Deputy Director of NHS Quality Improvement and Patient Safety Candidate Briefing Pack 1
Contents Welcome letter to applicants from Dr Aidan Fowler, Director of NHS Quality Improvement and Patient Safety/Director of 1000 lives Improvement Service Job advert Job Description and Person Specification Background information about NHS Quality Improvement and Patient Safety Directorate Background information about Public Health Wales Executive Summary of Public Health Wales Strategic Plan 2016-2018 and the Strategic Objectives for supporting the NHS to improve healthcare outcomes for patients. (This is Board approved and subject to Ministerial approval) 2
Letter to applicants 1 June 2016 Dear Candidate, Public Health Wales Deputy Director of NHS Quality Improvement and Patient Safety We are delighted that you have expressed an interest in this pivotal and exciting new NHS leadership role within Public Health Wales. The Deputy Director of NHS Quality Improvement and Patient Safety will be essential in supporting patients, the public and colleagues in the NHS to drive forward tangible and sustainable improvements in patient outcomes and embed a culture of patient safety, quality improvement and learning across the NHS in Wales. This exciting new role will have an NHS Wales wide remit working closely with Welsh Government and all Health Boards and Trusts across the country. It is an NHS leadership role working to the Director of NHS Quality Improvement and Patient Safety/Director of 1000 lives Improvement Service who has overall responsibility for driving improvements in patient safety, quality improvement and innovation through the principles of prudent healthcare across the NHS in Wales. We are now seeking to appoint an exceptional Deputy to the Director who can inspire the behavioural changes required in a high performing and learning health system, provide constructive challenge where improvements are required and build capacity and capability in improvement science to enable robust change to happen at scale. The successful candidate will also have specific responsibility for leading the support offered to NHS Wales in improving quality of healthcare services. Candidates will need to demonstrate an impressive track record in strategically leading and delivering improvements in quality and safety, have an in depth understanding of improvement science and ideally have senior clinical experience gained within a complex strategic or provider setting. They will also have the ability to engage and work with national and international partners to forge alliances, share good practice and innovation and apply learning in to Wales. The Public Health Wales Board is highly committed to achieving a healthier, happier and fairer Wales and to placing our organisation at the leading edge of 3
global public health. This is an outstanding opportunity for someone who is dynamic, visionary, innovative and transformational. We are a confident, flexible and imaginative directorate that is also undergoing internal transformation to best fit our challenging and exciting strategic priorities and this is a new role within these changes. If you want to explore your candidacy further please feel free to contact us and we would be more than happy to discuss the post with you in greater detail. Further information about us is provided in the attached pack. This could be the first step in a life-changing move! With kind regards, Dr Aidan Fowler Director of NHS Quality Improvement and Patient Safety/Director of 1000 Lives Improvement Service Stuart Silcox Head of Business & Planning 1000 Lives Improvement Service 4
ADVERT Agenda for Change Band 9 Based in Central Cardiff Public Health Wales plays a pivotal role in driving improvements in health and wellbeing, reducing health inequalities, improving healthcare outcomes, protecting the public and supporting quality improvement, innovation and patient safety across Wales. We have an exceptional opportunity for a talented and inspirational Deputy Director to join our organisation and further drive improvements in the public s health in Wales at this exciting time. To drive these improvements effectively, and make the maximum impact for our population, we need to work closely with our partners to improve the outcomes for the patients of today, help people stay healthier for longer, create a healthier destiny for our children and tackle the wider determinants of health. This role provides a significant opportunity to make radical changes and secure measurable improvements in these areas. This exciting new role will have an NHS Wales wide remit working closely with Welsh Government and all Health Boards and Trusts across the country. Together with a significant new focus on national strategic leadership, it also provides a new focus and remit for the 1000 Lives Improvement Service. It is an NHS leadership role with responsibility for driving improvements in patient safety, quality improvement and innovation through the principles of prudent healthcare across the NHS in Wales. The role will also have specific responsibility for leading the support offered to NHS Wales in improving quality of healthcare services. Candidates will need to demonstrate an impressive track record in strategically leading and delivering improvements in quality and safety, have an in depth understanding of improvement science and ideally have senior clinical experience gained within a complex strategic or provider setting. They will also have the ability to engage with and work with national and international partners to forge alliances. If you think this is the role for you and you are an innovative and transformational individual seeking a genuine opportunity to lead at this level, please apply today along with a copy of your CV. To arrange to discuss this role further and to apply, contact GatenbySanderson through Helene Usherwood 0121 6445717 or Emma Pickup 0113 205 6289 and visit www.gatenbysanderson.com job ref: GSe28137 to upload your application. Closing date for applications: Monday 27 th June 2016 Final interview date: Tuesday 12 th July 2016 5
Public Health Wales NHS Trust Job Description Deputy Director of NHS Quality Improvement and Patient Safety Accountable to Key Relationships Director for NHS Quality Improvement and Patient Safety/1000 Lives Improvement Service NHS Quality Improvement and Patient Safety Leadership team and staff Public Health Wales Executive Team Staff across the organisation Senior Professionals, Directors and Management Team in Public Health Wales Welsh Government officials Health Boards, Trusts and other NHS organisations Bevan Commission People using services, carers and the public Royal Colleges and Professional bodies Academic partners Local Authorities and Local Service Boards Local and National Third Sector Organisations Community Health Councils Professional bodies Advisory Committees Staff representatives and trade unions Assembly Members, Members of Parliament, Ministers and Government Officials Media Remuneration and Terms Agenda for Change Band 9 79,415-100,431 (Determined by the Public Health Wales Job Evaluation Committee within the Agenda for Change framework) Location: Managerially Responsible for: Central Cardiff based with requirement to travel All staff, resources and performance within the portfolio of functions outlined below 6
