1 Introduction Aneurin Bevan Health Board Executive Team Report The purpose of this paper is to provide the Board with an overview of current key issues locally and in NHS Wales through a report from members of the Executive Team of Aneurin Bevan Health Board. Not all members of the Team have provided content for the report as updates are also provided through other reports on the Board agenda. It also provides the opportunity to bring forward items to the Health Board to demonstrate in public, areas that are being progressed and achievements that are being made, which might not come through prior consideration by Health Board Committees or go directly to the Board as key discussions papers. This report is intended to ensure the Board remains up-to-date and also provides an opportunity to highlight areas that can be brought back for future agendas. 2 Executive Team Report 2.1 Staff Recognition Awards On Wednesday 14th September 2011, the Health Board held its first Staff recognition Event at St. Cadocs Hospital. Over 100 members of staff attended the event that celebrated the achievements of staff from across the Health Board. The event was compered by Dr. Andrew Goodall, with David Jenkins providing the welcome. There were over 90 nominations for the six awards, all of an incredibly high standard. The judging panel had a very difficult job making the decisions and in most categories it was too close to call and joint winners were announced. There were also two special awards from the Chair and Chief Executive. Feedback from staff was very positive at the event and we will look to build on this success for next year. All photographs and some of the videos will be available on our intranet and internet sites. 1
The winners in each of the categories were as follows: Health and Well Being at Work - Dr Chris O Connor, Clinical Director, Learning Disabilities and Janet Kelly, Head of Occupational Therapy Leadership - Harold Proctor, Directorate Manager Older Adult Mental Health Service and Jane Kirby, Senior Nurse County Hospital Partnership - The Orthopaedic Musculoskeletal Triage/Interface Project and Maria Evans, Substance Misuse Lead Officer Improving Patient Experience Darren Baulch, Healthcare Support Worker and Lynne Casbeard, Medical Secretary Quality, Sustainability and Efficiency -Dian Anderson and the Continuing Healthcare In House Provider Team and Siobhan Hargen, Prescribing Support Dietician Newport Locality Team of the Year - The School Nursing Service and the Facilities Team Two Special Awards: Chair s Award - Staff at Ysbyty Aneurin Bevan Chief Executive s Award - Stroke Service 2.2 Annual Nursing and Midwifery Conference Aneurin Bevan Health Board s second Annual Nursing and Midwifery Conference was held at the Riverfront Arts Centre in Newport on 15 th September. The theme this year was Stepping up: Stepping out addressing the ways in which Nurses and Midwives deliver high quality care and meet the required standards, and also how innovative ways of working are changing traditional roles in an integrated organisation. The day was opened with a montage of Nurses and Midwives who over the past year have developed practice, won wards and even an OBE (Consultant Nurse Karen Logan). T 2
he Dignity in Care Campaign for the Health Board look closer, see me was launched by showing a DVD of staff across the organisation reading the poem The crabbit old women. This set the tone for the day, the focus of which was the importance of seeing, listening and communicating with patients and that dignity and privacy was everyone s business. Col Tina Donnelly Commanding Officer of 203 Welsh Field Hospital, who is also the RCN Director for Wales presented her experiences in the TAs. This covered the setting up of a Field Hospital in the middle of a desert illustrated how it is possible to work under huge pressure and with little resource and yet deliver the highest standards of patient care. A Showcase session followed, narrated by Jill Evans (Lead for Equality & Diversity) where Nurses and Midwives presented a broad range of innovation and practice developments, thus celebrating and sharing excellence in their fields. One of the highlights of the day was a presentation by the parents of one of our patients, Mr and Mrs Dorricott, where they told the story of their journey to obtain a Care Package for Ceri. We were extremely fortunate to have Ceri come along with her parents too. The Poster session was well attended, with 44 Posters presented on topics that reflected the wide diversity of work including Care Bundles, Emergency Contraception in School Nursing and Learning from Critical Incidents. Prizes were presented by the Chief Exec for the best oral presentation, the best posters and 2 highly commended posters. Best oral presentation - Sian Lewis, Behavioural Clinical Specialist and Amanda Hale, Staff Nurse for We got it right! Working together in Learning Disabilities and Critical Care Best poster presentation - Tracey Baker for The Blaenavon Leg Club Best poster for the Margett's Award for care of the older person - Michelle Zeraschi for Improving the Way in Which District Nurses Identify, Assess and Record Patients who Fall in the Community Highly Commended Poster - Tony Bush and Karen Smith for Introducing a programme for post registration induction and essential skills development Highly Commended Poster - Dr Lyn Middleton for Learning from critical incidents: Improving the safety of patients receiving intra-venous morphine 3
