AGENDA ITEM 3.2 Title of the Health Board Report IMPLEMENTING THE OUTCOME OF THE SOUTH WALES PROGRAMME THROUGH ACUTE CARE ALLIANCES AND DEVELOPMENT OF THE SOUTH WALES HEALTH COLLABORATIVE Executive Lead: Director of Planning and Performance Author: Project Manager, South Wales Health Collaborative Contact Details for further information: ruth.treharne@wales.nhs.uk Purpose of the Health Board Report The outcome of the South Wales Programme (SWP) was confirmed in March 2014 and, since that time, attention has focused on moving from strategy to implementation on the future configuration of consultant-led maternity and neonatal care, inpatient children s services and emergency medicine (A&E) for South Wales and South Powys. Through this report, the Board will receive the SWP legacy and handover statement, an update on the establishment of three acute care alliances and their associated governance arrangements, and their relationship with the South Wales Health Collaborative. Governance Link to Health Board Strategic Objective(s) Supporting evidence The Board s key role is to ensure the Board s Strategy is being progressed. To ensure standards of good governance are in place and compliance with the regulatory framework See attached supporting documents. Engagement Who has been involved in this work? The related work has involved a collaborative partnership across Health Boards, the Deanery and the Welsh Ambulance Services Trust within the former South Wales Programme and also engaged widely Community Health Councils and other stakeholders as part of the broader public consultation. Acute Care Alliances Page 1 of 9 University Health Board Meeting
Health Board / Committee Resolution (insert ) To; APPROVE ENDORSE DISCUSS NOTE Recommendation The Board is asked to; CONSIDER and NOTE the SWP legacy and handover statement; and CONSIDER and APPROVE the governance arrangements for the ACAs. Summarise the Impact of the Health Board Report Equality and diversity Legal implications The Equality Impact Assessment post consultation analysis formed an important element of the decision-making process by health boards and must be taken into account during the implementation phase and mitigating action evidenced through this process. The EIA is an ongoing process and should be subject to continuing assessment and management through the LHBs and ACAs. A stage three final analysis document will need to be produced by the ACAs/LHBs to present the final decision, the reasons behind the decision, outline any proposed mitigations, and describe how the implementation of the outcome of the SWP will be monitored and reviewed. The related processes have been conducted in line with Welsh Government guidance and best practice guidance. Population Health The population health factors featured prominently within the EQIA process. Quality, Safety & Patient Experience The aim of the SWP was to create safe and sustainable specialist hospital services: quality and safety were two of the benefit criteria applied throughout the process of option appraisal and to inform recommendations and decision making. The service models for emergency medicine, inpatient children s services, neonates and maternity were developed through clinical reference groups (CRGs). The CRGs based their recommendations on the publications of Royal Colleges, and other medical colleges, and there was good engagement with the colleges (or their Welsh representatives) through clinical conferences and consultation. Acute Care Alliances Page 2 of 9 University Health Board Meeting
Resources Risks and Assurance Standards for Health Services The National Clinical Forum (NCF) also scrutinised the models in some detail with reference to college standards and strategic publications. Two phases of high level costing work were undertaken to inform and be part of the assurance mechanism for the recommendations from the SWP Board and the subsequent decision making by health boards. The legacy and handover statement confirms the requirement for ACAs, through implementation planning, to undertake a more detailed bottom up costing exercise for both capital and revenue cost implications. The SWP risk register was regularly updated and reported to the SWP Board. With decisions confirmed on the outcome of the SWP, and implementation to be managed through the ACAs, it is important that residual risks are carried forward via the governance arrangements for the ACAs. The final SWP risk register confirms the status of each risk and highlights those for inclusion on the risk registers for the ACAs. Access to the Standards can be obtained from the following link. www.wales.nhs.uk/siteplus/documents/1064/eas y%20read%20standards%20final%20decemb er%202010.pdf The report provides assurance against Standard 8 care planning and provision, contributes to the good governance elements of Standard 1, and, also, contributes to the delivery of overall standards. Workforce There will be workforce implications as implementation of service changes take place. The Board will continue to engage staff side fully as proposed implementation changes develop and also work closely with any individuals affected by the changes. Acute Care Alliances Page 3 of 9 University Health Board Meeting