1 JOB PURPOSE This is an exciting and pivotal senior leadership position in Public Health Wales with overall responsibility for leading and managing the quality improvement programme function of the NHS Quality Improvement and Patient Safety/1000 Lives directorate of Public Health Wales to support the NHS in demonstrably embedding a culture of learning, quality improvement and innovation with a focus on eliminating harm. This position is also the Deputy role to the Director of NHS Quality Improvement and Patient Safety and Director of the 1000 Lives improvement service and in addition to having leadership responsibility for the Quality Improvement Programmes, they will lead a portfolio of work on behalf of and as agreed by the Director and deputise for the Director as needed. This role will also enable the principles of prudent healthcare to drive the support that is provided. In order to achieve this, the post holder will need to ensure that Public Health Wales delivers step change in the design, development and implementation of improvement programmes ensuring measurement of outcomes are identified and evaluated. This will include the further adoption of evidence-based improvement interventions and the Institute of Healthcare Improvement s (IHI) Triple Aim to maximise health system performance across Wales. This will be focused through the provision of strong quality improvement and programme management being delivered with clear focused deliverable outcomes. The role is responsible for strategically leading and managing the Quality Improvement Programme Management function. This will include ensuring that principles for managing successful programmes are embedded; ensure that improvement activity within NHS Wales is led by evidence, impact assessment, ongoing evaluation, measurement and knowledge of best practice nationally and internationally whilst exploiting multiple means of digital communications. The role will also embed a culture of learning and continuous improvement within the team to maximise service delivery in order to meet service needs. As a Senior Manager for Public Health Wales, the post holder will fully contribute to, and participate in, the leadership and governance of Public Health Wales and providing both strategic input and operational management for the effective delivery and measurement of quality improvement and the successful development and implementation of the Integrated Medium Term and Operational Plans. 2 BACKGROUND 7
As is the case in many countries, the NHS in Wales is facing increasing challenges and opportunities to continually improve the quality, safety and effectiveness of the service it provides. These challenges include an ageing population, increase in people with long term conditions, persistent health inequalities for people living in areas of high and low deprivation and a challenging fiscal and economic environment. In rebalancing our healthcare system through strengthened primary and community based care and establishing equal relationships between patients and professionals, Public Health Wales has a significant role to play in securing improved healthcare outcomes. NHS Wales has a longstanding history of embracing quality improvement including the establishment of the 1000 Lives Improvement Service within Public Health Wales in 2013 from its predecessor organisations. This improvement service has provided a national resource for the NHS and has been instrumental in developing quality improvement capacity within NHS organisations and improving outcomes and experience for patients. Building on this strong platform, it is now timely to develop further the quality improvement support for NHS Wales and Welsh Government by developing the already established team to meet the healthcare challenges of today and tailoring the support resource in a way that adds maximum value for patients, NHS organisations, staff and the public. 3 KEY ACCOUNTABILITIES The key accountabilities for this role are as follows. 3.1 Strategic Leadership Lead the development and implementation of focused national and local healthcare quality improvement programmes on areas including those requested by the Health and Social Care Department of Welsh Government and also support requested by the Local Health Boards and NHS Trusts within Wales. Work with senior colleagues in Health Boards and NHS Trusts (including CEO s, Chief Operating Officers and Medical Directors) to identify and resolve the barriers and potential enablers for improvement in their NHS delivery and patient outcomes. Develop a rolling national and organisational improvement programme that best meets the needs of NHS organisations through the business planning process and as otherwise required. This will be focused on the achievement of measurable continuous improvement. Provide strong and effective strategic leadership, policy advice and direct support to the NHS and Welsh Government in the areas of quality improvement, patient safety, innovation and prudent healthcare. 8
Understand and apply systems working as an approach to demonstrably improve healthcare outcomes across a patient s journey and with the intention to reduce health inequalities in how improvement support is provided. Identify national policy and delivery challenges and opportunities across NHS Wales and support the approach to addressing these through, research, publications and learning events. Contribute to and help inform policy and strategy formulation within Public Health Wales, the NHS and Welsh Government through presentation of evidence, interpreting policies/strategies and how best to implement and embed as appropriate. 3.2 Deputise for Director of NHS Quality Improvement and Patient Safety Regularly Deputise for the Director of NHS Quality Improvement and Patient Safety/Director of 1000 lives Improvement Service as required at Executive team meetings, Welsh Government meetings, Health Board meetings etc. Lead a portfolio of work on behalf of and as agreed by the Director. Lead and contribute to discussions with Welsh Government including CMO, NHS Wales Chief Executive and senior civil servants on the role, impact and outcomes of the directorate as Deputy Director. Lead and contribute to discussions with Health Board Chief Executives, Chief Operating Officers, Medical Directors etc. on the role, impact and outcomes of the directorate as Deputy Director. Present at National / International forums as required representing the organisation / directorate. Lead on required organisational changes and the management of any consultations required to build a high performing and competent team to deliver Health Quality Improvement for Public Health Wales and the wider system. Manage any media / interviews / public facing communications required either in own specialist area of expertise or on behalf of the Director. 3.3 Manage a portfolio of programmes of work that aim to improve healthcare outcomes Discuss, negotiate and agree programmes of work in collaboration with Welsh Government, Health Boards or Trusts and third parties. Identify areas of work where quality improvement will have the most impact / outcomes and fit within the directorates strategic aims and goals. 9