In addition, 18 exhibition stands were set up covering areas such as Transforming Care, 1000 Lives plus, Well Being, The conference ended with the inspirational Deaf Choir from Newport. 2.3 8 th Diabetic Polyneuropathy Seminar Around 40 patients attended the 8 th Diabetic Polyneuropathy Seminar at the Royal Gwent Hospital in July. Health professionals from the diabetes team including dieticians and pain nurses talked to patients about a range of issues including; managing blood sugar levels, medication and living safely with diabetes. The event was arranged by Dr Ivanova Stoilova and members of her team. 2.4 Neonatal Transport Service A ground-breaking transport service to save the lives of very sick babies across South Wales was officially launched in July. The service has been in use since January and has already transported over 100 new-borns to life-saving care. It highlights the significant progress being made in improving neonatal services across Wales, backed by 2 million of recurrent Welsh Government funding. CHANTS (Cymru inter-hospital Acute Neonatal Transfer Service) is a mobile critical care baby unit, staffed by neo-natal doctors and nurses, with a dedicated ambulance and driver. The vehicle has been specially designed and provides intensive care to babies during transfer between Cardiff, Newport and Royal Glamorgan and Swansea. 2.5 New Research Office A new research office has been set up to at the Royal Gwent Hospital in Newport to boost research in South East Wales. The National Institute for Social Care and Health Research Clinical Research Centre (NISCHR CRC) has launched the first joint research office for South East Wales in Aneurin Bevan Health Board. The office brings together NISCHR CRC cancer and health and social care research teams led by research nurses. It provides an opportunity for the highly skilled teams to work together to support clinicians with high quality research studies active in Aneurin Bevan Health Board. 4
2.6 Work out at Work Day Physiotherapists, Dieticians and Occupational Health staff at Nevill Hall Hospital turned their attention to staff colleagues during a special day to promote the benefits of simple exercise and healthy living at work. Staff at Nevill Hall Hospital were invited to attend a Workout at Work Day (WOWD) at the hospital on September 8 th 2011. WOWD is a national day designed to raise the profile of the work of physiotherapists organised by the Chartered Society of Physiotherapists (CSP). Physiotherapists will join forces with hospital dieticians and occupational health staff to give advice and encourage staff to take breaks and become more active during their working day. 2.7 Research into Health Spending New research into spending by the Aneurin Bevan Health Board shows that for every pound spent the benefit to the Welsh economy is almost double. Commissioned by Caerphilly and Newport Councils, a significant piece of work was carried out by Cardiff University in collaboration with the Health Board. It used the Aneurin Bevan Health Board as a case study to examine the potential impact of local procurement on the local economy. The research showed that the health board directly supports 953m of output, more than 10,700 jobs and around 406 million of gross value added in Wales. 2.8 Clinical Pathways An article by Joanna Dundon, Strategic Health Evidence Manager, ABHB (and National Co-ordinator for Clinical Pathways, NWIS) with co-author Tony Paget, Swansea University, has been published in the International Journal of Care Pathways 2011; 15: 55-64. The article concerns student nurses' information seeking behaviour and how they took advantage of using Map of Medicine as an educational tool. 5
2.9 Seasonal Influenza Planning has commenced to prepare the Health Board for the potential impact of seasonal influenza. Last year the management of care was well coordinated and patient focused, with the Health Board building on lessons learnt from this approach. This year s approach is intended to increase the uptake of vaccinations to help protect patients, staff and the wider population. A comprehensive vaccination programme is therefore being developed, with the aim of primary care delivering vaccinations to individuals in at risk groups within the population. Occupational Health together with Health Board operational colleagues will provide access to influenza vaccinations for Health Board staff. 2.10 Serennu Children s Centre Official Opening The Serennu Children s Centre was formally opened by the First Minister on Friday 2 September 2011. It was a successful event attended by many individuals from across the partnership communities that have been involved in this exciting development. 2.11 Ysbyty Ystrad Fawr As Ysbyty Ystrad Fawr nears completion, the finishing touches are now being applied to the building. In the last month the roads have been prepared and painted and signage is being set up ready to guide people around the site. Many of the internal areas are now complete and ready to be cleaned and prepared ahead of services transferring to the new facility. Following the success of recent Community Public Engagement Forums it has been confirmed that a further session will be held on 12 October 2011 in the Caerphilly County Borough Council Offices at Ty Penallta, Hengoed. The digital story of Caerphilly District Miners Hospital is scheduled to be shown on a number of dates throughout September 2011 at the Hospital. Ysbyty Ystrad Fawr is a 269 bed Local General Hospital with four floors. It will feature 100% single en-suite bedrooms which will help to provide high quality care, reduce hospital acquired infection rates and give patients the privacy and dignity they need. 6
