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Bwrdd Iechyd Hywel Dda yw enw gweithredol Bwrdd Iechyd Lleol Hywel Dda Hywel Dda Health Board is the operational name of Hywel Dda Local Health Board Hywel Dda Health Board Annual Report 2009/10
CONTENTS
Page Nr
Welcome 3 About Us 5 Care Closer to the Community 10 Developing Our Hospitals 16 Enhancing Mental Health and Learning Disability Services 22 Healthy Living 26 Engaging with Patients 32 Award Winning Staff 37
Facts & Figures:
Performance 47 Governance 51 Committee Structure 55 Financial Statements 58 Making the Connections 64 Remuneration Report 65 Report of the Auditor General for Wales 71
Contact Us: Hywel Dda Health Board Merlin’s Court Winch Lane Haverfordwest Pembrokeshire SA61 1SB
Tel: 01437 771220
Web: www.hywelddahb.wales.nhs.uk
Page 2 Hywel Dda Health Board Annual Report 2009/10
Welcome
This has been a momentous year for the NHS in Wales, with the introduction of a completely new structure that fully integrates the planning and delivery of healthcare services. Our new organisation –Hywel Dda Health Board –delivers all types of healthcare to the local populations of Carmarthenshire, Ceredigion and Pembrokeshire, from primary care, such as your GP; community care delivered in your community or increasingly within your own home; or hospital care.
Our primary aim has been, and will continue to be, to provide world-class healthcare services for the benefit of our patients, ensuring they get the right care, at the right place, and at the right time, every time. Patients have told us that they would prefer, whenever possible, to be treated within their own homes and so we are investing in our community services to make this possible. For example, during 2009/10 we were successful in achieving funding from the Welsh Assembly Government to expand the Acute Response Team already operating in Carmarthenshire, to Ceredigion and Pembrokeshire. Not only does this service provide nursing care within the comfort of the patients own home, but is also releases hospital beds for the care of patients who need it the most. We are also committed to ensuring that when patients need intense hospital care, they get the best treatment possible. We are proud to have been named in the CHKS Top Hospitals Programme, which considers performance against criteria such as safety, clinical effectiveness, health outcomes, patient experience and quality of care.
We have also committed to ensuring that our facilities are fit for the 21st century. We have been pleased to work on some major capital programmes during 2009/10 including significant investment into a range of services at Bronglais General Hospital, a new Emergency and Urgent Care Centre at Withybush General Hospital, an extension to the Breast Care Unit at Prince Philip Hospital and engineering work at Hospital. Many of these services are already open to patients and providing the healthcare and accommodation that you deserve and are entitled to.
Re-organisation has of course come with its own challenges and so we would like to take this opportunity to thank our staff who have risen to this and made some remarkable achievements during the past 12 months, many of which are detailed within this report. These include numerous awards and plaudits for individual staff and departments on a regional and national basis, including NHS in Wales Awards. As an organisation we are also committed to recognising and rewarding staff ourselves and as part of this we held an internal staff awards scheme, called the Best of Health Staff Awards, to celebrate innovation and commitment to patient services.
Page 3 Hywel Dda Health Board Annual Report 2009/10
The standard of entries was extremely high. Staff are our greatest asset and so it is important for us to look after their health and well-being, as recognised this year when we were the only NHS organisation in Wales to be included in the Nursing Times Top 100 Employers. We were also very proud to receive the Gold Corporate Health Standard, which is only awarded after independent inspection.
The next year will bring new challenges, including the economic position which will mean difficult times for everybody –and the local NHS is no exception. Less money will be available so our objective is to make sure that what we spend is used effectively to give you the highest quality of care possible and the best life chances. We must also ensure that our services are sustainable for the future and, as part of this, we want to provide more care in the community and rely less on unnecessary visits to hospital. We recognise that change can be emotive and we commit to you that we will not make any changes until we are absolutely convinced that they provide both a better standard of care and improved outcomes. We are also committed to being a listening organisation and we will engage with you on all major changes that affect patient services. We will be launching a new involvement scheme during 2010/11 to ensure that we can communicate with you and, most importantly, that you can communicate with us.
This report outlines in more detail what we have been doing during the last year and what we are planning for the future. Please take time to read it and let us know if there is any further information you feel you need.
Mr Chris Martin
Mr Trevor Purt
Page 4 Hywel Dda Health Board Annual Report 2009/10
About Us
Meet the Board
Details of Board Members of the legacy organisations are available within the Governance Chapter at the end of this report.
HYWEL DDA LOCAL HEALTH BOARD Mr Chris Martin Chairman
Independent Members Mrs Janet Hawes Vice-Chairman Mr Eifion Griffiths Independent Board Member (Estates & Service Re-design) Mr Don Thomas Independent Board Member (Finance) Professor Melanie Jasper Independent Board Member (University) Mr Neil Sandford Independent Board member (Trade Union) Mrs Jane Jeffs Independent Board Member (Community) Mrs Margaret Rees-Hughes Independent Board Member (Community) Mrs Julie James Independent Board Member (Voluntary Sector) Mr David Wildman Independent Board Member (Local Authority) Mr Tim Irish Independent Board Member (Information Management and Technology)
Executive Directors Mr Trevor Purt Chief Executive Mr Ian Bellingham Interim Director of Performance & Operations (to 31/01/10) Mr Tony Chambers Director of Planning, Performance & Operations (from 01/01/10) Mrs Karen Miles Director of Finance Dr Sue Fish Medical Director Dr Simon Mahon Medical Director (from 26/11/09) Ms Kathryn Davies Director of Therapies & Health Science (from 01/03/10) Mrs Caroline Oakley Director of Nursing & Midwifery Mrs Bernardine Rees Director of Primary Care, Community & Mental Health Ms Janet Wilkinson Director of Workforce & Organisational Development Dr Lyn Harris Acting Director of Public Health
Page 5 Hywel Dda Health Board Annual Report 2009/10
Our Vision We want to deliver the highest quality of healthcare for the people of Hywel Dda by operating as a world class health system. We want to provide the right care, in the right place, at the right time - every time.
We will provide more care and treatment at home, in GP Practices and in the community. We will invest in prevention and treatment of long term illness. We will provide a greater focus on quality, safety and improving outcomes for our patients. We will eliminate waste, duplication and make sure we get value for money in everything we do. We will ensure we have a flexible, skilled and motivated workforce equipped for delivering a world class health system.
Services and Sites Hywel Dda Health Board is an integrated care organisation, bringing together for the first time, community, primary and secondary care services.
We provide health care services to a total population of around 375,200 throughout Carmarthenshire, Ceredigion, and Pembrokeshire.
We have four hospitals:
Bronglais General, Aberystwyth Prince Philip, Llanelli West Wales General, Carmarthen Withybush General, Pembrokeshire
Acute and community services are provided via our hospitals, as well as eight community hospitals, 11 health centres, and other accommodation.
There are numerous locations and settings across the three counties from which Mental Health, Learning Disabilities, Rehabilitation, Psychotherapy and Neurophysiology services are provided.
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Primary care services are provided mainly through contractors, including:
55 GP practices (main sites) - GPs provide essential services to their registered population including those with chronic disease. They can also provide additional services including vaccinations and immunisations, minor surgery procedures, and enhanced services, such as diabetes and sexual health; 56 Dental Practices (67 dental contracts); 99 Community Pharmacies; 51 Optometry Premises.
The Headquarters is based in Merlin’s Court, Winch Lane, Haverfordwest, Pembrokeshire and there are Locality Management Offices based in Ceredigion and Carmarthenshire.
How We Spend Our Money During 2009/10 we spent £669m. Of this, £407m was spent on secondary and community health services, £168m was spent on primary care services including prescribing, and £94m on healthcare from other providers (illustrated below).
Total Expenditure 2009/10
Healthcare from Other Providers £94m
Primary Care Services (including Secondary and Prescribing) Community £168m Health Services £407m
Page 7 Hywel Dda Health Board Annual Report 2009/10
Background The Health Board was formed following the re-structure of the NHS in Wales by the Welsh Assembly Government.