Encourage / deliver measurable and demonstrable outcomes which support the directorates function and strengthen the brand of Health Quality Improvement, 1000 lives. Design programmes of work in collaboration with partners and experts within the field, including academics and clinicians. Develop and embed a system to triage requests for programmes of work from colleagues within Public Health Wales, Welsh Government, Health Boards and Trusts Ensure that every quality improvement programme aims to measure and improve healthcare outcomes Design and develop methods to gain patient voice and feedback into the programmes of work. Work with the Head of QI Capacity and Capability and their teams building across NHS Organisations to identify areas where specialist quality improvement capability is needed and how best to deliver. Establish a process of ongoing evaluation of the effectiveness of the improvement support provided and adapt the improvement approach as required in line with emerging best practice in improvement science Ensure that improvement activity within NHS Wales is led by evidence, data, impact assessment, ongoing evaluation, measurement, outcomes and knowledge of best practice nationally and internationally working with partner data and intelligence functions. Work with Policy, Research and International Development directorate and academic communities with the aim of commissioning research into areas of quality improvement. 3.4 Performance Management Responsible for the quality and delivery of quality improvement programmes Develop and implement principles of good programme management to ensure high quality is provided and maintained Horizon scan to ensure that the post holder and the team are kept up to date with best practice and new innovative ways in programme management and improvement science Manage team and individual performance to ensure a high quality service. Work with the Head of Business and Planning to design and implement a performance management framework which will measure outcomes and meaningful improvements in the services. Analyse highly complex data and evidence to inform and measure improvements in practice and when developing programmes of work e.g. patient outcome data. 10
3.5 Build effective relationships Develop effective relationships with Senior Civil Servants and other colleagues within Welsh Government to understand expectations Develop effective relationships with Health Boards and Trusts to understand the needs and expectations of Health Boards and Trusts, including Chief Operating Officers, Director of Nursing and Quality Leads. Develop effective relationships with experts within the field of quality improvement to share best practice and horizon scan. Develop networks to share best practice between programme management. Develop networks with the Head of Capacity and Capability to share best practice and issues between programme management and quality improvement. Develop effective relationships with other Heads of Functions to share knowledge, information and improve collaborative working. Use effective relationships in order to influence agenda, promote directorate s agenda and improve collaborative and integrated working. Use effective sources of communications to deliver key messages, face to face media, presentations, social media etc. 3.6 Leadership and Management Establish a strong, effective and motivated team of staff who provide professional leadership, strong operational management and effective delivery to drive forward internal and external service transformation across the post holder s areas of responsibility. Lead the team to review the current design and skill mix of the current resource in order to ensure that resources are organised and managed optimally with the right range of skills and expertise to enable the improvements required within the current NHS environment. Ensure that staff across the Directorate are developed, supported and managed in accordance with the organisation s policies to enable staff to flourish and achieve the organisation s goals. Deputise for the Director in advising and managing the required changes to build high performing teams with clear goals, measures of success and handling and supporting any related HR issues that may arise. Support the Director in managing directorate change required aimed at improving service outcomes and tangible measures of success. Lead on the organisational changes required to deliver the various services within the directorate and support colleagues as required. Ensure effective use of financial and budgetary development / management is in place by effectively carrying out the role of overall 11
budget holder for each of the directorates programmes of work and ensure that resources are used for maximum benefit. Oversee and manage the distribution of allocated budgets across the directorate for Head of Patient Safety, Head of QI Capacity & Capability and Business Planning ensuring financial allocations are aligned with corporate strategic goals and aimed at improvement for the various programmes Lead on the development of the directorate s strategy and operational plan for delivery of quality improvement programmes. Contribute to the development of the directorate s strategy, operations plan, effective governance and risk management arrangements and the overall performance. Facilitate the development of a directorate which encourages staff engagement in decision making, a drive for continuous service change and improvement, personal development and learning and which supports innovation, team building, creative partnerships and a commitment to patient and public safety. 3.7 Governance and Risk Work with the Head of Business and Planning to develop and implement mechanisms for managing governance and risk Identify risks and provide actions plans in place to mitigate Identify the risks and issues to mitigate that may arise from any organisational changes required for the directorate to achieve its goals and objectives 3.8 Professional Development Continuously identify and carry out professional and self development in order to continuously improve, increase own impact and make positive contributions to the team and to Public Health Wales Deliver elements of programme management and quality improvement in order to maintain and continuously develop skills and knowledge to improve healthcare outcomes. Continuously seek feedback from colleagues, seniors and stakeholders in order to improve performance and impact. 3.9 Ambassador for Public Health Wales and NHS Wales Contribute to NHS Wales planning mechanisms and strategy development and delivery actively engaging in work at a national level. 12
As one of the cadre of senior leaders within Public Health Wales, contribute to the wider health and organisational agenda of organisation. Act as an ambassador of Public Health Wales and NHS Wales. Present at National / International forums representing Pubic Health Wales and NHS Quality Improvement as required. The post holder may be required to undertake other relevant duties, as required by the Director for NHS Quality Improvement and Patient Safety/1000 Lives Improvement Service. 4 PERFORMANCE APPRAISAL Performance will be appraised and objectives agreed on an annual basis with the Director for NHS Quality Improvement and Patient Safety, as part of the performance management and development arrangements within the organisation. The job description will be subject to review in consultation with the post holder and in the light of the needs of Public Health Wales and the development of quality and safety across Wales. 5 PROFESSIONAL OBLIGATIONS The post holder is expected to pursue a programme of continuing professional development, in accordance with their regulating body if relevant, as appropriate in order to keep skills updated as required. 6 PERSON SPECIFICATION The following are the essential and desirable criteria for the post holder. 1 Education/Qualifications Essential Desirable Educated to a minimum of Masters level (or in-depth professional knowledge and equivalent experience) in the field of quality improvement Educated to a minimum of Masters level (or in-depth professional knowledge and equivalent experience) in management Evidence of continued professional development Recognised qualification in improvement science or demonstrable experience e.g IHI Improvement Advisor Level 13