Ysbyty Ystrad Fawr will offer the following range of services: Emergency assessment and treatment. Birth centre with midwifery-led deliveries. Routine elective surgery including day case and inpatient care. More extensive diagnostics, including endoscopies. Adult and older adult mental health services. During October and November 2011 services will begin to move from Ty Sirhowy Mental Health Unit, Ystrad Mynach Hospital and Caerphilly and District Miners Hospital to Ysbyty Ystrad Fawr. Patients will be informed by letter if their out-patient appointments have transferred. In-patients will transfer on a phased basis; ward staff will inform patients and their carers about the date they will move and their new location in Ysbyty Ystrad Fawr. Ty Sirhowy Mental Health Unit, Ystrad Mynach Hospital and Caerphilly and District Miners Hospital will be closed towards the end of November 2011. The Executive Team will be providing a briefing on the outstanding affordability for the hospital, noting the changes in the capital charge arrangements which now have a more immediate impact on revenue in the first two years of operation, but more significantly so in 2014-15. 2.12 Specialist and Critical Care Centre As part of Clinical Futures service planning work for the Specialist and Critical Care Centre (SCCC), the service and capacity model planning process with Clinical Directorates is ongoing to ensure that planning for the SCCC, Local General Hospital, community services and any interim plans are updated through clinical dialogue and informed by current evidence and best practice, workforce and financial considerations. Work also continues on preparing and updating the Outline Business Case. 7
2.13 Chepstow Community Hospital Cleaning Team Shine in the Team Clean Challenge 2011 Contract Cleaning Staff at Chepstow Community Hospital have scooped 2 nd prize in OCS s Team Challenge Awards. Although these staff do not work directly for the Health Board, they are an important element of team working and this award demonstrates the quality of service that our patients receive. 2.14 Hearty Lives Torfaen Project The Hearty Lives Torfaen Project has been shortlisted for the 2011 CIPR Wales Pride Awards in the 'not-for-profit' category. The awards recognise excellence and reward achievement in public relations and communications. This is excellent news as the CIPR awards are the most prestigious in the industry and they had over 1,000 entries. The Hearty Lives Torfaen Project is funded and hosted by the British Heart Foundation and is supported by the ABHB Dietetic Team. The focus of the project is to tackle childhood obesity. The winners will be announced on the 28 of October 2011. 2.15 Enterally Fed Patients on ICU Lucy Morgan, Senior Dietician, in conjunction with Dr Rhian Thomas and Dr Chris Weaver, have undertaken an audit on enterally fed patients on ICU. Initial results have demonstrated a change in practice leading to enterally fed patients on ICU requiring fewer X- rays to determine tube position, thus saving on X-ray costs and reducing radiation exposure for patients. A re-audit will be undertaken shortly to measure on-going compliance with these recommended changes. The paper has been accepted by the European Society of Intensive Care Medicine and Lucy has been asked to present her findings at the ESICM International Conference in Berlin. 8
2.16 Support Workers from Sight Support Win Prestigious National Award A team of support workers from Sight Support based in Pontypool has won a national award in recognition of their outstanding work to help people with visual impairment at the Royal Gwent Hospital in Newport. Lisa Gomer, Eye Clinic Liaison Officer, and the team at Sight Support have received the Macular Disease Society s Annual Support Service of the Year Award, for their efforts to help improve the treatment, care, and quality of life of people with the condition. 2.17 Health and Housing Conference Thursday 3 November 2011 Further to recent discussions about improving partnership working across health, social services and housing plans have been taken forward for a joint Health and Housing Conference, which is to be held on the afternoon of Thursday 3 November 2011. The overall aims of the Conference are to: Raise awareness of the benefits to patients and the public of aligning current and future health, social services and housing service planning and delivery; and, identify mechanisms for further enabling this alignment. The Conference will be attended by both the Welsh Government Minister for Health and Social Services and Minister for Housing. 2.18 Centralisation of Health Records The Centralisation of Health Records is progressing well with a projected date for occupation of Online House, Cleppa Park, Newport being 10 October 2011. Tender documents for the removal of records from the five main current stores have been received and are being assessed. Staff meetings have been completed and rotas established. Further meetings are planned to advise staff of their new areas of work and to finalise transfer arrangements. 9