The new unified health organisations carry out the functions undertaken by former Local Health Boards (LHBs) and NHS Trusts. The legacy organisations of Hywel Dda Health Board were Hywel Dda NHS Trust, Carmarthenshire LHB, Ceredigion LHB and Pembrokeshire LHB.
The aim of the re-structure was to improve services for patients through:
the end of the internal market; reinstating democratic engagement at the heart of the Welsh health service; and making co-operation, rather than competition, the bedrock of public service delivery in Wales.
The inaugural meeting of Hywel Dda Health Board was held on 2nd October 2009. The Board received the Executive Summary of the Legacy Statements for each of the four former organisations and noted the significant challenges ahead.
As Hywel Dda Health Board progresses and matures, we will demonstrate benefits such as:
Service Quality –an improvement in the services offered to the population, which should result in improved health outcomes, improved access to services, a shift in the balance of care towards more services to support people in the community, and reductions in geographical health inequalities. Operational –a reduction of the administrative burden of working across multiple organisations and more efficient use of resources across organisations. Investment –a reduction of the administration costs of NHS Wales through the reduction in the numbers of organisations, more effective management and improved purchasing and negotiating power at a national and local level. Better Working Across the NHS –improved perception of NHS Wales amongst patients, the public and stakeholders, a greater sense of stability of direction, and the achievement of improved service integration through closer working with its partners. Staff Benefits –an improvement in morale and individuals’ experiences of working within NHS bodies through increased career opportunities in unified organisations, working in a positive and progressive culture, and enhanced opportunities for learning and development.
Page 8 Hywel Dda Health Board Annual Report 2009/10
Partnership Working Partnership working is a key area for the Hywel Dda Health Board and to ensure this work is developed rapidly and delivers tangible benefits a Director of Strategic Partnerships has been recruited to join the team and lead the strategic oversight of partnership working. This post will work closely with the three counties in the overall alignment of strategic goals and help form, build and deliver meaningful partnerships particularly with Local Authority and Third Sector organisations as well as working closely with the Community Health Council on the third key element of our strategy, that of public co-production, patient experience and population engagement.
Local Service Boards We are actively working with each of the three Local Service Boards to lead the public service agenda. The Local Service Board consists of the Chief Officers and Chair/Leaders of the main public service organisations. The strong relationships between partners and desire to work closely together, have allowed us to look at how we link and deliver our services in a better way together than we do alone. This means we can provide easier, less confusing access to all our public services, reduce the duplication that exists and do things together more effectively rather than separately. Each LSB responds to the specific issues and opportunities in each county and has the power to make decisions that really improve services for the citizens of that county.
Underneath these Local Service Boards sit a range of partnerships which include:
Health Social Care and Wellbeing Partnership; Children and Young Peoples Partnership.
These partnerships develop joint plans and strategies to make sure that the health and social care divide is removed and they are fully integrated. It also allows us to design a community-led health system which works for our predominantly rural area.
Working with partners is a key component in the co-design of health and social care in the three counties and we are fully committed to it.
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Care Closer to the Community
A key focus for the re-organisation of the NHS in Wales, and a priority for us, is to bring care closer to home, ensuring patients get the right treatment at the right time and in the right place.
Investing in Community Services
Crymych Healthcare Centre - During 2009/10, we were able to invest £350,000 into accommodation at the centre, improving the environment for both patients and staff. Padarn Surgery, Aberystwyth - A successful bid for was made to the Welsh Assembly Government for the relocation of Padarn Surgery to a new Primary Care Resource Centre located on the Aberystwyth University campus.
The centre will include:
eight GPs providing general medical services a base for health visitors, district nurses and midwives University crèche and medical centre on-site pharmacy
Works are expected to commence during 2010, with a view to the scheme being up and running by 2011/12.
We are also working on the following proposals:
Gwendraeth Valley - We are working with Penygroes, Tumble and Crosshands surgeries on a proposal to provide a new, modern primary care centre for the area, which would provide GP services as well a community dental service, podiatry and a purpose built base for district nurses, health visitors and midwives. This proposal is in its early stages and consultation with the public will be carried out. Andrew Street Surgery, Llanelli - We are working with the GP and Alliance Boots to relocate the surgery into new premises within Boots
Page 10 Hywel Dda Health Board Annual Report 2009/10
town centre store. The new surgery would remain independent and would be a new, larger, purpose designed accommodation. It would allow the appointment of an additional partner and development and expansion of services. Meddygfa Taf, Whitland - We are working with GPs on a proposal to provide a new modern surgery on the former creamery site. It would also house a pharmacy, podiatry, health visitors, district nurses and midwives. Milford Haven Primary Care Resource Centre - We are working with the two GP practices and a developer, to co-locate both with community based teams and other health care professionals into one integrated, multi-disciplinary Primary Care Resource Centre. This would enable a joined up and co-ordinated approach to the provision of high quality patient care in a modern, purposely-designed centre. Crymych Primary Care Resource Centre - We are working in partnership with the GP at Newport Surgery, Pembrokeshire County Council and the Family Housing Association to provide a new health and social care facility, which would include extra care housing services. As well as providing improved accommodation, this project would enable older people to continue to live in their own home with health and social care close by. GP Practices in Cardigan, Tregaron and Aberaeron - We are working closely with GPs in the community to develop integrated health and social care facilities and in conjunction with plans for the future development of community hospitals in the county.
GP Services GP services are central to the future as we work to deliver more care and support to patients closer to their homes. We are proud that the Welsh GP Access Survey 2009/10 demonstrated that we have the highest proportion of patients that were able to see a GP or healthcare professional on the same, or next, day.
The Protected Time for Learning (PT4L) scheme has been successfully implemented within Carmarthenshire and is providing constructive learning opportunities for all staff within GP practices. Work is ongoing to extend this scheme to Ceredigion and Pembrokeshire.
Quality and Outcome Framework (QOF) visits have been undertaken in all 55 GP practices in Hywel Dda and they continue to show overall improvements in the quality of primary care services for the whole population.
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A range of enhanced services are being offered by GP surgeries, including annual health checks for people with learning disabilities and mental health needs. The Health Board is working to align enhanced services to ensure equitable access to services for patients in the Hywel Dda Health Board area.
We are also working much more closely with GPs in the area to ensure they are brought closer to the planning and commissioning of healthcare. During 2009, seven new GP Locality Leads were appointed to cover local areas within the three counties. This will ensure that patient needs are integral to the re-design of services and will also provide clinical leadership within locality areas. This work will be pivotal in improving GP services, and access to them, in the coming year.
Out-of-Hours Care We were one of the first Health Boards in Wales to roll-out the Individual Health Record. The service has already been introduced in some surgeries in Pembrokeshire and Ceredigion and is due to start in Carmarthenshire later in 2010. It allows critical parts of a patient’s medical record to be available to healthcare staff outside surgery hours for urgent care and with the patient’s consent. This also allows staff to make informed decisions based on knowledge of a patient’s medical history, improving safety and quality of care.
Leaflets and posters explaining how the Individual Health Record works are available at GP practices taking part and online at www.wales.nhs.uk/ihc.
Dental Services We have worked to maintain the NHS dental provision that had been established over recent years. Key achievements include:
the total number of patients treated increased by almost 5,000 over the previous year, representing 47.5% of the county’s population, in Carmarthenshire alone; relocation of a dental practice into a new purpose built premises in Carmarthen, allowing for additional NHS dental capacity; continuation of the dental domiciliary service in Carmarthenshire, which provides oral healthcare and screening within residential care homes to those who cannot attend practices. The Health Board will investigate if this scheme can be extended to the other counties in the future; the Dental Access Scheme, which provides urgent treatment for people who do not have a regular dentist, has been centrally co-ordinated, offering access appointments across Pembrokeshire, Ceredigion and Carmarthenshire. Access into the scheme is via NHS Direct Wales on 0845 60 10 128.
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Urgent dental sessions on weekends to relieve patients who are in pain continue to be provided across the three counties with access via NHS Direct Wales.