Recognised qualification in programme management (e.g. Managing Successful Programmes; Prince 2), in-depth professional knowledge or equivalent experience Qualified as a healthcare professional (for example medicine, nursing, pharmacy) Gold IQT or equivalent experience Personal qualities Essential Desirable Strong commitment and passion for improving health and reducing inequalities Forward looking, scans horizon and interested in new thinking and innovation Adaptable to situations and able to work well against a background of change and uncertainty Strong personal commitment to working collaboratively and ability to build effective relationships with people of all capabilities and attitudes Commitment to team-working, and respect and consideration for the skills of others Self-motivated, pro-active and passionate about delivery High standards of professional probity Motivates and encourages people to strive for service and personal improvement 2 Experience Essential Desirable Significant demonstrable experience at a senior management level in a large complex sector organisation with a successful track record in delivering improvements in outcomes and operational performance Experience of working in health or public sector 14
Significant achievement in driving improvements in quality and safety in complex settings Experience in working at a national or regional level to improve health outcomes Experience in working across multi sector organisations Significant demonstrable experience of using statistical methods to measure and evaluate improvement Experience of developing and leading quality improvement programmes Experience of using evidence to drive quality improvement Experience of leading individuals and teams through complex programmes of organisational and cultural change including the ability to recognise and manage ambiguity Demonstrable experience in the effective leadership and operational management of large dispersed teams of staff to deliver priorities Track record of sound financial management combined with experience of developing effective business cases to secure funding from external sources x 3 Skills Essential Desirable Extensive knowledge, experience and expertise in both the theory and application of improvement methods to deliver better healthcare outcomes Demonstrable experience in successfully applying behavioural change approaches both nationally and locally in order to improve patient outcomes Knowledge and skills in applying the Triple Aim to improve healthcare outcomes nationally and local level Knowledgeable and skilled in using data and statistical methods to drive improvement at both a team and organisational level 15
Excellent oral and written communication skills Effective interpersonal and influencing skills Strong and effective presentational skills Sensible negotiator with practical expectation of what can be achieved High level of skill in relationship building and able to operate in an environment of complex relationships Leadership skills to build and promote a strong presence for Public Health Wales across the NHS in Wales. Highly developed analytical skills Computer literate and substantially numerate Financially literate and budget management skills Research literate Welsh speaker or willingness to learn 4 Knowledge Essential Desirable Awareness of the challenges and opportunities for the NHS and other public services in Wales Cognisance of the social, economic, fiscal and political environment in Wales. Awareness of the Well-being of Future Generations Bill, the Public Health Bill and the Social Services and Well-being (Wales) Act 2014. Knowledge of methods of developing clinical quality assurance and evidence based clinical practice Aware of socio-economic determinants of health and wellbeing Understanding of and commitment to delivery of improved health through mainstream NHS activities Cognisant of socio-economic and political environment in Wales 16
Background information on NHS Quality Improvement and Patient Safety Directorate NHS Wales is on a journey of quality improvement. We have seen great success by organisations and individuals to improve the quality and safety of healthcare. We know that there is much more to be done. Like many other healthcare systems, we are continuing to increase the improvement capability across our health service. The original 1000 Lives Campaign in Wales focussed on patient safety in secondary care. Our ambition and remit is now much broader and greater. We are integrated into the work of every health board and trust in Wales, supporting local and national improvement programmes across primary, community and acute care. Our reach doesn t end there - Welsh universities, voluntary organisations, charities and public sector organisations are all involved in our work. Our goal is to work with NHS Wales and its partner organisations to achieve sustainable, measurable improvements. This is underpinned by the philosophy of prudent healthcare and the Institute for Healthcare Improvement s Triple Aim of improving population health, enhancing the experience of care and reducing the cost of healthcare. To achieve this we need a national commitment to a coordinated approach. Improvements need to be achieved reliably at scale and a culture of improvement truly embedded across whole organisations and across NHS Wales. Many more of our NHS Wales staff and our partner organisations will need to be involved in improvement work. This is our focus. We are proud to be NHS Wales. Team The team has a current establishment of 44 with a view to develop further. There is a good mix of professional expertise within the team that are keen to progress the delivery of measurable and successful outcomes as described in the Strategic priority found on page 48 of this briefing pack. As you can see within the directorate structure, there are four leadership positions alongside the Director, one of which is filled and three, including this exciting position, are currently being advertised. This is the output of a review of leadership positions within the directorate in order to meet the strategic objectives. 17
Directorate Structure Director PA Posts within the structure Head of Patient Safety (vacant) Deputy Director & Head of Quality Improvement (vacant) Head of QI Capacity and Capability (vacant) Head of Business & Planning Draft alignment of areas of work Acute Deterioration team Mental Health team IQT team Business Cancer team Primary Care (inc. prescribing) team PCC (& CCW) service Programme Support Maternity team Safe Staffing team Planned Care (inc. outpatients) team Unscheduled Care team Measurement team Responsive / customised support team Stakeholder engagement (comms) Strategy HCAI team Integrated Care (inc. Falls) team Hubs 18
About Public Health Wales 1 Background Public Health Wales is the national public health agency in Wales and exists to protect and improve health and wellbeing and reduce health inequalities for people in Wales. We are part of the NHS and report to the Minister for Health and Social Services in the Welsh Government. With a strong Board, 1,400 staff and a budget of 106 million, the organisation employs the majority of the specialist public health resource in Wales. We provide advice, expertise and specialist services to Welsh Government (working across departments), the seven health boards, two NHS Trusts, 22 local authorities, other agencies and to the population of Wales. We provide the public health knowledge, scientific expertise and intelligence to lead transformational change and to drive a focus on ensuring that we deliver tangible improvements in health and wellbeing outcomes and reduce health inequalities in Wales. Health and local government are among the devolved areas in Wales and therefore, working nationally and locally, Public Health Wales has access to both policy levers and local delivery systems by working closely with our partners. Each of the seven health boards in Wales employs a Director of Public Health who is supported by the critical mass of expertise employed by Public Health Wales at the local and community level and who, under an honorary contract, manages locally based Public Health Wales staff. Public Health Wales, health boards and local authorities work closely together to promote public health in their areas and will jointly identify and set the local strategic agenda in partnership with communities, housing, education, police, fire and rescue and the voluntary sector. 2 What we do Our vision is for a healthier, happier and fairer Wales. To achieve this, we work locally, nationally and, with partners, across communities in the following areas: Health protection providing information and advice and taking action to protect people from communicable disease and environmental hazards Microbiology providing a network of microbiology services which support the diagnosis and management of infectious diseases Screening providing screening programmes which assist the early detection, prevention and treatment of disease 19