2.19 Abernant Practice, Abertillery Abernant Practice in Abertillery has reverted to independent status from 1 August 2011. The practice, which also has a branch surgery in Trinant, has been managed by the Health Board and Blaenau Gwent Local Health Board since 2002. The two salaried General Practitioners have taken over the practice and all staff have transferred. There has been full continuity for patients and there are no plans to change any of the services offered by the Practice. 2.20 HM Prisons, Usk and Prescoed Monmouthshire Locality has commenced a programme of work with the nursing team in HM Prisons Usk and Prescoed to integrate the prison nurses with ABHB nursing teams. The first step has been to hold a team meeting and to second a Band 7 nurse into the prison team to support a review of the team and ways of working. Steve Cross, Governor and his colleagues alongside Locality senior nurses have provided strong leadership to start this change programme. Identified benefits include improved professional development, better use of nursing resources, more efficient team working. 2.21 Palliative Care Aneurin Bevan Health Board is one of the first areas in Wales to appoint specialist Palliative Care staff, working with Macmillan Cancer Support to improve patient choice and access to quality endof-life care. The Health Board and Macmillan Cancer Care have jointly created two GP Facilitator posts as part of a three year project. The aim is to improve the quality of palliative care across Gwent through the promotion of advanced care planning and identification of areas for service improvement. The two GP Facilitators based within Caerphilly Borough work across all the five Localities. The GP Facilitator s Role is to: Support GPs in improving Palliative Care: Through identification of appropriate patients Encouraging advance care planning Endorsing information sharing 10
Improve continuity of care between GP practices and OOH: Promoting seamless care Optimise Out of Hours Provision Improve the interface between Primary and Secondary Care: Reduce unnecessary admissions Ensure safe and effective rapid hospital discharges The aims of the project are: To support patients and families during the last days of life. To improve the care that patients receive at home. To maximise patient involvement in their own care promoting patient choice. To support family and carers enabling people to remain at home at the end of their lives if they wish. To promote increased recognition and respect for different faiths, religions and communities. To improve medical care for patients at night time and during the weekends by planning in advance and alerting other professionals to potential changes. To improve the support families receive after a relative has died. The GP Facilitators Projects are: Analysis of current methods of providing palliative care in the community. Education A formal programme provided by Palliative Care Consultants and GP facilitators in each locality providing teaching on a wide range of Palliative Care topics to enhance knowledge around End of Life Issues and promote good communication. Neighbourhood Care Network support - Providing a resource pack to support the Neighbourhood Care Network scheme. A scheme aimed at improving community medical care, reducing hospital admissions and developing systems to improve communication. Locality meetings to offer support to the individual localities to help develop and identify any gaps in their service provision. Recognising that each specific Locality and its community have different needs to address. 11
Liaison with secondary care - To understand reasons for unnecessary admissions and provide solutions in the community to reduce these figures. To provide information to hospitals about the community to enable them to predict patient needs once discharged. Promotion and support for Macmillan Cancer Support services. 2.22 My Health Online Tonyfelin GP practice in Caerphilly Borough recently became the latest GP practice in Wales to introduce the My Health Online system, which allows patients to book and cancel appointments and request repeat prescriptions, without having to telephone the surgery. Website users are also be able to get advice and information to help them manage health conditions. My Health Online is part of a wider programme improving patient safety and the quality of health and social care through digital technologies. The system should not only make it easier for patients to book an appointment, without having to phone, but will also reduce some of the phone traffic to the practice therefore making it easier for patients, who still need to phone the surgery, to get through. Before patients can start using My Health Online they must register their details at the surgery. They will need to provide some photographic proof of identity, then complete their registration securely online and set up their account. The majority of GP surgeries in Caerphilly Borough will shortly be using My Health Online. 