In the coming year, we will continue to work with contractors to improve access to orthodontic treatments and find a long-term solution for providing NHS dental care following the retirement of an NHS dentist in Adpar, near Newcastle Emlyn.
Developing Community Based Teams We are investing in community based teams, which provide care for patients within their own communities, and often within their own homes.
Acute Response Team (ART) The ART team provides acute nursing care within patients’ own homes, avoiding unnecessary hospital admissions and reducing hospital lengths of stay. The scheme began in Carmarthenshire and was hugely successful, reducing hospital admissions annually by 1,217 patients, equating to approximately 12,170 bed days. Thanks to a successful funding bid to the Welsh Assembly Government, the scheme is due to be rolled out in Ceredigion and Pembrokeshire during 2010/11.
Chronic Disease Management Work to align Chronic Disease Management across the three counties began in 2009/10 and will continue in the coming year. Carmarthenshire was chosen as one of three ‘demonstrator’ sites across Wales to test improvements in chronic condition management and this work, called C4 locally, is informing improvements across the whole area.
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This includes development of locality based teams, a pilot generic work post in conjunction with the local authority, improved engagement with patients and development of a generic care pathway.
Expert Patient Patients with long term health conditions are being offered support to help them live life to the full via the Expert Patient Programme.
The training programme, delivered in community settings, provides participants with skills to help them better manage their condition on a daily basis. Almost 150 participants took part in the training course during 2009/10.
Health Inequalities We are committed to engaging with hard-to-reach groups in the community and improving services and access to them.
For example, we have a dedicated youth health team - Iechyd Da Carmarthenshire Youth Health Team (YHT) - which works with vulnerable, hard-to-reach-groups not in education. The team are able to address emotional health support needs by providing one-to-one care plans.
Achievements during 2009/10 include:
Worked one-to-one with 169 individual young people regarding a variety of health issues; Facilitated 234 health workshops; Facilitated 15 Youth Health Panels; Conducted 294 open-access community drop-in sessions; Took part in various community activities, from World AIDS Day to Career Fayres.
Alcohol and Substance Misuse We are committed to tackling alcohol and substance misuse in partnership with other agencies and each county has its own action plan to address local needs.
A key achievement during 2009/10 has been in improving the needle exchange scheme in Carmarthenshire, which had caused significant concern amongst local residents. Measures were taken locally to improve implementation of the national scheme, and included introduction of smaller packs, increased engagement with service users, targeted outreach work by drug agencies and a publicity campaign.
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Over a three month sample (April-June), the return rate improved from 30 per cent in 2008 to 43 per cent in 2009.
Improving the Safety of Community Services Healthcare staff in primary and community care have played an active role in ensuring safer services for patients as part of the national 1000 Lives Campaign.
Key achievements include:
A pharmacy warfarin project has encouraged community pharmacists to increase the amount of time spent monitoring and discussing medication issues with high-risk patients, meet recommendations from the National Patient Safety Agency and carry out Medication Reviews
Patient Safety WalkRounds by Independent Members have been carried out within primary care settings, such as GP surgeries and care homes, and allowed frontline staff to have frank discussions about the need for any change or to champion and roll-out best practice. Primary care staff have been using an e-learning infection control tool and care homes are undertaking hand hygiene compliance audits and prevention work by monitoring catheter associated infections and improving care in this area. Partnership work between chronic conditions staff, pharmacy staff and GP practices has resulted in improved take-up of flu immunisation for heart failure patients, as well as better medicine management of these patients so that they maximise benefits from medication. Patient stories have been gathered as a powerful learning tool for healthcare professionals.
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Developing our Hospitals
Whilst we invest in more care in the community, such as the new Acute Response Teams, we want to ensure that when our patients do have to go to hospital, they will get the highest quality of treatment possible.
Improving our Hospitals A number of exciting developments are taking place within our hospitals and estates, totalling £27m in 2009/10. These include improvements to accommodation, as well as investment in new technologies and medical equipment.
Some of the exciting hospital capital developments started in 2009/10, thanks to Welsh Assembly Government funding, include:
Emergency and Urgent Care Centre and New Theatres, Withybush General Hospital This £14m investment began in September 2008 and is due to open to the public in July 2010. As Wales’ most modern and up-to-date emergency facility, it will deliver a completely new model of care for local patients that integrates emergency hospital services with GP Out-of-Hours and urgent social care. It will establish the county’s first Clinical Decisions Unit as well as providing a range of other new facilities and equipment.
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Breast Care Phase 2, Prince Philip Hospital
The state-of-the-art extension to the Breast Care service commenced in January 2009 and is due to open in August 2010. The £7m project, which has also benefited from almost £900,000 of funding for world class medical equipment from the local community, will provide a one-stop-shop for breast care patients with extra examination and consultation rooms, lymphoedema services, a dedicated mammography room and associated treatment rooms.
Bronglais General Hospital, and Development of Community Facilities in Ceredigion Enabling works of £7.5m, which include improvements to car parking facilities, up-grading of the site and re-location of pathology, began in December 2009 and is due to complete in 2010/11. With total investment planned in excess of £40m, this is the Health Board’s largest on-going capital development project. This project upgrades a wide range of clinical services, including emergency care and day surgery in a new purpose-built facility at the hospital. It will also involve the development of community hospital facilities in the county.
Engineering Infrastructure, Health Board-Wide An £8m programme, initial phases totalling £4.5m, were completed in February 2010. This included improvements to medical gas systems and heat distribution infrastructure. In addition, funding has been approved for a new boiler house at Bronglais General Hospital, improving costs and environmental impact. It is hoped this will be completed late in 2011/12.
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New Mortuary and Post Mortem Facilities, West Wales General Hospital Commencing in October 2009, this will deliver much improved post mortem and body storage facilities. The total investment is in the order of £5m and will complete on site in November 2010.
Upgrading A range of investments are being made to upgrade patient areas. This includes £1m for Owain Glyndwr and Llewelyn wards at Bronglais General Hospital and the provision of new £400,000 cardiology facilities at Prince Philip Hospital. In addition, £1m has been invested in fully automated pharmacy dispensing facilities at both Withybush and Bronglais General Hospitals.
Discretionary Capital Programme Other investments are set out in the table below:
Carmarthenshire Upgrade of Central Sterilisation Services £229,000 Department/Sterilisation Equipment
Upgrade of Ceri Ward, West Wales General Hospital £283,000
Redevelopment of Former A&E, West Wales General Hospital to £315,000 pre-assessment treatment room and administration offices
Upgrade of Endoscopy facilities at West Wales General Hospital £136,000
Provision of new Finance offices £219,000
Ceredigion
Upgrade of Theatre Plant and environment £154,900
Phase 1 Upgrade to Owain Glyndwr Ward £375,000 (whole project value circa £1 million)
Upgrade/compliance work at Cardigan Hospital £490,000
Pembrokeshire and Mental Health (Derwen)
Modernisation of Adult Mental Health Facilities £459,000
Final Phase of Fixed Patient Hoist Installation at General £116,000 Hospital
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Future Plans The coming year will see completion of many of our major capital developments at our main hospital sites, which will significantly improve services for patients.
We also continue to invest in our community facilities, with plans progressing for the provision of new healthcare facilities in the communities of Aberaeron, Cardigan and Tregaron.
Improving the Safety of Patients Whilst in Hospital
Hospital staff, as well as those in the community (see page 15), are ensuring patients are receiving safer and better quality healthcare thanks to improvements delivered by the national 1000 Lives Campaign to improve patient safety.
A number of changes have been put in place to save even more lives.
For example, we have led the way in piloting the Transforming Care at the Bedside project, which has empowered frontline healthcare staff to make changes to improve the patient experience, resulting in nurses spending up to 18 per cent more of their time at the patient bedside delivering direct patient care.
We were the first in Wales to implement the World Health Organisation Surgery Checklist, ensuring safer surgery for our patients. Other improvements have included implementation of screening tools for very ill patients, development of medicine management, and initiatives to reduce the spread of infection.