NHS quality improvement and patient safety providing the NHS with information, advice and support to improve patient outcomes Health improvement working across agencies and providing population services to improve health and reduce health inequalities Primary, community and integrated care strengthening its public health impact through policy, commissioning, planning and service delivery Safeguarding - providing expertise and strategic advice to help safeguard children and vulnerable adults Health intelligence providing public health data analysis, evidence finding and knowledge management Policy, research and international development influencing policy, supporting research and contributing to international health development 2 Our Strategy Public Health Wales has developed a three year Strategic Plan for 2016-2018. Please see an extract of the strategy below. 3 Organisational structure Public Health Wales has a new organisational structure to ensure that the organisation is suitably designed to deliver its strategic priorities and to add maximum value to improving health in Wales. The organisation is in the process of implementing the new structure and therefore there is considerable exciting change taking place. Please see the organisational structure below. Public Health Wales is a national organisation with staff spread throughout Wales. Its headquarters is based in the heart of the capital city of Cardiff. Staff are also based in offices and laboratories across Wales with many based in the premises of the seven health boards. 4 Establishment Order Public Health Wales was established as an NHS Trust on 1 October 2009. Its functions as set out in its Establishment Order are to: (a) manage and provide to or in relation to the health service in Wales a range of public health, health protection, healthcare improvement and health advisory services, child protection services, microbiological laboratory services and services relating to the surveillance, prevention and control of communicable diseases 20
(b) develop and maintain arrangements for making information about matters related to the protection and improvement of health in Wales available to the public in Wales; to undertake and commission research into such matters and to contribute to the provision and development of training in such matters (c) undertake the systematic collection, analysis and dissemination of information about the health of the people of Wales in particular including cancer incidence, mortality and survival; and incidence of congenital anomalies (d) manage, provide, co-ordinate, monitor, evaluate and conduct research into screening for a range of health conditions and health related matters. 6 Membership of the Board Chair Third Sector Representative Local Government Representative (interim) Independent Member Independent Member University Representative Independent Member Chief Executive Executive Director of Public Health Services Executive Director of Health and Wellbeing Deputy Chief Executive and Director of Operations and Finance Executive Director of Quality, Nursing and Allied Health Professionals Professor Sir Mansel Aylward CB Dr Carl Clowes, OBE Vacant Professor Simon Smail, CBE Kate Eden Professor Gareth Williams Terence Rose Dr Tracey Cooper Dr Quentin Sandifer Dr Chrissie Pickin Huw George Rhiannon Beaumont-Wood Other members of the Executive Team 21
Director for NHS Quality Improvement and Patient Safety/Director of 1000 lives Improvement Service Director of People and Organisational Development Director of Policy, Research and International Development Dr Aidan Fowler Phil Bushby (Commencing end of June 2016) Professor Mark Bellis Further information Web: www.publichealthwales.org Email: generalenquiries@wales.nhs.uk Twitter: @PublichealthW Facebook: www.facebook.com/#!/publichealthwales 22
Background to the NHS in Wales The health of the people of Wales continues to improve. Significant progress has been made against the big killers of cancer and heart disease in the past 20 years. Male premature deaths from heart disease have reduced by 60 per cent since 1991. There has been considerable success in concerted efforts against smoking, alcohol and substance misuse and risk behaviours. This has resulted in year on year improvement in health outcomes as a nation. Despite this progress, there is more to do and there remains a commitment and aspiration to work together to further reduce the impact of ill health. There remain considerable challenges in levelling the health status for the whole population. Traditional, stubborn, pockets of deprivation exist in different parts of the country. The aim of Welsh Government is to tackle the inequalities that exist in Wales by pursuing a health in all policy approach, supported by coordinated and determined research and intelligence. The recently passed Well-being of Future Generations (Wales) Act is ground-breaking legislation that places health and sustainability firmly in the fabric of public services in Wales in order to build a healthier, happier and fairer Wales. The NHS in Wales was reconfigured with the formation of seven health boards taking responsibility for the planning and delivery of all services in their areas from primary to tertiary care. There is an ideal opportunity to build this on the platform of a prevention-based integrated model that focuses on keeping people healthier for longer. Wales faces similar pressures to the NHS in the rest of the UK. Moreover, in a time of serious economic stringency the financial challenge faced by the NHS and public services in Wales is a formidable one which necessitates a radical re-appraisal in the way in which health and care services are provided and delivered to the people of Wales. We need to ensure that, over the next few years, significant work is done to continue to modernise services and secure a sustainable health service which meets the ever growing demand. This must be achieved in the context of helping people to stay healthier for longer. 23
