SETTING THE DIRECTION PROGRAME BOARD PROGRESS REPORT

AGENDA ITEM 2.7 11 December 2012 SETTING THE DIRECTION PROGRAME BOARD PROGRESS REPORT Executive Lead: Executive Director Public Health Author: Head of PCSDU Contact Details for further information: Rhian Blake 029 20 556038 SITUATION SETTING THE DIRECTION PROGRAME BOARD PROGRESS REPORT The Setting the Direction Programme Board is accountable to the Strategic Planning and Performance Committee. It has been agreed via the Executive Director of Public Health and the Director of Governance that bi-annual reports on the progress of the Programme Board and its associated workstreams will be provided as assurance to the Committee. BACKGROUND Setting the Direction - The Primary and Community Services Strategic Programme (Welsh Government, 2010) proposes a system of care that will deliver an easily recognisable model of integrated and evidence based health and social care services in the community. This will act as a bridge between primary care and the acute sector bringing together all partners and will focus on the whole needs of the individual, moving from a reactive to a proactive model of care. The framework is predicated on whole systems working within the NHS and with local authorities and third sector partners. The framework aims to ensure a degree of consistency across Wales to enable key impacts and outcomes to be identified and monitored. However, accountability for delivery is retained locally with recognition of the need for local flexibility. The vision for primary and community services in Cardiff and the Vale of Glamorgan was set out initially in 2006 through the Programme for Health Services Improvement. That vision aligned well with Setting the Direction - The Primary and Community Services Strategic Programme. And our delivery structures through the Division of Primary, Community & Intermediate Care (PCIC) enable and lead the delivery of Setting the Direction locally. The Setting the Direction Programme Board was established in March 2012 and its purpose is to provide a local mechanism across Cardiff and Vale UHB together with partner organisations, to ensure that pace and focus is given to the implementation of Setting the Direction Programme Board SPPC Meeting Progress Report 11 December 2012 Page 1 of 3

the primary and community services framework outlined in Setting the Direction, as per the attached Terms of Reference (Appendix1). PROGRESS To date the Programme Board has met on 5 occasions. The Programme Board currently has 11 live workstreams (Appendix 2). A further 5 workstreams have been identified for future consideration by the Programme Board and new workstreams can be put forward via Programme Board members for consideration at any point. As part of the Primary Community and Intermediate Care Divisional Operational Plan, priority actions were identified for the PCIC Division, a number of which have been overseen by the Programme Board. An update against those actions is attached as assurance to the Committee of the work supported by the Programme Board to date (Appendix 3). COMMUNICATIONS The Assistant Director of Strategic Communications has been invited to attend the Programme Board and has been requested to develop a communication framework to support and highlight the work of the Programme Board and its workstreams. The Communications framework will be presented to the January Programme Board and will be implemented thereafter. RECOMMENDATION The Committee is asked to: NOTE the report and support the work of the Setting the Direction Programme Board, in terms of implementing the Primary and Community Services framework across Cardiff and Vale UHB. Financial Impact Not applicable. Quality, Safety and Experience Standards for Health Services The focus of this work is to maximise the health, wellbeing and independence of individuals. Setting the Direction and the associated pathways/workstreams supports the delivery of the standards for Health Services specifically standards1,3,6,7,8,9,18,19,24 and 26 Risks and Assurance Not applicable. Setting the Direction Programme Board SPPC Meeting Progress Report 11 December 2012 Page 2 of 3

Equality and diversity Not applicable. Setting the Direction Programme Board SPPC Meeting Progress Report 11 December 2012 Page 3 of 3

APPENDIX 1 SETTING THE DIRECTION PROGRAMME BOARD TERMS OF REFERENCE March 2012 1. Purpose The purpose of the Programme Board is to provide a local mechanism, UHB-wide together with partner organisations, to ensure that pace and focus is given to the implementation of the primary and community services framework outlined in Setting the Direction. 2. Objectives The objectives of the Programme Board include the following: To co-ordinate the implementation of Setting the Direction, providing regular progress reports to the Health Board and partner organisations. To establish clear workstreams related to the key themes of the Setting the Direction policy framework. To agree the membership of these work streams, ensuring that there is appropriate representation from clinical staff and partner organisations. To ensure that each of the workstreams develops clear and coherent implementation plans with intended outcomes, and clear timescales. To monitor the progress of these workstreams. To ensure that there is an appropriate balance between Locality and Health Board wide approaches. To ensure that lessons are learned and experiences shared across and between Health Boards. To commission evaluation of service models as needed to inform evidence base and to establish cost effectiveness. To address other specific issues affecting primary and community service development in line with needs assessment. 3. Key Interfaces There may be some overlap with the work of the Unscheduled Care Programme Board and the Frail Older Peoples Services Delivery Programme. For these areas, the Setting the Direction Programme Board will ensure good communication between the Programme Board and will receive updates on progress however, they will not constitute a workstream for the Board. The Programme Board will act as an enabler where there is overlap between it and other Programme Boards. 1