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Empowering Ward Sisters Our nurses have risen to the challenge of developing and implementing changes to empower ward sisters as part of the Welsh Assembly Government’s Free to Lead, Free to Care initiative.
We were the first Health Board to launch the All-Wales nursing and midwifery staff uniforms - aimed at helping patients to readily identify the staff who are caring for them - and we continue to work with partners to finalise this initiative.
A number of other schemes to ensure senior nursing staff have more authority over their ward areas were also implemented during 2009/10 and will be further developed in the year to come.
This includes:
nutritional care; monitoring of cleaning and hygiene standards; leadership education and professional opportunities for ward nursing staff.
Choose Well In the coming year, we will be launching a new campaign –Choose Well - to help provide information to the local population on the health services available for unscheduled (unplanned) care.
The aim is to encourage people to choose the service that best suits their needs and in doing so reduce the number of inappropriate 999 calls and attendances at A&E.
The campaign uses the visual of a thermometer logo, which demonstrates the spectrum of services available for self-care, routine medical care, urgent medical care and emergency services.
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Reducing our Effect on the Environment As an organisation, we both directly and indirectly influence our environment through the resources we use to heat our buildings, run equipment, purchase and dispose of consumables, and travel for business.
To improve our impact on the environment, a range of good practice initiatives and technical solutions have been implemented and include:
installation of energy saving lighting and water saving measures at each main hospital; introduction of plastic and can recycling schemes across Carmarthenshire; establishment of a sustainable transport group to drive forward policy and improvement projects.
Results include:
350 tonnes of CO2 saved in 2008/09 on degree day adjusted energy consumption (a common means of assessing CO2 reduction taking account of climate changes over an extended period) a reduction of 3% on the 2008/09 degree day corrected energy consumption, mitigating increases in energy rate charges a reduction of 121 tonnes in clinical and domestic waste from the 2008/09 tonnage through waste minimisation projects and efficiencies, equating to a 5.7% reduction in overall waste produced
Future work in 2010/11 will include:
development of further initiatives to encourage sustainable travel for staff; examination of bore hole water extraction and wind turbine development at Withybush General Hospital; capital investment in energy efficiency; improving the green credentials of our organisation through partnership working, pursued through the Local Service Boards.
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Enhancing Mental Health and Learning Disability Services
We invested more than £37m into mental health and learning disability services across Carmarthenshire, Ceredigion and Pembrokeshire during 2009/10. Our staff worked closely with users, the voluntary sector and our partner organisations to promote and protect mental health and well-being in the area. We have continued to strengthen existing services and to develop evidence- based new services in line with policy guidance from the Welsh Assembly Government.
Adult Mental Health Services We have worked hard to re-design and modernise adult mental health services through effective use of existing resources, building on work done in previous years.
As part of re-organisation, we have been able to work more closely with colleagues in primary care GP services, including First Access teams in Ceredigion and Pembrokeshire and a team working in primary mental health services in Carmarthenshire. We have shared training opportunities, including the delivery of psychological (talking) therapies, especially Cognitive Behavioural Therapy (CBT).
Building on the success of the pilot service established last year to enable people currently placed out of area to return to more local services, a project was established in 2009 to enable more people to return to services closer to their families and friends. The new service will be extended as part of a five- year strategy for mental health services.
Other areas of work focused on the continued development of early intervention services and crisis resolution and home treatment teams. Staff have worked to ensure that people were able to receive early and effective help and support to enable them to remain at home rather than have to come in to hospital for treatment. As part of this, a therapeutic day service was piloted in Carmarthen. After evaluation this will be rolled-out across the three counties.
A showcase day was held in November to highlight the new developments in our services. Many of our partner organisations attended, including representatives from advocacy services, the police, local authorities, community health councils and Swansea University. In response to requests from service users similar events have been held for voluntary sector organisations and service users in each of the three counties.
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Prompted by concerns about access to physical health care for people with mental illnesses, Health Inspectorate Wales (HIW) launched a major review of services across Wales. The review team visited services provided by Hywel Dda Health Board in November 2009 and an action plan has been developed to ensure that the work continues to progress.
The Mental Health (Wales) Measure has been laid before the National Assembly for Wales. If enacted, it will make a number of important changes to the current legislative arrangements in respect of the assessment and treatment of people with mental health problems. Mental health services within the Health Board are working to assess the potential impact of these changes and to ensure that staff and service users are fully prepared for their introduction.
Staff in the Early Intervention in Psychosis team have continued to develop services in line with the Welsh Assembly Government “intelligent targets” for the year. The Hywel Dda health economy was selected as one of the sites for the pilot baseline measurement of the duration of untreated psychosis in Wales.
David Groves, policy officer with the Equality and Human Rights Commission was welcomed to the launch of the training DVD developed by the Unscheduled Care project team. The launch was attended by Welsh Assembly Government representatives, who highlighted the links between the provision of unscheduled care services and the national plan for suicide prevention.
A joint review of advocacy services was undertaken during the year. The final report and recommendations is expected later in 2010.
We are working to strengthen engagement with service users across the three counties. Using the principles outlined in the Three Counties Service User Involvement Guide, service users have been actively involved in the interviewing and selection of staff for some of the new services being developed. A representative from West Wales Action for Mental Health (WWAMH) is a member of the Service Modernisation Group. Work is in progress to identify a framework for the involvement of users in the future planning of services.
The service worked with its partners to deliver a number of training initiatives during the year.
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These included:
a crisis resolution home treatment module with the School of Health Science at Swansea University; a care co-ordination module with the School of Health Science at Swansea University; award-winning training with Dyfed Powys Police Authority to raise awareness of mental health issues; Cognitive Behaviour Therapy accredited training as part of the improved access to psychological therapies project; worked with voluntary organisations on several awareness publications, such as the service user guide and Mind Your Heart book.
Eating Disorder Services During the year work was done by the local health community and its partner agencies to develop a service in line with the WAG proposals. Staff recruitment has started and it is anticipated that the service will be operational shortly.
Services for Older Adults We have continued to work towards the provision of non-age discriminatory services for older adults. We have also contributed to the development of the All-Wales Dementia Strategy, and are working with partner agencies on the development of integrated services.
Page 24 Hywel Dda Health Board Annual Report 2009/10
Learning Disability Services A number of areas of work for learning disability services were brought together in a Service Improvement Team. This focused on the development of a facility and specialist services to enable people currently placed out of the area to return to accommodation nearer to their families. This facility has now opened.
The service is exploring the development of psychological therapies for people with learning disabilities.
The service is working with local authority colleagues to develop integrated services for people with learning disabilities and their families.
Staff from the Speech & Language Therapy Team received a major award from the College of Speech and Language Therapy for work done to develop communication skills for people with learning disabilities.
Substance Misuse Services Development of integrated care pathways continues with a range of partner agencies across the three counties for drug and alcohol services. The team were invited to undertake a presentation on the work undertaken to date at the All Wales Substance Misuse Conference.
The alcohol service is now well established in Carmarthenshire in conjunction with Social Care and voluntary sector partners.
The core competency training programme continues for clinical staff with training on group work, Community Reinforcement Approach, and Motivational Interviewing.
Structured day programmes have been developed in Carmarthenshire and Pembrokeshire to support clients to move through treatment and towards community reintegration. The feedback from service users has been very positive.
Page 25 Hywel Dda Health Board Annual Report 2009/10
Healthy Living
Each of our counties has populations with specific health needs. The very low population density in Ceredigion with two university populations; the post industrial areas of Carmarthenshire; and the 11 community first areas scattered across all three local authority areas recognising areas of particular deprivation and health need. At the highest level, however, the populations of the three counties are broadly similar especially in the challenges the population projections pose over the next decade and beyond.
Demographics
Hywel Wales Key Statistics Dda LHB
Area size 20,779 km2 5,781 km2
Total population 2,980,000 375,200
Life expectancy at birth –males 76.8 years 77.1 years
Life expectancy at birth –females 81.2 years 82 years
Persons per km2 143.4 64.9
Total number of births 34,572 3,894
Number of deaths 32,148 4,186
Across our area (compared to the Welsh average) there are few people aged 25-44 and more people aged 55-79. In rural Ceredigion and Pembrokeshire, there are relatively high numbers of older people. There has also been a reduction in the death rate with more people living longer and the “over 50s” age band shows expansion, especially in the very elderly.