2.23 Torfaen Partnership and Planning Arrangements The Torfaen LSB has agreed to move toward a single partnership model to subsume the work of the previous 3 partnership boards Children and Young People, Health Social Care and Wellbeing and the Community Safety Partnership, these new arrangements will work in shadow form from October 2011 with a view to live running from April 2012. 12
Torfaen Service Planning Group has held its first meeting to discuss future arrangements for County Hospital and community services in line with Clinical Futures and Frailty. 2.24 Blaenavon Primary Care Resource Centre Welsh Government approval has been received to start work on Blaenavon Primary Care Resource Centre with a view to opening in Spring 2013. 2.25 County Hospital The model of care implemented on Phoenix ward is being formally evaluated with academia following a 6 month interim review. This should be completed by the end of the year. The interim review is being used to inform the next phase of service reconfiguration. 2.26 Approved Clinician Submissions The submission of an application by Dr Julia Claire Lewis, Consultant Addiction Psychiatrist, Gwent Specialist Substance Misuse Services to become an Approved Clinician in the context of the Mental Health Act, has been supported by the Director of Primary, Community and Mental health Services. In accordance with the agreed procedure, all such applications are to be reported to the Board. 2.27 Nursing Times Awards Each Year, the Nursing Times asks the nursing profession to showcase their practice and demonstrate the positive impact nurses have on patient care. The awards have seen a significant increase in the number of entries this year with a 138% increase from last year s awards. The Nursing Times have acknowledged that to be selected as finalists is a fantastic achievement. We are delighted to inform the Board that Aneurin Bevan has two finalists in the 2011 Nursing Times Award. The Fast Track initiative for end of life care is a finalist in the Care of Older People Category. Entitled I want to go home : Respecting older people s rights to spend the end of life in the preferred location this initiative has already received national and international recognition. Nationally, the Office of National Statistics suggests that only around 20% of people die in their preferred location. Aneurin Bevan Health Board is able to demonstrate a 95.5% success rate. Aneurin Bevan is the only Welsh Health Board to have a finalist in this category. 13
The Aneurin Bevan Health Board Continence Service is also a finalist in the Continence Promotion and Care Category. Entitled Developing new strategies to change the culture and improve dignity in continence care across hospital and community settings this initiative is reflective of the Government and Nursing Agenda to enhance dignity and respect for all patients. Aneurin Bevan is the only Welsh Health Board to have a finalist in this category. The next stage is for our finalists to present in front of a judging panel. Presentations will take place on 20 and 21 September respectively. The winners will be announced at the Nursing Times Award Ceremony on 2 November 2011. 2.28 Bryn Compost Facility, Caerphilly CBC. Two media articles have recently appeared on a report produced by Director of Public Health, Dr Gill Richardson, into the possible health risks posed by Bryn Composting Facility on Gelliargwellt Farm, Gelligaer. Whilst the majority of reporting was factually correct some of the coverage carried the headline Compost plant s risk to public very low and concluded that the report said the facility was not likely to have any significant effect on the physical health of the public. However, another report carried the headline Composting site is safe says health board report the article went on to say that the plant is not a danger to nearby residents. Although the next paragraph correctly quoted the report as saying not likely to have any significant effect on the physical health of the public there were real concerns over the misleading headline and first paragraph. This appeared to mislead the public as the following week a letter was received from a local resident who linked breathlessness experienced by both her and husband to the compost facility. The lady s letter went on to criticise the report specifically for saying the facility was safe. In fact Dr Gill Richardson had never indicated that the facility was safe that had merely been the papers interpretation. A complaint has been made to the Editor of the publication, and requested that the content of future reports are reported as written. 14
