Freedom of Information Request: Our Reference CTHB_217_15 You asked: 1. Do you have any community based dermatology services within your local health board? Yes. (only primary care, not linked to dermatology) 2. Do you have any secondary care dermatology services provided within your local health board? Yes. 3. Do you have any secondary care plastic surgery services provided within your local health board?. Secondary plastic surgery services are provided at Morriston Hospital, Swansea (AbertaweBroMorgannwg UHB). 4. Which of these services are: a) contracted as consultant led 18-week services Community care dermatology service. Secondary care dermatology service. Secondary care plastic surgery service. 18 week target does not apply in Wales, the Health Board works to a Welsh Government 26 week target. b) GPs with special interests GPwSI services Community care dermatology service. - Yes Secondary care dermatology service. - Secondary care plastic surgery service. - c) Secondary care nurse services Community care dermatology service. - Secondary care dermatology service. - Secondary care plastic surgery service. - 5. Does the local health board contract directly with GPwSI services? Yes If yes, what dermatology services are offered by GPwSI: The range of services being provided are currently under review. It currently includes the following: Warts and verrucae
Molluscum contagiosum Skin lesions, including skin tags, benign cysts, naevi, sebhorroeic keratoses Actinic keratoses, Bowen s dermatofibroma 6. If you have a GPwSI dermatology service directly contracted by the LHB do all the GPwSIs: a) deliver a monthly clinic at their local hospital. b) have access to another consultant dermatologist resource. Please provide details below a. A clinic is currently run on a weekly basis b. Consultation and Needs Assessment 1. Does your local health board put community dermatology services locally out to tender? 2. Do you have care pathways for the following skin conditions? Please append any detailed protocols: Condition Malignant melanoma Squamous cell carcinoma Skin Cancer Basal Cell Carcinoma Pigmented lesions Contact dermatitis Paediatric dermatology Vulval disorders Leg ulcers Acne Eczema Psoriasis Allergy Patch Testing Care pathway Y/N As per USC Wales pathway As per USC PATHWAY WALES AS per BAD guidelines Dedicated paediatric clinic Yes, dedicated vulval clinic seen by tissue viability yes NICE Guidelines* NICE Guidelines* Seen by respiratory medicine Yes, patch test service
NICE Guidelines are available on the National Institute for Health and Care Excellence website https://www.nice.org.uk/ 3. How were care pathways informed? Skin cancer as per Wales USC national pathwayand inflammatory pathways are informed by the British Association of Dermatologist/NICE Guidelines. 4. What activities do you undertake to identify the local health care need or requirements for service redesign? (please list and give specific examples in relation to dermatology) As part of the overall planning for the Integrated Medium Term Plan (3 year planning cycle) each directorate and locality develops its plans for inclusion in the overall plan for the organisation. Dermatology would be considered as a specific service within the Acute Medicine and A&E directorate. The current IMTP is available here 5. Has the local health board conducted: a. A healthcare needs assessment to determine the likely level of demand for a dermatology service? b. A review of current service provision? a. b. Peer review of the cancer pathway has taken place and a Kings Fund letter was discussed by the Medical Director with the team 6. When was the last time your local health board conducted a review of local dermatology service demand in relation to workforce capacity? This is part of the work captured by the Integrated Medium Term Plan an approach which captures quality, finance, demand and capacity and of course workforce issues. The current IMTP is available here When was the last time your local health board conducted a review of local plastic surgery service demand and workforce capacity?. Secondary plastic surgery services are provided at Morriston Hospital, Swansea (ABMUHB). Specific service usage questions (dermatology)
1. How many consultant dermatologists do you employ within your local health board broken down by: a. Posts - 5 b. WTE - 3.4 2. How many consultant dermatologist vacancies currently exist within your local health board broken down by: a. Posts - 0 b. WTE - 0 3. How many locum dermatology consultants are employed by the Local Health Board broken down by: a. Posts - 0 b. WTE - 0 4. If you employ locum dermatology consultants, how many are not on the specialist register. 5. Of the above locum consultant dermatologists how many have been in post for a. longer than 12 months b. longer than 24 months c. Longer than 36 months d. longer than 48 months 6. Is your local specialist secondary care dermatology service fully staffed? - Yes If you have vacancies: a. where in the LHB does this specialized secondary care dermatology service vacancy/vacancies exist? GPwSI Service b. have you advertised them? - c. how many times have you advertised each vacancy? - NA 7. Do you have any dermatology nurse specialists employed in secondary care in the local health board? If Yes, where are these nurses located and how many in total does the LHB employ? We have 2 nurses employed in Cwm Taf University Health Board 8. If you employ dermatology nurse specialists- are these nurses accredited dermatology nurse practitioners?