Although the 2001 Census reported that one per cent of the population came from a black and ethnic minority background, the effect of migration since this time is more difficult to quantify.
Across Wales and the UK, the general fertility rate (the number of births per 1,000 women of child bearing age) had been falling until 2001/2002, however it has been slowly rising since. Hywel Dda general fertility is lower than the Wales rate but closely reflects the Welsh pattern.
Page 26 Hywel Dda Health Board Annual Report 2009/10
Key Illnesses/Disease The greatest causes of death in people aged under 75 among our residents are cancer (43%), circulatory disease (27%) and respiratory disease (9%), together accounting of approximately 1,400 deaths during 2007. It is predicted these major causes of death will continue.
Older People Over 75 years old Current projections see a rise in those aged 75 years and over from 35,000 (10% of the total population) in 2006 to 70,000 (16% of the total population) in 2031. These estimates are based on assumptions about births, deaths and migration.
Under 75 years old In our area, the under 75 age-standardised mortality rate dropped by 22% between 1998 and 2007 (Health Needs Assessment 2007). This reduction in death rate means that more people are living longer and has remained consistently below the Wales average.
It is predicted that the increase in the older population with chronic diseases will be the predominant change in health care needs. These conditions cannot be “cured”, however, there are now interventions at many stages of life to delay deterioration and improve health outcomes, thus achieving the goal of longer, healthier lives.
Healthy Lifestyles People living in our area have generally healthier lifestyles than is typical across Wales. Yet there are still challenges including obesity, smoking and alcohol consumption.
Obesity There are better than average levels of physical activity and fruit/vegetable intake. However, nearly 6 out of every 10 adults are either overweight or obese.
We continue to educate and encourage a greater number of our population to improve their health and well-being.
Page 27 Hywel Dda Health Board Annual Report 2009/10
Information from Welsh Health Survey:
Statistically significantly e r i worse e r h i s h n s a n e
Not statistically significantly e d o h k i t D o r g
different i r l a s d e b e e m l w m r r a y e
Statistically significantly e a
better W H C P C Adults who eat fruit & vegetables 36 40 42 40 38 (5-a-day) % Adults meeting physical activity 30 32 32 35 30 guidelines %
Adults who are overweight or obese % 57 58 54 59 60
Smoking Around one in five adults smoke, leading to over 700 deaths each year. This equates to an average of 22% of adults who smoke in our area. Although the rate of such deaths is lower than in Wales as a whole, the effects of smoking present continuing challenges to service providers in the area.
Adults who smoke % 25 24 23 22 21 20 19 Wales Hywel Dda Ceredigion Pembrokeshire Carmarthen
Alcohol and Substance Misuse In our area over 6,300 hospital admissions each year are caused by alcohol, despite the rate in every local authority area being lower than the Wales average.
During 2007, there were approximately 140 deaths per 100,000 of the Hywel Dda population which were attributable to alcohol misuse. There are around 200 patients admitted to hospital each year because of drug misuse within Hywel Dda area.
Page 28 Hywel Dda Health Board Annual Report 2009/10
Promoting Health in Non-Health Settings
Health promotion activity in our area is consistent with Improving Health in Wales and the strategic direction as set out in Our Healthy Futures.
Success for Healthy Schools All schools across Hywel Dda are part of the Welsh Network of Healthy School Scheme (WNHSS). The scheme aims to promote health across all aspects of school life encouraging them to make health a part of their culture and philosophy through food and fitness, personal development, school hygiene, safety, the school environment and promoting good mental and emotional wellbeing throughout the whole school environment.
Local healthy school schemes were set up 10 years ago and are funded and supported by the Welsh Assembly Government. The WNHSS recently developed a National Quality Award to recognise high standards and achievements in promoting health in schools involved in the scheme for a minimum of nine years.
Two Pembrokeshire schools (Sir Thomas Picton School, Haverfordwest and Pembroke Dock Community School) were the first schools in Wales to receive the award from the Welsh Assembly Government. Assessors visiting the award-winning schools were impressed by the efforts of staff, pupils, parents and governors to create a healthy school ethos. This includes active playtimes, and healthy food schemes, as well as initiatives to support children’s physical and emotional wellbeing like anti-bullying schemes, pupil mentoring and a range of curricular activities from road safety training, to sex education and lessons about the dangers of substance misuse.
Chronic Conditions Management Chronic conditions make a significant contribution to the burden of ill-health in the Hywel Dda area. In response, two pioneering programmes have been developed in Carmarthenshire with the aim of identifying and reducing the risk of people developing chronic conditions.
Page 29 Hywel Dda Health Board Annual Report 2009/10
Success for Health at Work (Prosiect Sir Gâr) Prosiect Sir Gâr is one of the first schemes of its kind to use the workplace as a setting for identifying and managing increased cardiovascular (CVD) risk. Launched in March 2009, the programme is a partnership between Hywel Dda Health Board, Public Health Wales, Carmarthenshire County Council, Corus Steel Works (Trostre), Swansea University (School of Medicine) and the Pharmaceutical industry.
The programme equips Occupational Health staff with the skills to assess and manage CVD risk within the workplace, including near-patient testing, lifestyle advice and motivational interviewing to support behaviour change. All employees over the age of forty years, not known to have vascular disease or diabetes, are invited to an initial cardiovascular risk assessment at the workplace, followed if necessary, by the offer of a tailored risk reduction programme and referral to GP for further investigations. The project went live in September 2009 and to date over 300 members of staff from Hywel Dda Health Board and Corus (Trostre) have received a health check.
Early results indicate the following improvements:
More people identified at an earlier stage of developing cardiovascular disease, with a better chance of putting in place positive interventions to reduce the risk of premature death or disability; Appropriate management of risk factors according to the degree of predicted risk; Improved quality of life for those with previously undiagnosed CVD i.e. diabetes, hypertension, hyperlipidemia; Integration of Occupational Health services into other healthcare services; Improved knowledge and understanding of CVD risk assessment and management within the Occupational Health workforce.
Page 30 Hywel Dda Health Board Annual Report 2009/10
Carmarthenshire Chronic Conditions Collaboration (C4) As part of the prevention element of the Carmarthenshire Chronic Conditions Collaboration (C4) project, a Lifestyle Adviser service is being developed. The service aims to reduce the risk of people developing chronic conditions. Lifestyle advisers will be linked to GP practices and provide a support programme to help clients modify their lifestyles that may be putting them at greater risk of developing chronic conditions. This might include giving up smoking, eating a healthier diet, becoming more physically active, reducing alcohol consumption and achieving and maintaining positive emotional and mental health.
Emotional and Mental Health Promotion Action Plan 2010- 2013 Our emotional and mental health is important to all of us as it affects every aspect of our lives, with emotional and mental health being fundamental to our health and wellbeing. In Ceredigion, the Health Social Care and Wellbeing Strategy and The Children and Young People’s Plan identified emotional and mental health promotion as a priority area for action. Ceredigion Public Health Team took the lead on delivering this action holding an ‘Improving Emotional and Mental Health’event and setting-up a task and finish group.
Eight themes were identified:
Mental Health Literacy (understanding and being able to describe emotional issues); Early Years and Parenting (supporting babies, infants and their parents’ wellbeing); Children and Young People (develop key skills for resilience in later life); Older People (age healthily); Workplace (supporting healthy workforce); Health & Social Care (supporting independence and wellbeing); Whole population; Communities.
The task and finish group has completed the development of the action plan with an official launch planned for September 2010 in Ceredigion.
Page 31 Hywel Dda Health Board Annual Report 2009/10
Engaging with Patients
We recognise that local people should be involved in decisions about health services and policies that affect their lives and we aim to:
keep people well-informed about health services and policies; listen and respond to people’s views and concerns through established ongoing engagement mechanisms; engage people in decisions about changes to services and policies; improve accessibility and accountability to local people; build trust; encourage well-being and healthy lifestyles.