IMPLEMENTING THE OUTCOME OF THE SOUTH WALES PROGRAMME THROUGH ACUTE CARE ALLIANCES AND DEVELOPMENT OF THE SOUTH WALES HEALTH COLLABORATIVE 1. SITUATION / PURPOSE OF REPORT The outcome of the South Wales Programme (SWP) was confirmed in March 2014 and, since that time, attention has focused on moving from strategy to implementation on the future configuration of consultant-led maternity and neonatal care, inpatient children s services and emergency medicine (A&E) for South Wales and South Powys. Through this report, the Board will receive the SWP legacy and handover statement, an update on the establishment of three acute care alliances and their associated governance arrangements, and their relationship with the South Wales Health Collaborative. 2. BACKGROUND / INTRODUCTION The South Wales Programme (SWP) was a joint programme of work between five health boards providing healthcare services in South Wales and South Powys Abertawe Bro Morgannwg, Aneurin Bevan, Cardiff and Vale, Cwm Taf, and Powys and the Welsh Ambulance Services NHS Trust (WAST). The services reviewed through the programme were consultant-led maternity and neonatal care, inpatient children s services, and emergency medicine (A&E), due to their fragility in terms of their ability to deliver safe and sustainable models of care. Extensive work was undertaken over a two year period to prepare plans for the future configuration of services, central to which was clinical leadership, engagement and professional advice, complemented by broader stakeholder engagement and formal periods of engagement and consultation. Decisions on the outcome of the programme were taken by Health Boards and WAST at special board meetings held in February 2014 and the collective position of all partner organisations was confirmed in March 2014. Further background information, including post consultation documentation, communication updates and reports from the SWP Board continue to be available via the SWP website http://www.wales.nhs.uk/swp/home SOUTH WALES PROGRAMME LEGACY AND HANDOVER STATEMENT Implementation of the outcome of the SWP is being progressed through three acute care alliances (ACAs) and supported by the South Wales Health Collaborative (SWHC). Further detail on the ACAs and SWHC is provided later in this report. Acute Care Alliances Page 4 of 9 University Health Board Meeting
A legacy and handover statement has been prepared to provide the context within which the ACAs and their constituent local health boards will take the SWP from strategy into implementation. The statement highlights the work that needs to be taken forward in implementation planning and the critical issues that will influence each ACA s success. Specifically, the legacy and handover statement: Confirms the recommendations agreed by the constituent local health boards (LHBs) and community heath councils (CHCs), and endorsed by WAST; Confirms the commitments made to individual LHBs and CHCs in support of the outcome of the SWP; Highlights the need for ongoing review, monitoring and implementation of the equality impact assessment (EIA) action plan and the requirement for health boards to prepare a final analysis EIA report; Highlights the need to maintain and build upon clinical engagement and leadership, and CHC and stakeholder engagement, in the implementation of current plans and in the development of other change proposals; Records the outcome of the Gateway review process and the need to prepare for a follow up review on recommendations in respect of implementation plans, roles and responsibilities, and capturing the lessons learned to carry forward into implementation; Confirms the requirement for ACAs, through their implementation planning, to undertake a more detailed bottom up costing exercise for both capital and revenue cost implications; Notes continuing work on the potential impact of the SWP outcomes on other hospital services, i.e. acute medicine and surgical services, and the need for ACAs to consider the outcome of this work within their respective geographical areas; Highlights work to prepare a transport action plan to minimise challenges posed by public transport in accessing hospital care and which ACAs and health boards will need to take into account within implementation planning; Notes the need for health boards and ACAs to prepare risk registers as part of the governance arrangements for the ACAs and which incorporate residual risks from the SWP; Reports on lessons learned from the SWP and the need for health boards/acas to consider how these lessons might inform the governance and operational arrangements for the ACAs and the interface with the SWHC. The legacy and handover statement, attached at Appendix 1, aims to support the health boards and ACAs deliver the implementation of the outcome of the SWP and establish the basis on which further service change can be achieved. Acute Care Alliances Page 5 of 9 University Health Board Meeting
ACUTE CARE ALLIANCES In taking their decisions on the outcome of the SWP, all SWP partner health boards and WAST supported the creation of three acute care alliances (ACAs) across South Wales and South Powys. Hywel Dda Health Board has also supported the introduction of the ACAs. These ACAs will ensure that hospitals no longer work in isolation but instead work more closely together across health board boundaries as part of a network providing care to patients. Hywel Dda University Health Board has joined the South West ACA and this will support the implementation of both the SWP recommendations and support the joint planning that is underway between Hywel Dda and Abertawe Bro Morgannwg (ABM) health boards. South Powys residents will use the services of all three ACAs as appropriate and the governance arrangements supporting the ACAs will reflect this. The ACAs will be population focused and will work together on implementing the outcome of the SWP and on service planning and delivery, particularly where the catchment population crosses over LHB boundaries or are on the borders between ACAs: South West ACA will primarily focus on the provision of acute hospital services from Neath Port Talbot Hospital; Singleton and Morriston Hospitals; Prince Philip Hospital; Glangwili Hospital; Withybush Hospital, and Bronglais Hospital. South Central ACA s primary focus will be on the acute hospital services provided by Prince Charles Hospital; Royal Glamorgan Hospital; University Hospital of Wales Cardiff; University Hospital Llandough, and the Princess of Wales Hospital (POWH). Whilst POWH is included in the South Central ACA due to its geographic position to the alliance and its close working relationships with hospitals in Cwm Taf, the commissioning responsibility for the Bridgend population and the accountability for the delivery of services