Background Information on Wales With a population of three million, a unique and outward looking cultural identity, beautiful countryside, a thriving capital city in Cardiff and strong and varied communities, Wales is a great place in which to live and work. 1 Geography Wales has national parks in Snowdonia, the Brecon Beacons and the Pembrokeshire coast and a great expanse of rural landscape across the centre. Its population is primarily based in the South and North Wales coastal belts and in the South Wales valleys. The capital city, Cardiff, is a growing commercial, cultural and shopping centre with readily access to attractive urban and rural residential areas linked by rail, air and road transport. 2 Culture A bilingual nation in which about a fifth of the population speaks Welsh as well as English, Wales has a distinctive Celtic culture found in it music, art and heritage. Cardiff is home to theatres, including the internationally acclaimed Millennium Centre, concert venues, cinemas, galleries and museums. The Millennium Stadium is home to Welsh rugby, the SWALEC Stadium is the newest international cricket venue and, in Swansea City, the country hosts a Premiership football team. 3 Government The Welsh Government was established in 1999 following a referendum the previous year. The Welsh Government has gathered further powers since and is now able to pass laws on all subjects in the 20 devolved areas without first needing the agreement of the UK Parliament. Economic development, health, education, local government, transport, planning and culture are among the devolved issues so, working nationally and locally, Public Health Wales has access to both policy levers and local delivery systems. The current Government is labour and there will be a Welsh Assembly election in May 2016. 24
There are 22 unitary local authorities in Wales and a range of all Wales institutions covering public life in the country. 4 Useful websites Official Gateway to Wales www.wales.com Visit Wales www.visitwales.co.uk Welsh Government www.wales.gov.uk 25
Chairperson Chief Executive Public Health Wales Organisational Structure Board Secretary Board support Corporate Governance Internal Audit Executive Director of Health and Wellbeing Executive Director of Public Health Services/ Medical Director Director of Policy, Research and International Development Executive Director of Quality, Nursing and Allied Health Professionals Deputy Chief Executive/ Executive Director of Operations and Finance Director of People and Organisational Development Director for NHS Quality Improvement and Patient Safety/Director 1000 Lives Health Improvement Local Public Health Teams Multi-agency Engagement Primary, Community and Integrated Care Health Intelligence and Knowledge Management Health Protection Microbiology Services Screening Services Professional Oversight Policy Development Research and Development Academic Liaison International Development Quality and Standards Clinical and Information Governance Risk Management Complaints/ Claims Service User Engagement Safeguarding Finance Communications and Stakeholder Engagement Operations Planning and Performance Information Technology Programme Management Human Resources Organisational Development/ Change Management Health and Safety Staff Engagement Welsh Language and Equality Centre for Equality and Human Rights NHS Strategic Leadership for Quality 1000 Lives Improvement Prudent Healthcare Innovation 26 Professional oversight
This is an extract from our Board approved three year strategic plan. This is a draft and subject to Ministerial approval. 1 Executive summary 1.1 Introduction We are building on a successful first year where we have made considerable progress delivering our organisational priorities set in 2015. This has involved both laying the foundations for future action and also delivering improvements against key public health areas. As a result, we have undertaken a process to refresh this plan to sharpen its focus, where required, consider changes in the wider legislative and social environment and build on the priorities we have previously agreed. However, we continue to face significant challenges to improve the health and well-being of the people of Wales. These challenges will only increase in the coming years if what we do in the future is the same as we have done in the past. While these challenges should not be underestimated, we believe that significant opportunities exist to deliver tangible improvements for the people of Wales at a pace and scale not previously seen. This will require us to work across boundaries and with organisations that we have not previously worked closely with, to deliver tangible action aimed at improving health outcomes in a more dynamic and flexible way. This plan, and the priorities and actions outlined within it, serves as our compass over the next three years. It sets out, at a high level, the action we will undertake and how we will direct our resources to achieve the maximum impact. Throughout the plan, we have also sought to treat the intrinsically related physical and mental components of health with parity. This is reflected in the content of a number of our priorities and the specific objectives and actions within each. The plan s development was informed by a strategic look back and forward to ensure our priorities remained right and our actions would have the biggest impact possible (see section 18.2). This has resulted in a sharpening of focus within the plan, including changes to some of our strategic objectives (see appendix 6). 27
1.2 Our challenges 1.2.1 Tackling inequalities in our health Across Wales, we have a substantial gap between the health and wellbeing of people living in areas of low deprivation compared to people living in areas of high deprivation. This gap is over eighteen years in healthy life expectancy and shows no signs of improving yet. Inequalities can be seen across many aspects of health. For example, the incidence of cancer is 20 per cent higher and cancer mortality is 50 per cent higher in the most deprived areas compared to the least deprived areas in Wales. Similarly, 29 per cent of all reception year children living in the most deprived areas of Wales are overweight or obese, compared with 21 per cent in the least deprived areas. The efforts that have been made to date to reduce the inequalities gap for people living in Wales are simply not having the impact needed. We therefore have to do things differently. 1.2.2 Our early years development The early years for a child are a critical part of childhood. Many factors influence a child s life chances and progress. These factors shape the destiny for children as they grow up, their educational achievements, their ability to secure an income, their influences on their own children and their health in older age. The origins of many health inequalities lie in differential experiences in early childhood and before birth and must become an increasing focus if we want to improve the health of our population and address inequalities. 1.2.3 Mental well-being Mental well-being is a fundamental component of good health. Mental illness is hugely costly to the individual and to society. Lack of mental well-being underpins many physical diseases, unhealthy lifestyles and social inequalities in health. There can be no separation of mental and physical health if we are to improve the health of the people of Wales. Public Health Wales recognises and promotes the importance of mental health as an integral part of overall health and wellbeing. It is our intention that our general approach to improving population health will always include a holistic interpretation of health, which places physical and mental health of equal importance. In many parts of this plan we have not 28