Patient and public involvement We have used a variety of methods to engage and involve patients and service users over the last 12 months including:
Citizen’s Panels; Patient Advisory Groups; Reader’s Panel; Focus Group; User Groups; Voluntary Sector links via Building Strong Bridges Pictured is one of the Health Board’s many facilitators; A network of Volunteers set Louise Richards, who as the first volunteers to be appointed as part of a new scheme up during 2009. called Volunteering for Health
Page 32 Hywel Dda Health Board Annual Report 2009/10
One of the Health Board’s community focus events in action
This two-way communication has helped develop the Health Board in many ways, these include:
input into the planning of new services, such as footcare and the proposed Good Neighbours scheme; testing awareness of health campaigns and sharing of information, such as the recent campaign aimed at reducing the number of patients ordering prescription items they do not need; amendments to the design of patient accommodation, such as the extension to the breast care unit.
Page 33 Hywel Dda Health Board Annual Report 2009/10
Compliments and Complaints Valuable feedback is gained from comments, suggestions, complaints and compliments made by patients, their relatives, carers or visitors. This can help to develop constructive dialogue between the organisation, patients and the wider general public.
We have now set up a process to capture information on the many hundreds of compliments that are received both formally and informally throughout the year. This includes those received by the Chief Executive’s Office and by individual wards and departments.
We recognise that sometimes things go wrong. The philosophy underlying our complaints policy is that concerns are resolved promptly and satisfactorily, remedial action is initiated as quickly as possible and any ‘lessons learnt’ are transferred across the organisation without unnecessary delay.
During 2009/10, a total of 1125 formal, written complaints were received across the three counties. 331 complaints arose from primary care including complaints about general practitioners, dentists and out of hours GP services. 794 complaints arose from acute services such as complaints about clinical care of patients in hospital, waiting times and cancelled appointments.
Formal written complaints
1200 1000 800 600 400 200 0 Total across 3 counties Primary Care Acute Services
Patients/complainants who remain dissatisfied after the Local Resolution or first stage of the complaints procedure may request a second stage, Independent Review of their complaint. In addition to this, complainants can ask the Public Services Ombudsman for an investigation as part of the second stage of complaints management. During 2009/10 the following number of complaints were referred on to the second stage:
Referrals to Independent Review –23 (0.2% of total number received) Referrals to Ombudsman –11 (0.1% of total number received)
Page 34 Hywel Dda Health Board Annual Report 2009/10
In line with All Wales Complaints procedures, we are obliged to provide complainants with a written response to their formal complaint within 20 working days. This is a performance target that is monitored closely within the organisation and by the Welsh Assembly Government. Since the establishment of the Health Board in October 2009, compliance with the 20 day target has been improved to 71% to the end of March 2010.
Learning from Feedback It is essential that the information obtained through complaints is used in a positive way to bring about improvements to services, and over the last 12 months, a significant amount of effort has been invested in ensuring that systems for learning lessons from complaints have been carried out.
The following are examples of some changes which have been implemented following concerns that have been raised from patients and service users:
Training on the end of life care pathway organised for staff to improve communication with patients and relatives during this difficult time; Arrangements made to ensure that patients having fertility tests do not wait in the ante-natal clinic; Improvements made to the presentation of patient information leaflets, following a complaint that the leaflets were photocopies and of poor quality; Updated information supplied from Health Commission Wales on treatments that fall within their remit for Individual Patient Commissioning purposes, following a delay in considering an Individual Patient Commissioning application; Protocols and procedures have been revised for referral between GPs and the Radiology Department to improve waiting time for diagnostic results; Change to the call triage arrangements in Carmarthenshire during GP Continuing Professional Development (CPD) sessions, made as a result of lack of continuity of care. Calls now triaged by Primecare rather than the Carmarthenshire locality office during the afternoon sessions to ensure that relevant patient information is known to the call handler in making triage decisions.
Page 35 Hywel Dda Health Board Annual Report 2009/10
Committed to a Bilingual Service We are committed to the principle that in the conduct of public business we will treat the Welsh and English languages on the basis of equality. A new Welsh Language Scheme was approved by the Health Board in March 2010 and submitted to the Welsh Language Board for approval. Our dedicated Welsh Language Development Officers work closely with all services and departments and key developments in 2009/10 included successfully applying for £14,500 funding from the Welsh Language Board to develop an e-learning package, and making the staff newsletter available bilingually. Key priorities for the coming year will be achieving the 10 Targets and Welsh Language Indicators as set out in the Health Board's new Welsh Language Scheme.
Informing the Public and Media We work closely with the local, regional and national media in order to respond to information requests and provide information about service change, health promotion and to celebrate the success of the local NHS and its staff.
During 2009/10, we:
issued 222 press releases, and responded to approximately 370 media queries.
We promoted a number of campaigns including 1000 Lives, HIV awareness, Prosiect Sir Gar, Chronic Conditions Demonstrator (C4), and Organ Donation. We were involved in the publicity of all major capital developments and Ministerial visits. A number of public road-shows and open events were also held in order to facilitate face-to-face communication with members of the public.
We are also developing our Internet for use by the public and will be making increasing use of new media in the year to come including on-line polls, social networking and pod-casts.
Page 36 Hywel Dda Health Board Annual Report 2009/10
Award Winning Staff
We value our people and the delivery of effective healthcare services would not be possible without the considerable effort from all of our 9,481 staff.
Figure 1 Total number of staff by staff group and gender
Female Male Total Staff Group % % Total % Head of Head of Total Head of FTE Count FTE FTE Count FTE FTE Count FTE Additional Professional Scientific and 156.76 188 65.2% 83.51 110 34.8% 240.27 298 3.2% Technical Additional Clinical 1,054.93 1,672 80.9% 249.38 340 19.1% 1,304.31 2,012 17.5% Services Administrative and 1,060.64 1,334 80.3% 260.47 275 19.7% 1,321.11 1,609 17.7% Clerical Allied Health 355.12 438 82.3% 76.31 80 17.7% 431.43 518 5.8% Professionals
Estates and Ancillary 465.97 741 50.9% 449.32 581 49.1% 915.29 1,322 12.3%
Healthcare Scientists 61.75 71 52.9% 55.00 58 47.1% 116.75 129 1.6%
Medical and Dental 251.02 316 36.6% 434.32 538 63.4% 685.33 854 9.2%
Nursing and Midwifery Registered 2,186.98 2,824 90.4% 233.56 257 9.6% 2,420.54 3,081 32.5%
Students 8.35 17 93.3% .60 1 6.7% 8.95 18 0.1%
Total 5,571.52 7,601 1,842.47 2,240 7,443.99 9,841
Page 37 Hywel Dda Health Board Annual Report 2009/10
It is our aim to ensure a safe and friendly work environment for all our staff and they are encouraged to report any abuse or harassment at work from patients or colleagues. We endeavour to protect our workforce by enforcing the robust procedures we have in place. The organisation gained a Commendation in the Excellence in Partnership Working category of the Best of Health Staff Awards 2009 in relation to work on the Prevention and Management of Violence and Aggression at Work. The organisation has also achieved the Gold Corporate Health Standard, which is a quality mark for workplace health promotion and only awarded after an independent assessment and inspection.
Equality, Diversity and Human Rights As an employer we recognise our obligations to comply with current and future legislation, and we remain committed to provide equal opportunities for all employees, as well as applicants for employment.
The Single Equality Scheme for Hywel Dda Health Board was approved and published in January 2010 and positive feedback has been received from the communities we serve. Work is ongoing to streamline activities relating to Training, Equality Impact Assessment, and Patient and Public Involvement and Engagement across the three counties.