Yes 9. Within your local health board area, how many GPs are providing skin surgery locally? And where are they located? NA Questions 10-15 The UHB is unable to provide you with the specific break down requested for questions 10 to 15, as the information requested is held in the patient s manual files and to provide the information would entail a review of each patient record. It is estimated that the cost of providing you with the information is above the amount to which we are legally required to respond, i.e. the cost of locating and retrieving the information exceeds the appropriate level, as stated in the Freedom of Information (Fees and Appropriate Limit) Regulations 2004. However, to aid and assist with your request we able to provide the overall totals. 10. Please provide activity levels for the service, according to specific skin conditions, for the last 5 financial years (-, -, -, -2014, 2014-) for: Please see provided in the table below the activity levels for daycase and inpatient episodes in surgical specialties with dermatology being the identified condition. - - - - 2014-2014 - June Total 236 217 289 253 283 138 Please note that specific skin conditions are only recorded on the 11. How many routine referrals are made from primary care to your local secondary care specialized dermatology services each year? - - - - 2014 - - June
2014 Total 1497 1883 1601 1135 1254 * 536 * To June only Criteria: Source of referral = GP, Specialty = Dermatology, Letter Priority = Routine Please note that specific skin conditions are only recorded on the 12. How many patients attended for a new outpatient appointment in dermatology? Condition - - - - 201 4-201 4 -June Total 4370 4976 4797 4817 5243 2085 Please note that specific skin conditions are only recorded on the 13. How many patients attended follow-up outpatient appointments in dermatology? - - - - 2014-2014 - June Total 7398 8622 9195 10065 10635 4070 Please note that specific skin conditions are only recorded on the 14. How many patients had dermatology surgery in the local health board? (day cases in secondary care) - - - - 2014-2014 - June Total 0 0 0 0 0 0
Please note that specific skin conditions are only recorded on the 15. How many dermatology inpatient admissions were there in your local health board? - - - - 2014-2014 - June Total ** ** 10 ** ** ** Please note that specific skin conditions are only recorded on the Where the figures are less than 5, this has been denoted by **. The exact figures have been withheld due to the low numbers involved. Where numbers are low we have considered that there is the potential for the individuals to be identified from the information provided, when considered with other information that may also be in the public domain. Also, responses under the Freedom of Information Act are made available to the public at large. We are therefore withholding this detail under Section 40(2) of the Freedom of Information Act 2000. This information is protected by the Data Protection Act 1998, as its disclosure would constitute unfair and unlawful processing and would be contrary to the principles set out in Schedules 2 and 3 of the Act. Section 40 is an absolute exemption and does not require the Health Board to consider the public interest test. 16. Do you have dedicated ward space for dermatology inpatients within your LHB? 17. What is the waiting time in your LHB for urgent dermatology referrals that do come under the category of a 2 week wait referral? Please provide details below: 10 working days 18. Does the local health board operate a rapid access clinic for dermatology?
Yes for cancer patients 19. In terms of new to follow up referrals coming in, within your agreed contracts, has the local health board ever flagged up unmet need in the last 5 financial years (-)? Yes as part of the demand and capacity process which is linked to the IMTP process and plan (The current IMTP is available here) 20. In each of the last 5 financial years (-, -, -, -2014, 2014-) for how many patients have you breached your 2-week wait targets for cancer referrals.? There is no two week target for cancer referrals in Wales, it is an English target and therefore we do not measure it or report it. 21. In each of the last 5 financial years (-, -, -, -2014, 2014-) how many patients with skin cancer have been referred from secondary care dermatology services to plastic surgery services? This information would need to be obtained from the Plastic Surgery centre, which in our case is Morriston Hospital, part of ABMU Health Board. 22. Do dermatology patients have access to specialist psychological/psychosocial support services in the local health board? Yes for cancer patients 23. Please provide details of who provides this psychological / psychosocial service, details of the service and the details of the posts available (eg WTE, located at which hospital site)? Macmillan clinical Psychologist Full time in Cwm Taf Specific service usage questions (plastic surgery services) 1. How many consultant plastic surgeons do you employ within your local health board broken down by:
There are no Plastic Surgeons employed by the UHB. All Plastic Surgery referrals are seen by Abertawe Bro Morgannwg University Health Board. 2. How many consultant plastic surgeon vacancies currently exist within your local health board broken down by: a. Posts. b. WTE. c. Specialism in skin cancer. 3. How many plastic surgery locum consultants are employed by the Local Health Board broken down by: a. Posts. b. WTE. 4. If you employ plastic surgery locums, how many are not on the specialist registry? 5. Of the above locum consultants how many have been in post for a. longer than 12 months. b. longer than 24 months. c. longer than 36 months. d. longer than 48 months. 6. Is your local specialist secondary care plastic surgery service fully staffed? 7. How many nurse specialists are employed in plastic surgery to manage skin cancer in the local health board in secondary care? 8. Are these nurses accredited skin cancer nurse practitioners? 9. How many routine referrals are made from primary care to your local specialized plastic surgery service each year for patients with skin cancer?
. There are no Plastic Surgeons employed by the UHB. All Plastic Surgery referrals are seen by Abertawe Bro Morgannwg University Health Board. 10. What are the other sources of referral for new skin cancer patients to your specialized plastic surgery service? -. 11. How many skin cancer patients attend for a new outpatient appointment in plastic surgery?. 12. How many skin cancer patients attend follow-up outpatient appointments in plastic surgery? -. 13. How many plastic surgery day cases in secondary care (skin cancer)? -. 14. How many plastic surgery inpatient admissions in your local health board (skin cancer)? -. 15. Do you have dedicated ward space for skin cancer inpatients? -. 16. What s the waiting time for urgent skin cancer referrals in plastic surgery that do not fall under a 2-week wait referral?. 17. Does the local health board operate a rapid access clinic for skin cancer patients in plastic surgery services? -.