Commissioner for Wales and National Collaborative Commissioning Unit (NCCU) Other national role (working directly to Welsh Government) National Director Unscheduled Care Programme. NCCU Team Director Julian Baker Clinical Director Shane Mills Assistant CASC Ross Whitehead Adult Mental Health and Learning Disabilities Interim Clinical Directors : Dr Kishole Kale / Lynne Garwood Directorate Manager: Lucy Timlin Head of Psychology Juan Delport Head of Nursing: Phillip Lewis

3.3 MSc Genomic Medicine, Swansea University MSc Genomic Medicine Swansea University Medical School NHS FUNDING AVAILABLE _ Advanced knowledge and skills to develop and deliver personalised health care Swansea University Medical School is one of the fastest growing medical schools in the UK and is recognised as a centre of excellence in world-class medical and healthcare teaching and interdisciplinary research Key Features This new programme offers research scientists and Health Care Professionals an interdisciplinary approach to translational medicine. Its Innovative curriculum is informed by Health Education England, NHS England and Genomics England Ltd Develop knowledge and skills to understand and interpret genomic data to inform scientific research and clinical practice Develop an understanding of the range of genetic and genomic techniques available and their application in the clinical setting Study data analysis for health and medical sciences, which introduces the bioinformatic approaches required for the analysis of genomic data Undertake an in-depth literature review or a research project within a professional work environment in the NHS or industry This course is suitable for graduates with a 2.2 honours degree (or equivalent) in a bioscience or health related discipline. Candidates who can demonstrate sufficient relevant work experience may also be considered on an individual basis. UK TOP 3 Medical School Modes of study This modular course offers research scientists and Health Care Professionals the opportunity to gain a Master s Degree on a full or parttime basis. PG Certificate and PG Diploma exit qualifications are also available. For more information, visit www.swansea.ac.uk/medicine Email: study@swansea.ac.uk Tel: +44(0)1792 295111 SwanseaMedicine Swansea University Medical School, Singleton Park, Swansea SA2 8PP, Wales, United Kingdom 20 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18

3.3 MSc Genomic Medicine, Swansea University MSc Meddygaeth Genomeg Ysgol Feddygaeth Prifysgol Abertawe ARIAN GIG AR GAEL _ Gwybodaeth a sgiliau uwch i wella datblygu a darparu gofal iechyd personal Ysgol Feddygaeth Prifysgol Abertawe yw un o r ysgolion meddygol sy n tyfu gyflymaf yn y DU. Caiff ei chydnabod fel canolfan ragoriaeth mewn addysg feddygol a gofal iechyd ac ymchwil rhyngddisgyblaethol gorau r byd Nodweddion Allweddol Mae r rhaglen newydd hon sy n gynnig dull rhyngddisgyblaethol at feddygaeth drosiadol i gwyddonwyr ymchwil a gweithwyr proffesiynol ym maes gofal iechyd. Mae ein cwricwlwm arloesol yn cael ei lywio gan Health Education England, y GIG yn Lloegr a Genomics England Ltd. Datblygu r wybodaeth a r sgiliau sydd eu hangen i ddeall a dehongli data genomig i lywio ymchwil wyddonol ac ymarfer clinigol Datblygwch ddealltwriaeth o r ystod o dechnegau genetig a genomeg sydd ar gael a sut y maent yn cael eu defnyddio mewn lleoliadau clinigol Astudiwch ddadansoddi data ar gyfer gwyddorau iechyd a meddygol, sy n cyflwyno r dulliau biowybodaeth sydd eu hangen er mwyn dadansoddi data genomeg Ymgymerwch ag adolygiad manwl o lenyddiaeth neu brosiect ymchwil mewn amgylchedd gwaith proffesiynol yn y GIG neu ddiwydiant Mae r cwrs hwn yn addas i raddedigion gyda gradd 2.2 (neu gyfwerth) mewn biowyddorau neu ddisgyblaeth sy n gysylltiedig ag iechyd. Ystyrir hefyd, ar sail unigol, ymgeiswyr sy n gallu dangos profiad gwaith perthnasol helaeth. Ysgol Feddygaeth 3 Uchaf yn y DU Dulliau astudio Mae r cwrs hwn yn cynnig y cyfle i wyddonwyr ymchwil neu Weithwyr Gofal Proffesiynol ennill Gradd Feistr ar sail amser llawn neu ranamser. Mae cymwysterau gadael ar ffurf Tystysgrif a Diploma Ôl-raddedig ar gael hefyd. Am rhagor o wybodaeth, ewch i www.swansea.ac.uk/medicine E-bost: study@swansea.ac.uk Ffôn: +44(0)1792 295111 SwanseaMedicine Ysgol Feddygaeth Prifysgol Abertawe, Parc Singleton, Abertawe SA2 8PP, Cymru, y DU Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 21 of 72

22 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 MSc Genomic Medicine Dr Claire Morgan, Course Director c.morgan@swansea.ac.uk 3.3.1 Additional information

Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Course Philosophy MSc Genomic Medicine at Swansea University Medical School has been developed in line with Health Education England, NHS England and Genomics England Ltd. to equip research scientists and Health Care Professionals with: knowledge and skills to understand and interpret genomic data to inform scientific research and clinical practice an understanding of the range of genetic and genomic techniques available and their application in the clinical setting bioinformatic approaches required for the analysis of genomic data advanced knowledge and skills, preparing graduates to develop and deliver personalised health care 3.3.1 Additional information 23 of 72

24 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Course Overview Students will be introduced to: The fundamentals of human genetics and genomics Techniques required for DNA and RNA sequencing to study genomic variation observed in the clinical setting Bioinformatic approaches required for the analysis of genomic data Subsequent study will build on these foundations. Specific modules will focus on: The application of genomics to Molecular Pathology of Cancer Application of Genomics in Infectious Disease Common and rare inherited diseases 3.3.1 Additional information

Exit Qualifications Three exit qualifications are available: 3.3.1 Additional information Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Postgraduate certificate (60 credits) Postgraduate diploma (120 credits) MSc (180 credits) All modules are also available on a CPD basis 25 of 72

26 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Programme Structure Postgraduate Certificate (60 credits) Fundamental Knowledge 3.3.1 Additional information

Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Programme Structure - Postgraduate Diploma (120 Credits) Year 1 Fundamental Knowledge Year 2 specialisation and application PMGM14 Molecular Pathology of Cancer (10 credits) PMGM15 Application in Genomics and Infectious Disease (10 credits) PMGM16 Genomics of Common and Rare Inherited Diseases (20 Credits) Optional Module may include: PMGM19 Pharmacogenomics and Stratified Health care OR PMRM01 Critical Appraisal and Evaluation OR PMLM16 Leadership in Practice Progression to Year 2 and optional module choice selection Provisional Optional modules 3.3.1 Additional information 27 of 72

28 of 72 Healthcare Professionals Forum Meeting 13 March 2018-13/03/18 Programme Structure - MSC (180 credits) 3.3.1 Additional information