Partnership Working and Staff Engagement The Health Board is committed to engage with staff organisations at the earliest opportunity in key discussions on workforce and health service issues. The Local Partnership Forum meets every other month, supported by an infra- structure of three county Partnership Fora, and staff representatives are involved in Policy Review, Agenda for Change and Organisational Change sub- groups to name a few. In addition, the Local Negotiating Committee (LNC) is actively involved in medical workforce issues, and the newly created Junior Doctor Forum ensures an arena for open discussion with our doctors in training.
Agenda for Change Agenda for Change has been integrated into the new organisation as part of the wider pay modernisation role and work has been ongoing to develop new organisational wide procedures and protocols in partnership in line with the new 3rd edition NHS Job Evaluation handbook.
Page 38 Hywel Dda Health Board Annual Report 2009/10
Recruitment All vacancies are advertised online via NHS Jobs and the Health Board continues to attract high calibre candidates.
As we are experiencing a high number of vacancies at junior, staff grade, associate specialist and Consultant level, like health organisations across the UK, there has been a concentration of energy and resource on an International Recruitment Strategy that is proving to be successful.
Figure 2 Illustration of flexible workforce –full-time and part-time by staff group and gender
Female Male
Staff Group % of % of % of % of FTE FTE FTE FTE Full- Part- Full- Part- time time time time Additional Professional Scientific 67.0% 33.0% 88.6% 11.4% and Technical
Additional Clinical Services 52.9% 47.1% 90.2% 9.8%
Administrative and Clerical 64.9% 35.1% 96.9% 4.0%
Allied Health Professionals 63.9% 36.1% 90.4% 9.6%
Estates and Ancillary 35.8% 64.2% 84.8% 15.2%
Healthcare Scientists 74.5% 25.5% 98.2% 1.8%
Medical and Dental 87.6% 12.4% 96.2% 3.8%
Nursing and Midwifery Registered 61.6% 38.4% 89.1% 10.9%
Students 83.8% 16.2% 0 100%
Page 39 Hywel Dda Health Board Annual Report 2009/10
The Occupational Health Service (OHS) An outline of the activity of the service saw:
Figure 3 Outline of OHS Activity
Number of appointments Activity
Management referrals for attendance 1200 medical appointments management, ill-health retirement and workplace adjustment. Pre-employment screening, vaccination programmes and 5875 nurse appointments self/management referral for ill- health and other workplace issues.
1192 nurse appointments 1192 nurse appointments
Attendance management for 362 physiotherapist appointments musculo-skeletal disorders
The Carmarthenshire service has contributed to and supported the introduction of Prosiect Sir Gar, a multi-site/organisation screening programme for staff (more information, page 30).
The Staff Psychological Well-Being Service The Staff Psychological Well-Being Service continues to provide psychological expertise, helping to build organisational and individual resilience and to prevent and manage work related stress. The programme of workshops for staff has included Resilience Training, Supporting People through Change, and training for managers on how to use the stress risk assessment tools.
(delegate on Supporting People through Change)
Page 40 Hywel Dda Health Board Annual Report 2009/10
Counselling sessions are offered by the service to all employees on a self- referral basis:
(comment from an employee following counselling sessions)
Sickness Absence Management We monitor absences through illness very closely and make sure that staff receive every support to return to work when they have recovered. Our well- developed Occupational Health Service and Staff Psychological Well-Being Service reflect our commitment to support the health and well-being of our staff by focusing on prevention and reduction of sickness absence episodes.
The Health Board’s sickness absence level for the financial year is 5.24%, which is below the national target. This equates to a total of 141,419.00 days lost for 2009/10 from 9,741.42 total staff years available (140,279.06 total days lost and 9,783.25 total staff years available based on 2009 calendar year). This represents an average of 12.0 working days lost in 2009/10 (an average of 11.8 working days lost for the 2009 calendar year).
% FTE FTE Days FTE Days Days Available Sickness Sickness
January to December 2009 2,695,422.10 140,279.06 5.20
April 2009 to March 2010 2,687,319.16 141,419.00 5.26
FTE Days Sickness FTE Days Absence / Available / 260 Staff Years
January to December 2009 10367.01 11.8
April 2009 to March 2010 10335.84 12.0
Page 41 Hywel Dda Health Board Annual Report 2009/10
Leadership, Education and Development The department incorporates corporate education, personal development and risk training teams, medical education, knowledge management and business service. The department provides comprehensive internal learning and development opportunities for all staff, and facilitates external learning and development opportunities where required.
New initiatives for 2009/10 include:
Development of Management Passport to underpin all leadership and management development programmes; Development of EAGLE –Excellence, Assurance and Governance in a Learning Environment. A governance framework for an employer-led system of registration and regulation of Healthcare Support Workers. The principles of this framework are also being used for a number of other initiatives, including the development of Advanced Practice; Investment in the development, in partnership with Swansea University, of education programmes to support a new role of Assistant Practitioner within the Health Board; Skills to Care –Foundation Programme for all new Healthcare Support Workers is now completed as part of the induction programme, and underpins NVQ awards; Graduate Entry Medical Students from Swansea University commenced their first placements during April; Prince Philip and Withybush Hospital Post Graduate Departments will be hosting a Year 2 Nursing attachment from Cardiff Medical School for the first time; Promotional sessions for the Connecting Health through Learning Project were organised by individual Libraries, providing learning opportunities for basic skills in the workplace; The Knowledge Management service received a visit from a Librarian at the University of Columbo, Sri Lanka.
Successes include:
Skills to Care –Development Programme has awarded nearly 600 educational credits at levels 2 and 3, and equates to 6,000 hours of learning undertaken. A presentation event took place in April at Bronglais Hospital to celebrate the success of Health Care Support Workers in completing the NLIAH funded Skills Development Programme.
Page 42 Hywel Dda Health Board Annual Report 2009/10
Pictured are Health Care Support Workers who attended the presentation, with their managers, and Sue Morgan, who developed and delivered the programme. The programme won the 2008 NHS Wales Award for Developing a Flexible and Sustainable Workforce
Winner of NHS Wales Awards 2009, for developing Flexible and Sustainable Workforce. The work involved the introduction of the Rehabilitation HCSW Role as part of modernising the Rehabilitation Service and was centred on extending the role of the HCSW to enable the organisation to provide a holistic approach to rehabilitation which is flexible and creative.
Pictured are staff from Ward 9, Prince Philip Hospital with members of the multi- disciplinary team, receiving their award at the NHS Wales Awards 2009 ceremony in Cardiff.
Achieved 100% staff with a knowledge and skills framework outline, which underpins their personal development review; Introduction of ‘The Hywel Dda Way’ –to build and develop the organisational culture of Hywel Dda Health Board; Re-accreditation as an ILM centre;
Page 43 Hywel Dda Health Board Annual Report 2009/10
Bronglais Post Graduate Centre participated in the ‘Supervising theRoute to Excellence’ pilot, working closely with the Welsh Deanery aiming to provide high quality Professional Development in Education for Consultant Educational Supervisors; A clinical skills training development has successfully been delivered in Prince Philip Hospital, providing an additional resource for Junior Doctors in Training and Medical Students.
Research and Development (R&D) R&D within the Health Board continues to go from strength to strength. The R&D Department has been expanded to provide support and advice to health professionals in primary and secondary care. Our R&D Director continues to raise the profile of Hywel Dda as a centre for research in Wales, and we have recently acquired external funding for an additional Clinical Trials Nurse to support participation in large scale clinical trials.
Internal Communications We communicate with staff using a range of mechanisms, including the Corporate Team Brief, staff newsletter ‘Hywel’s Voice’, regular bulletins, open forums, topical road-shows, team meetings and the intranet. During 2009/10, meetings were arranged with staff and led by Board members and key team leads, where significant changes or developments were proposed, e.g. the integration of NHS Trusts and Local Health Boards in Wales.