within POWH remain with ABM University Health Board. South East ACA is primarily focused on the pathway to the establishment of the Specialist and Critical Care Centre (SCCC), which is expected to be completed in 2018-19 as a new base for some services currently provided at Nevill Hall and Royal Gwent hospitals. This ACA will work closely with the South Wales Central ACA particularly in respect of services provided to the heads of the valleys and South Powys. Princess of Wales Hospital, although part of the South Central ACA, will maintain links with the South West ACA where there are close clinical ties and where many patients receive tertiary care. Similarly, Prince Charles Hospital, whilst part of the South Central ACA, will work closely with the planned SCCC, Nevill Hall Hospital and Ysbyty Ystrad Fawr to serve the population of the Heads of the Valleys and South Powys and maintain clinical relationships across this area. Acute Care Alliances Page 6 of 9 University Health Board Meeting
3. ASSESSMENT / GOVERNANCE AND RISK ISSUES The principles and governance arrangements for each of the ACAs are described in the document attached at Appendix 2. At ACA level, the governance structure will have three levels: ACA Chief Executives Delivery Group, ACA Implementation Team and ACA Clinical Implementation Group/s. The ACA structure will link with that of the SWHC through the SWHC Board and SWHC Executive Steering Group. A broad description of responsibilities follows for each of these groups and the terms of reference are included with Appendix 2: SWHC Board acts as the collective sponsor for regional programmes of work; agrees the priorities for, and shapes the direction and delivery of, the collaborative work programme and ensures it remains consistent with meeting the needs of patients; ensures the work programme is consistent with national strategy and policy and that it makes links with associated clinical developments in partner organisations and other parts of NHS Wales; makes clear recommendations to individual health boards on decisions that need to be taken or major issues affecting the collaborative work; drives forward the programme of work which emerges from programme/project scoping and supports the implementation of agreed changes following public engagement and consultation. SWHC Executive Steering Group monitors the implementation of service change plans within and across the three ACAs; considers the potential impact of implementation plans on other service areas and across the region; oversees the delivery of the SWHC work programme and provides assurance to the SWHC Board. ACA Chief Executives Delivery Group provides assurance to individual boards that plans are being implemented in line with the agreed service model/governance framework; reviews and scrutinizes any proposed recommendations for individual boards prior to reporting to boards for formal approval; supports alignment of decision making across boards; identifies any issues that may interface or impact on another ACA and ensures this is discussed with all South Wales Chief Executives through the SWHC structure; ensures early and systematic engagement with CHCs. ACA Implementation Team plans implementation of agreed service models and ensures delivery; agrees work programme of ACA Clinical Implementation Groups (CIG); signs off detailed implementation plans from ACA CIGs and ensures they are aligned with individual boards, with other CIGs and with other ACAs; Acute Care Alliances Page 7 of 9 University Health Board Meeting
ensures effective stakeholder engagement; links with the SWHC via lead executives and into local health board planning groups via lead executives and senior clinicians; ensures availability of appropriate resources and support. ACA Clinical Implementation Group/s develops implementation plans for the ACA for paediatrics, maternity/neonates and emergency medicine, in accordance with the outcome of the SWP; develops agreed changes, and participates in a review mechanism to test models as they are developed; links into individual health board planning groups for that speciality/service to ensure it is aligned; scopes impact of detailed plans on other services and recommends to the ACA Implementation Team ways of aligning these; ensures ongoing effective clinical engagement in the work of the CIG and maintains effective communication of the outcome of the work to wider staff groups. A key role of the ACAs is to implement the outcome of the SWP. The legacy and handover statement highlights the work that needs to be taken forward in implementation planning and is underpinned by the extensive range of documentation produced to inform the SWP. SOUTH WALES HEALTH COLLABORATIVE The SWHC works on behalf of six health boards - Aneurin Bevan, Abertawe Bro Morgannwg, Cardiff & Vale, Cwm Taf, Hywel Dda and Powys and undertakes work programmes with a regional focus as directed by health board chief executives. The SWHC provides objective input into change programmes and in supporting the ACAs in delivering agreed changes. The SWHC team together with each health board s ACA executive lead has formed an Executive Steering Group, chaired by the SWHC Director, to oversee the implementation of service change plans within and across ACAs and consider the potential impact of implementation plans on other service areas and across the South Wales and South Powys area. Consideration is being given as to whether the SWHC should have a broader all Wales responsibility as many of the work programmes being undertaken have a national focus rather than a regional perspective e.g. Pathology Collaborative, Major Trauma network and support for the Emergency Medical and Retrieval Service (EMRTS). Acute Care Alliances Page 8 of 9 University Health Board Meeting
4. RECOMMENDATION The Board is asked to; CONSIDER and NOTE the SWP legacy and handover statement; and CONSIDER and APPROVE the governance arrangements for the ACAs. Acute Care Alliances Page 9 of 9 University Health Board Meeting