specifically labelled mental health as a separate health issue, as it is our view that our strategic intent to achieve a Happier Healthier and Fairer Wales could not be attained without mental health being of high level importance in achieving this vision. Public Health Wales has a number of specific work streams which will support the delivery of the Mental Health Delivery Plan, particularly through our 1000 lives improvement function and work we will support in the area of Community Adolescent and Mental Health Services (CAMHS). We also aim to ensure that where we provide direct services to the public and that our staff are equipped with the right skills and knowledge to support and sign post people appropriately. We also recognise the importance of our workforce experiencing positive mental health and wellbeing. We therefore intend to focus on improving recognition and support in this area to prevent and minimise the impact of stress experienced either at home or in the workplace as the two are inextricably linked, which is reflected in the Developing the Organisation section of this plan. We have identified the Executive Director of Quality, Nursing and Allied Health Professionals as the executive sponsor for mental health across all of our internal and external activities, as we have mental health elements in a number of portfolio areas. This role will provide oversight and coordination at Board level to monitor mental health contribution made by Public Health Wales. It will be complimentary to the role of the Vice Chair as a champion for mental health as attributed to Independent Members within all NHS organisations across Wales. 1.2.4 Shifting to a partnership model of prevention As more and more people live longer but with increasing ill health, the way our health system is currently designed simply cannot meet these increasing demands. Nor is it financially viable for it to do so in its current model. The current situation was predictable and the future is equally predictable unless we all change our way of working as a society and our way of living as individuals. Our health services are predominantly organised around our hospitals. Yet much of healthcare can and should be provided in the community through primary and community care services. Such care and support should be driven by a partnership ethos that is about tackling the factors that affect people s health. Helping people to prevent their ill health in the first place 29
and then preventing their exacerbations of ill health must be thoroughly addressed through good self care with the provision of excellent health and social care based on evidence of effectiveness. This partnership begins with individuals their needs, their choices and their care. It must also reflect real partnership with communities at a local level to achieve a measurable and welcome impact. This is done by actively listening to their needs and working with them to coordinate support and enable people to influence the provision and planning of services both locally and nationally. Essential to this is the partnership with other public services, including local government, and the voluntary and private sectors. This partnership should also achieve maximum impact to improve people s health by building strong working relationships with a common, tangible and measured purpose. A journey has already started to move us towards this approach. Recent developments have begun to modernise primary and community care services. They include the Welsh Government s Our plan for a primary care service for Wales up to March 2018 published in 2014. Similarly, the advent of prudent healthcare to ensure that we are providing safe, effective and efficient healthcare services to achieve best outcomes for, and with, patients has heralded a new approach to healthcare provision. In parallel with this, links are being strengthened across the public sector in Wales in light of the report of the Commission on Public Service Governance and Delivery. 1.2.5 Improving healthcare outcomes In the last few years, progress has been made in improving outcomes for patients across a wide range of conditions. For example, since 2001, death rates from circulatory disease have declined by 44 per cent and those from cancer have declined by 13 per cent. However, we are still not achieving the improvements in patient outcomes that we should. Further improvements need to be made, with a more driven approach to quality of care, patient safety, innovation, sharing and implementing good practice. Such approaches should be actively targeted in areas that we know are associated with avoidable harm to our patients and that require improvement. Factors that cause avoidable harm and unnecessary expenditure such as patients with healthcare associated infections (HCAIs); the inappropriate management of patients with sepsis; poor medication management and 30
the lack of implementation of evidence based practice are all areas in which we need to deliver improvements as an NHS. Much of the solution lies with ensuring that the culture in our healthcare facilities is one that does not tolerate harm to patients, that encourages innovation and that strives to learn when things go wrong. Public Health Wales is committed to safeguarding and promoting the health and well-being of all individuals, including older people. Our work will support individuals, including the older population of Wales, to have clear information to ensure they can access and take up screening services and appropriate immunisations, which will promote and protect their health. The Safeguarding Service is supporting NHS Wales, working through a network approach, to improve systems and processes across the NHS to better safeguard and protect vulnerable people (including children and older people), in line with the Social Services and Wellbeing (Wales) Act. The health and well-being of older people will also be addressed through a range of broader health improvement programmes of work, via the community settings work, and through our Healthy Working Wales workplace programmes of activity and our NHS settings approach. 1.2.6 Continuously improving the services we provide Public Health Wales, along with the wider NHS in Wales, faces a number of strategic challenges and opportunities over the next five years. These include: increased financial and capacity/demand pressures being placed upon services as part of an ever-changing operational environment the need to ensure our services meet the principles of prudent healthcare the need to better align and integrate resources to address major public health issues, such as: HCAIs and antimicrobial resistance; outbreak response; inequalities and lifestyle challenges, especially smoking cessation; and participation in screening programmes the need to maximise the opportunities afforded through advances in technology the age profile of our current workforce and the challenge of recruiting to key specialist roles the modernisation of our key services 31
a commitment to creating a culture that puts the citizen at the heart of what we do as part of continual improvement ensuring that we develop a culture where the work we do is informed and inspired by sound knowledge i.e. data and evidence We intend to build on the strong platform that we have in many of these areas and further address these challenges and opportunities over the next three years. In so doing, our intention is to undertake significant transformational changes in the way we deliver public health services for the people of Wales and our partners. 1.3 Our opportunities 1.3.1 Well-being of Future Generations (Wales) Act The Well-being of Future Generations (Wales) Act is a pivotal piece of legislation that aims to improve the social, economic, environmental and cultural well-being of Wales. The Act provides us with a legislative framework and driver for adopting a more radical and transformational approach to the way we work as an organisation and with partners. It will provide an opportunity to introduce a fundamental shift in approach to the development of plans and delivery of action with the increased focus that it will place on: Long-term thinking an integrated approach preventative action collaboration engagement sustainability and resilience As part of the refresh of this plan, we have undertaken initial work to assess ourselves against the goals and governance principles set out in the Act. This will provide us with a road map for how we plan our work and carry out our business in the future. Public Health Wales will provide support in relation to the use of Health Impact Assessments (HIAs), particularly through the policy development process. This will include providing support and advising the Welsh Government on HIAs and Health in All Policies, including responding to the developments which emerge from the Well-being of the Future Generations of Wales Act. In addition, we will support improvements in the quality of HIAs through the development of a quality assurance tool. 32