APPENDIX 1 4. Membership Director of Public Health (and strategic lead for Primary, Community and Mental Health Services) Programme Board Chair Assistant Director of Strategic and Service Planning Programme Board Vice Chair (currently Interim Director of Strategic and Service Planning) Dr Sharon Hopkins Sian Harrop-Griffiths Divisional Director, Primary, Community and Intermediate Care (PCIC) Divisional Manager, PCIC Divisional Nurse, PCIC Divisional Therapy Lead Operational Director Primary Care Locality Managers Head of Unscheduled Care Head of Primary Care Service Delivery Unit Programme Board Management Divisional Representation Local Authority representatives Corporate Support LMC CHC Third sector Staff Side TBC Sue Morgan Vicky Warner Alun Morgan Steve Davies Lance Carver Rachel Lewis Lynne Topham Chris Cashmore Rhian Blake Pat Blackwell Richard Evans Karen Elcock Jonathan Kell David Scott-Coombes Bernie Steer Ian Wile Ian Morris Rachel Jones Mike Murphy Andrew Cole Chris Lewis Alan Roderick Maureen Fallon Julie Cassley Dr Andrew Jones Steve Allen Rachel Connor Nigel Gibbs/Dawn Ward WAST TBC Note: There will be additional representation of workstream leads that will attend to update on progress and for the duration of the workstream. 5. Workstreams A programme of workstreams to be undertaken will be agreed at the inaugural meeting of the Programme Board. This will inform the agenda and membership and should be received as an addendum to these terms of reference. 6. Meetings The Programme Board will meet on a bimonthly basis. 2

APPENDIX 1 The specific workstreams will meet as required in order to ensure progress against the deliverable outcomes. Workstream monitoring will be via a standard project template approach, as co-ordinated by the Programme Management. Agendas and supporting papers will be distributed no less than 2 working days before the meeting following approval by the Chair. 7. Accountability The Programme Board is accountable to the Strategic Planning and Performance Committee. 3

APPENDIX 2 SETTING THE DIRECTION PROGRAMME BOARD Workstreams September 2012 Workstream Title Lead Support Status COPD Tom Porter Rosemary Kavanagh, Guy Marshall Open End of Life/ Advance Care Planning Helen Howson Julie Yapp, Chris Absi Open Hot Access Anne Wei Sue Morgan, Jessica Castle, Nav Masani Open ENT Ian Morris Chris Absi, Alun Tomkinson, Tina Bayliss, Anna Kucynska Open Dermatology Fiona Kinghorn Chris Absi, Andrew Dearden, Mark Smithies, Andrew Morris Open Diabetes Helen Howson Lindsay George, Sarah Morgan Open BNP INR Gastro H Pylori Pathway Community Acquired Pneumonia Cough Urology Chronic Pain DVT service Jessica Castle Rachel Rayment John Green Simon Barry Simon Barry Shibs Datta Ian Morris Rachel Rayment Jonathan Kell, Nav Masani, Zaheer Yousef Clare Evans, Gina Gwynne, Sarah Morgan, Darrell Baker David Hanks, GP TBC David Hanks, Guy Marshall David Hanks, Guy Marshall Sian Griffiths, Alex Rees, Rebecca Walberg Sharmila Khot & Helen Lawton Richard Evans Open Open Open Open Open For consideration For consideration For consideration Cardiac Pathways TBC TBC, Sarah Morgan For consideration