The report says that Bryn Composting is not likely to have any significant effect on the physical health of the public. GP records support that the rates of respiratory conditions and chronic obstructive airways disease are not elevated. If you wish to obtain a full copy of the report Dr Richardson can provide a copy. 2.29 Sustainable Development Success The Blaenau Gwent Wellbeing Alliance; which brings together statutory and third sector partners to improve health and reduce inequalities; has secured some funding through Welsh Government Sustainable Development Challenge Fund at this year s Hay on Earth, part of the Hay on Wye Festival. The Wellbeing Alliance worked together to develop a project which aimed to bring about lifestyles changes by increasing community engagement in local food production through the creation of new allotment sites for community growing and/or the introduction of tubs for home growing. The produce grown will be shared across the community and will be used to support existing community projects such as luncheon clubs and cookery skills courses. The Pots, Tubs, Troughs and Tucker project was submitted as a proposal for the Connecting Communities element of the scheme which focuses on finding new and better ways to bring together the shared interests of local, councils, businesses, communities and the third sector to build resilience and reduce impact. Following a open session where the general public could view the projects and vote on their favourite the Wellbeing Alliance representatives (Rhys Burton The Cooperative, Rachel Elston Communities First/Gwent Association of Voluntary Organisations and Jenny Evans ABHB Gwent Public Health) were required to pitch their project to the Green Dragons. Combining the public s vote with that of the Dragons the Wellbeing Alliance successfully secured 10,000 to deliver their project. Feedback on how the project has taken shape is expected at next year s Hay Festival. National press coverage from the Guardian and Telegraph accompanied the award. 15
2.30 Infection Rates Fall Ward staff on C5 West at the Royal Gwent Hospital were congratulated on reaching 350 days without a single case of Clostridium Difficile being reported. Nurse Director, Denise Llewellyn and Grant Robinson, Medical Director, visited the ward to offer their personal thanks on behalf of the Health Board for the hard work that has kept the ward safe for patients. The ward was the first in the hospital to undergo a full refurbishment and this, together with the introduction of a series of safety measures, known as a care bundle, are now beginning to drive down infection rates. 2.31 Revalidation The Medical Directors of the Health Boards in Wales have been identified as the Responsible Officers. Responsible Officer training will take place this autumn, and the Medical Director will join a Revalidation and Appraisal Implementation Group at Welsh Government to coordinate actions. Existing IT systems used for GP appraisal will be improved to be used more widely. 2.32 1000 Lives Plus A mini-collaborative event in early September to develop actions to improve prevention of Hospital Acquired Thrombosis (HAT) was attended by a team from Aneurin Bevan including the Medical Director and Dr Simon Noble from the health board, who is the national Clinical Lead in this area. Useful progress has been made on measurement of the rate of HAT and the use of the individual risk assessment tool for patients. A celebration cake was presented to ward C5W at the Royal Gwent to celebrate 300 days without a C. difficile infection the hard work of the cleaning supervisor on the ward was particularly noted. In the last week of August the Medical Director joined 1000 Live Plus leads from other healthcare providers in Wales to visit Jonkoping county in Sweden, which has high quality indices and relatively low costs of healthcare. A white paper detailing the learning from this visit will be published in the near future 16
2.33 Monthly Review of Deaths After a short break over the summer holiday period this process is operating once more within the Health Board, with improvements following a review through the 1000 Lives Plus mini-collaborative process to include a focus on the care of patients with sepsis. Notes are reviewed on a Tuesday evening at the Royal Gwent hospital and on a Thursday ay Nevill Hall, with a summary of findings being circulated from the Medical Director to all consultants at the end of the week. 2.34 Quality measures for Emergency Medicine There are now weekly meetings of A&E clinical staff, joined by the Medical Director, to frame actions against the expanded suite of quality measures developed by the College of Emergency Medicine. The measures are reported biweekly to the A&E/Flow meeting chaired by the Chief Executive. 2.35 Doctor and Dentists Pay Review Body The health board hosted the visit by the DDRB to Wales in September, and facilitated interviews with medical staff at all levels in the organisation. The funding environment for pay remains constrained, but the DDRB expressed thanks for the time and information given by Health Board staff in support of this UK-wide process. 3. Conclusion and Recommendation: The Board is asked to receive this report for information. Report prepared and sponsored by: Executive Team Aneurin Bevan Health Board September 2011 17