1.3.2 System wide public health system planning Work has been undertaken to strengthen arrangements during 2015, particularly on joint planning around key public health issues. This is intended to strengthen and develop the alignment of organisational plans, particularly with health boards and our local public health teams, to enable complementary action to be taken by respective organisations in relation to each priority. Also, more collaboration has taken place with the broader public services and other partners in focusing together on public health challenges. The focus of the public health system planning during 2015/16 was: reducing childhood obesity tobacco control to reduce smoking prevalence vaccination and immunisation uptake rates primary care The integrated planning process will support agreement on the best approach and specific organisational action required to deliver improvements within a defined number of priority areas. It aims to develop clarity and agreement on the specific nature of the challenge and the actions each organisation will need to undertake to deliver improvements. 1.3.3 Prudent healthcare Public Health Wales aims to ensure that all of the work taken forward within our priorities is underpinned by the prudent principles. Public Health Wales also has a national role in supporting the implementation of prudent healthcare through our Quality Improvement and Patient Safety Directorate which includes the NHS 1000 lives Improvement Service. The prudent healthcare principles were embedded as key drivers in the development of our priorities and underpin the specific strategic objectives detailed within this plan. A particular focus for us within our strategic priorities is systems-working. This can only be done with effective and mutually beneficial partnerships locally and nationally across all sectors. Consequently, applying a prudent approach to public services and broader sectors is, and will continue to be, essential for us to achieve improvements in health and well-being. 33
1.4 Our response This strategic plan presents our strategy to make the maximum impact for our population over the next three years. It has been shaped by the context set out above, our engagement with colleagues in health boards and trusts to integrate our approaches, our colleagues across the broader public services and other partners, and by us challenging ourselves to focus on the areas that will make the most difference. It has been informed by the state of health and well-being in Wales; the experience of effective models in other countries; our reflections on what has worked and what has not worked and how we can assist and work with other partners in health, other public services and other organisations to mobilise people to focus on making an impact. These priorities reflect the challenges facing us as a country today and for the coming years. The approach outlined within this plan represents an integrated approach to the issues facing us and supports key elements of Welsh Government policy. There is considerable overlap and interplay between the activity that will be undertaken within each priority area and the systems approach can be seen as overarching other priorities, as indicated in our strategy map. Our strategy map on page 14 (or our plan on a page ) articulates our vision, our mission, the strategic priorities on which we will be focusing and how we will enable the organisation to deliver on the mission. Each priority is underpinned by strategic objectives that articulate what we will be focusing on in the next three years. Each is driven by principles that ensure that we must: be outcomes focused reduce absolute inequities be informed by, add and contribute to best available knowledge be measurable adopt and fully exploit all of the principles of prudent healthcare 1.5 Our priorities and deliverables The table below provides an overview of our seven strategic priorities and the key deliverables we will achieve for each over the next three years: 34
Priority: Adopting and implementing a multi agency systems approach to achieving significant improvements in our public s health Key deliverables: There is evidence of mobilisation across sectors around the first 1000 days There are demonstrable changes in policy and practice in schools, workplaces, communities and the NHS which create supportive environments for health There are demonstrable changes in policy and practice in schools, workplaces, communities and the NHS which create supportive environments for health An agreed integrated model of support for smokers who wish to quit Priority: Working across sectors to improve the future health and well-being of our children Key deliverables: Proposals for an Early Years Collaborative are implemented in pathfinder areas for the first 1000 days Early Years Settings Scheme is implemented and at least 100 new Early Years Settings are recruited to the scheme We have increased the proportion of pregnant smokers who access help to quit smoking during pregnancy Systematic approaches to identify children who need early intervention to improve outcomes are developed and implemented Priority: Developing and supporting primary and community care services to improve the public s health Key deliverables: Delivery of our shared and agreed contribution to developing the primary and community care system in Wales Effective support mechanisms to clusters coordinated through the Primary Care Hub Priority: Supporting the NHS to improve outcomes for people using services Key deliverables: Delivery of key agreed actions within Prudent Healthcare Securing Health and Wellbeing for Future Generations Development and implementation of Choosing Wisely Wales Health boards have achieved reductions in HCAI rates At least 50 per cent of NHS staff with direct patient contact receive the flu vaccine Priority: Influencing policy to protect and improve health and reduce inequalities Key deliverables: Public Health Wales is a trusted source of evidence and expertise to inform policy development at all levels across Wales Our support is available on a multi-sectoral basis and we are able to articulate and inform cross-sector working to tackle the major threats to public health in Wales Our Health Impact Assessment team is supporting policy work capacity across Wales 35
Priority: Protecting the public and continuously improving the quality, safety and effectiveness of the services we deliver Key deliverables: An integrated and modernised health protection service An all-wales microbiology network based on a three region model Meeting or exceeding national screening standards in service performance Priority: Developing the organisation Key deliverables: Establishment of a modern approach to digital and social media A vision for the future workforce underpinned by a new workforce plan Reversed the trend on sickness absence and, as a minimum, returned to 2014 levels Implementation of an integrated corporate governance framework 36
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