Cataracts Ian Morris Dan Morris + 2 Optometrists APPENDIX 2 For consideration

PCIC Operational Plan Priorities April November 2012 APPENDIX 3 Priority Actions: Complete one pathway redesign template and implement Q1 April July 2012 Develop pathway redesign templates for: COPD; ENT; Dermatology; Diabetes; Heart Failure; End of Life Care; Falls; Barry Minor Injury Service. Q2 July October 2012 Implement if evidenced. Update Q1&2 Setting the Direction Programme Board established to provide a local mechanism UHB-wide, together with partner organisations, to ensure that pace and focus is given to the implementation of the primary and community services framework outlined in Setting the Direction. Programme Board has met on 5 occasions and has 11 live workstreams it is currently supporting and 5 workstreams which will be brought to the Programme Board in the coming months for consideration. COPD identify resource requirements for pilot and review data re UHB performance COPD initiate pilot if evidenced COPD Resource requirements identified. Benchmarking exercise undertaken. 3 practices identified to participate in pilot commencing Dec/Jan. Engaged CHC & LMC. Workstream leads also requested to consider the shape of the respiratory service to ensure the best generic response in the community linked to specialist support. ENT complete VFM evaluation and consider funding arrangements. Dermatology cost primary/secondary service and scope impact of tele-dermatology ENT finalise service specification and implement service (if evidenced) Dermatology finalise service specification and implement service (if evidenced). ENT Current community service provision in Vale continuing as Phase 1, hoping to roll out integrated model across Cardiff as Phase 2 early 2013.. Dermatology Clinical Strategy developed and presented to the September Programme Board. Accreditation process currently being finalised. BNP Pilot across Cardiff and Vale commenced in Oct 2012. Use of a BNPguided pathway for use in primary care to help identify and refer appropriate patients for evaluation of heart function. End of life and advance care planning - SBAR models in place. Diabetes Impact on patient flow assessed and fed into the organisational capacity plan. Educational opportunities and self help groups being explored. Impact of transition to be reviewed in coming months including referral patterns and qualitative feedback. 1

PCIC Operational Plan Priorities April November 2012 APPENDIX 3 Priority Actions: Q1 April July 2012 Q2 July October 2012 Update Q1&2 Hot Access Cardiology to act as pilot for e-referral. Barry Minor Injuries Service conduct audit of patients to determine potential benefits and decide on whether to implement primary care model. Implement or close new model. Barry Minor Injuries Service Primary Care model implemented. Maximise resources from Primary/Commu nity Care Right size phase 1 CRTs through additional recruitment. Develop detailed service specifications for 2 nd phase Invest to Save Bid (Wyn Campaign) CRT Operational Policy agreed via the Wyn Steering Group. Develop service specifications to support 1 st phase Invest to Save Bid (Wyn Campaign) If 1 st phase approved, develop change management processes and start recruitment. Recruitment almost complete. WOD has provided support via The Road to Integration programme which invited all key stakeholders. IDS Service Specification currently being developed will be complete by 30/11. Maximise use of Communication Hub through promoting its role internally and externally; rolling out the new estates helpline; integrating local authority and health call handling out of hours and provide access to befriending Maximise use of Communications Hub to act as the access point for adult intake and assessment team in Cardiff and the Vale of Glamorgan LAs and provide call handling for the speech and language directorate. Services now provided by the Hub include GP OOH, Dental Helpline, District Nurse Booking, Estates Helpline, currently the centre answers over 200,000 calls per year. May - first stage in call handling integration being reached, with LA staff now answering NHS Out of Hours calls, only Hub in Wales to achieve this. Commenced delivery of first third sector service Care & Repair in June. Number of presentations and discussions taken place across the UHB and with stakeholders to promote the role of the Hub. Communications Hub Plan developed to highlight key areas of development/focus for prioritisation. 2

PCIC Operational Plan Priorities April November 2012 APPENDIX 3 Priority Actions: Q1 April July 2012 and care and repair services. Re-profile the district nursing skill mix to agree re-profile and identify changes required. Q2 July October 2012 Start to implement changes to district nursing skill mix. Update Q1&2 Workshop with Community Directors undertaken in order to develop a vision paper. Lead Nurses to distribute revised paper to commence staff consultation. Work jointly with Mental Health Division throughout year to implement the primary care mental health measure and shared care service. Division represented on steering groups and working closely with implementation leads. Undertaken programme of engagement with GPs and Mental Health. Primary and Secondary Care pathways for HMP Cardiff and Cardiff Health Access Practice, being reviewed in light of the Measure. Improve the primary and community care estate to ensure it is fit for purpose for delivery of service through opening Loudon Square; developing the primary care arm of CRI. Improve the primary and community care estate to ensure it is fit for purpose for delivery of service through starting the Rumney and Splott developments; opening Grange surgery and completing the refurbishment of Grangetown Health Centre. Loudoun Square opened April 2012 and is a flagship for local, cross-sector working and community-based health care service delivery. Single Assessment Centre opened in August 2012, creating a one-stop-shop opportunity for homeless people in the city centre and is bringing together a range of exiting organisations from both the statutory and voluntary sector to provide coordinated service. As well as an Assessment Centre the scheme will provide two replacement hostels and a modern Day Centre. Grange Surgery Development completed and opened 22 October 2012. CRI - Locality Health and Wellbeing Centre presents an opportunity for the UHB to deliver its vision for creating a hub which will work as part of a network of primary and community services within a safe and clinically effective environment. Completion date for stage 1 is estimated to be Summer 3

PCIC Operational Plan Priorities April November 2012 APPENDIX 3 Priority Actions: Q1 April July 2012 Q2 July October 2012 Update Q1&2 2013. Rumney & Splott Developments Sod cutting ceremonies taking place imminently. Completion estimated as Summer 2013. Grangetown Health Centre Refurbishment due to complete Spring 2013. Across the Cardiff and Vale GP Estate Number of Improvement Grants and IPDs submitted to WG, awaiting consideration. Ensure that all GP practices provide comprehensive access during weekdays through full achievement of no half day closures in any of the 67 practices across Cardiff and the Vale Ensure no practices closes 2 hours or more before 6.30pm one day per week. Primary Care Team have worked closely with practices to improve access to primary care services across Cardiff and Vale. To date: 13 practices that historically operated half day closing have agreed to open fully Minority of practices who historically closed early once a week have in the majority agreed to extend their hours. In line with the Health Ministers manifesto, Primary Care Team are currently reviewing consultation rates across all GP Practices, including access arrangements at the beginning, lunch time and end of day,. Roll out 50 tele-health monitors for the in-hours management of chronic conditions (throughout year). Pilot Commenced July 2012 for 6 months to assess whether the system adds value beyond standard care and which types of patients do best when using it. It is anticipated that the project will be wide ranging in terms of types of patients but numbers maybe small. Update being taken to the February Programme Board. Prepare, publish and implement a strategy for the benefit of unpaid carers (throughout the Carers Strategy developed (led by Patient Experience Team). Number of actions already taken place including: carer awareness section now included in UHB induction programme Carers information being placed on all wards and Health 4

PCIC Operational Plan Priorities April November 2012 APPENDIX 3 Priority Actions: Q1 April July 2012 year) Q2 July October 2012 Updat e Q1&2 Centres/Clinics draft pathway for hospital clinical staff showing the support and involvement carers need when the person they care for is admitted to hospital developed Communications Hub and Cardiff Council Adult Services developed a pilot project to help identify adult carers through the OOH Service. developed an information strategy for patients, families and carers Vale Citizens Advice Bureau (CAB) placing information kiosks, in Barry Hospital). UHB to seek funding to place kiosks in UHW and UHL. A Vale of Glamorgan A-Z of carer support organisations has been widely distributed and a joint version for Cardiff and the Vale of Glamorgan is in development. Working with Primary Care Contractors Review high cost prescribing through developing a data set to support practice visits; consider providing additional support to a practice on a trial basis; introduce activity run rates; agree with LMC the potential use of sanctions and develop a list of the top 10 effective drugs to direct practice usage. Work with the Community Directors through using QP Framework to review emergency admissions and referrals at a neighbourhood level Prescribing - Data set and run rates developed for top 10 Practices. Sanctions (Annex 8) agreed with LMC and Medicines Management Group. Key Prescribing messages developed and shared with all GPs and Secondary Care Prescribers. QP Emergency Admissions & Referrals Regular neighbourhood peer review meetings in place and improvement plans developed by practice. Reports submitted in line with required timescales. 5

PCIC Operational Plan Priorities April November 2012 APPENDIX 3 Priority Actions: Information Framework Q1 April July 2012 Develop performance metrics for CRT Phase 1 through an immediate reporting framework and potential future reporting framework via PARIS. Develop performance metrics for Invest to Save bid (1 st phase bid) and potential future reporting framework via PARIS. Q2 July October 2012 Update Q1&2 Reporting framework agreed with key performance metrics identified for the delivery of CRT services. In addition, development work with the PARIS team has led to this reporting framework being provided by PARIS. This has run in shadow over the summer with a data quality exercise being undertaken in September in preparation for reporting from 1 November via PARIS. This is a significant step-forward. The next objective is for CRT staff to have mobile working to ensure they working at optimal efficiency. The wider impact of the CRT s within the Wyn Campaign is being scoped with the feeder specialities. This includes reduced length of stay due to earlier referral to the CRT s and admission avoidance i.e. the whole pathway impact. 6