Page 44 Hywel Dda Health Board Annual Report 2009/10
Awards The hard work and dedication of our staff has been recognised by numerous awards and plaudits during the year. These include:
The former Hywel Dda NHS Trust was the only Trust in Wales to be included in the CHKS Top Hospitals Programme for 2009. This award by independent benchmarkers considered performance in safety, clinical effectiveness, health outcomes, efficiency, patient experience and quality of care. The Trust was also named in the Health Service Journal and Nursing Times Top 100 Employers list for 2009, recognising excellence in flexible working, equality and diversity and training and development. Numerous individuals and teams were awarded for innovation and good practice at the Best of Health Staff Awards 2009. The Awards will be held on an annual basis as they celebrate staff achievement in the improvement of patient care and service delivery. Each month, staff are also awarded and recognised internally by special Chairman Commendations. Former LHB staff - Donna Pritchard, Jean Pool, Jane Topham, Christine McLachlan, Penny Lamb and Stephen Seagull - were awarded in the Innovation Leadership challenge organised by the Nursing Times and the National Leadership and Innovation Agency for Healthcare to promote and encourage leadership development.
A West Wales General Hospital Junior Doctor, Dr Lawrence Williams from Essex, impressed judges at the Welsh Assembly Government’s W elsh Language Unit and won Welsh Learner of the Year (less than two years) at the Welsh Language in Healthcare Awards.
Page 45 Hywel Dda Health Board Annual Report 2009/10
The Royal College of Speech and Language Therapists presented their Assistant of the Year Award for 2009 to Speech and Language Assistants Brian Pearson, Michael John, and Non Elias in recognition of their dedication towards assisting and promoting the rights of people with learning disabilities to communicate in different ways. Carmarthenshire’s Continuing Care Team was awarded the Extra Mile Award by the Motor Neurone Disease Association after being nominated by a member of the public following the care of his wife in her final months.
Cleddau River Day Unit in South Pembrokeshire was awarded the Innovation and Best Practice Award, in recognition of integration of health and social care services, by the Community Hospital Association.
Pembrokeshire Assertive Outreach Team Leader Phil Collings was the only nurse working in Wales to be included in the first UK Nursing Times Hall of Fame. The honour was bestowed in the category of Delivering Care Closer to Home and due to the work led by Phil to develop community- based mental health outreach teams. The Community Police Development Programme, providing specialist mental health training for police won numerous awards including a special Judge’s Award at the MediWales Innovation Awards and Best Nurse-Led Project Award at the Annual Mental Health and Learning Disability Awards for Wales in 2008/09. West Wales General Hospital’s Emergency Unit won three Building Excellence Awards for 2009, which recognises projects that are outstanding in their design and construction.
Page 46 Hywel Dda Health Board Annual Report 2009/10
Facts & Figures
Performance In parallel to embedding new management structures, we have delivered on a number of challenging performance targets. Our targets are wide ranging and numerous, but Key Indicators are presented here.
Referral to Treatment Waiting Times –RTT The Access 2009 targets set out that referral to treatment times (including those for cardiac services), should not exceed an absolute maximum of 36 weeks and that 95% of patients should be waiting less than 26 weeks at the monthly census point. The tolerance between 26 weeks and 36 weeks was applicable to patients whose pathway was extended due to complex clinical conditions or where patients chose to wait longer for their treatment.
The table below demonstrates that we met both targets.
January February March Target 2010 2010 2010 % of Patients Waiting 100% 100% 100% 100% < 36 weeks % of Patients Waiting 95% 98.1% 97.8% 97.6% < 26 weeks
A&E The three major A&E Departments have treated a total of 95,579 patients. Performance has continued to be challenging, with a target of 95% of patients spending no longer than four hours in the department. Over the financial year, our average performance was 89%, which mirrors the all-Wales average performance.
The run chart shows performance against the four hour target since April 2009.
We met the eight-hour target on three occasions during the year.
Page 47 Hywel Dda Health Board Annual Report 2009/10
AOF 7 - To ensure that: (i) 95% of new patients (including paediatrics) spend no longer than 4 hours in a major A&E department from arrival until admission, transfer or discharge - 2009/2010 Performance on a monthly basis
HYWEL DDA HEALTH BOARD (Bronglais, West Wales & Withybush)
10000 100%
8000 95%
6000 90%
4000 85%
2000 80%
0 75% Apr-09 May -09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov -09 Dec-09 Jan-10 Feb-10 Mar-10
Attendances 7927 7724 9927 7814 9910 7592 7603 8323 6726 6437 6760 8836
4 hour breaches 990 733 673 750 791 776 898 949 992 1114 1083 1195
4 hour performance 87.5% 90.5% 93.2% 90.4% 92.0% 89.8% 88.2% 88.6% 85.3% 82.7% 84.0% 86.5% 4 hour target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
An unscheduled care action plan has been agreed in order to tackle the following key issues, which directly impacted upon the performance:
Appointment into additional substantive Consultant posts; Development of the Emergency Nurse Practitioner roles; Integration of the Out of Hours and A&E services; Recruitment of middle grade doctors.
Ambulance Handovers Within 15 Minutes This target is jointly shared with the Welsh Ambulance Services NHS Trust. The graph below shows the performance since April 2009, illustrating the number of patients handed over within 15 minutes as a percentage of all ambulance handovers. Whilst the handover target has not been met, we have performed better throughout 2009/10 than the All Wales average monthly performance.
AOF 9 - To achieve a handover of patients from an emergency ambulance to major accident and emergency department within 15 minutes - April 2009 to March 2010 Hywel Dda Health Board % in 15 mins Target
100% 97.8% 96.2% 93.4% 94.1% 90.6% 90% 89.8% 87.1% 86.0% 83.3% 81.5% 80% 79.8% 78.2%
70% Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10
Page 48 Hywel Dda Health Board Annual Report 2009/10
Cancer Access The first cancer access target states that 95% of patients who were referred by their GP with urgent suspected cancer and subsequently diagnosed as such by a cancer specialist should start definitive treatment no more than 62 days after receipt of referral.
Throughout the year we managed to meet the target on six occasions. Note the numbers of breaches are small in number and average three per month.
We have consistently achieved the second cancer target, ensuring 98% of patients not referred as urgent suspected cancer but subsequently diagnosed with cancer, start definitive treatment no more than 31 days after diagnosis.
Access to Sexual Health Services We have made great progress towards achieving this target, with March 2010 performance falling short of the 100% target by 2.7%.
Access to Diagnostic and Therapy Services We are required to ensure patients not already on an open RTT Pathway, receive their respective diagnostic scan within eight weeks or their Therapy service in 14 weeks from referral. Performance within the Therapy target has in the last four months, been consistently met. However, a small number of patients have breached the diagnostic scan target, which in the main has been due to equipment failure.
Estates Performance We place the utmost importance on the effective and efficient management of our Estate and performance is considered against specific key indicators applicable across the whole of the Welsh NHS Estate.
Hywel Dda Health Board is one of a small number of Health Boards in Wales which has performed strongly against National Estate Performance targets.
Page 49 Hywel Dda Health Board Annual Report 2009/10
Estates & Facilities Performance Management Submitted Data - 2008-2009 84% 87% 92% 87% 94% 69% 100 90 80 Target 90% 70 60 50 40 30 20 10 0 Physical Condition
n ty ty y n y io e e lit io rg Statutory and Safety it f f i t e d a a b a n n S S ita lis E Fire Safety o d e u ti C n ir S U l a F l a a e Functional Suitability ic ry n c s o a y t tio p h tu c S Space Utilisation P ta n S u F Energy
We have exceeded targets in the key areas outlined in the chart, and are fully committed to significant improvements against all key performance indicators as part of our strategic investment strategy. The planned investment in the new energy centre in Bronglais Hospital will bring the whole of the Estate up to the 90% target for energy performance.
Backlog Management We currently have a backlog maintenance total of circa £63 million, of which circa £1.3 million represents high risk and a further £28 million represents significant risk. In order to appropriately manage this backlog, we have sound risk assessment processes in place to prioritise investments in areas of greatest risk. We now have an improved investment plan to remove all high risk backlog during 2010. The Health Board also has well developed plans for the strategic management of all backlog as part of its major capital investment strategy.
Page 50 Hywel Dda Health Board Annual Report 2009/10
Governance
Accountability We are accountable to the Minister for Health and Social Services through the NHS Wales Chief Executive. The Board is responsible for planning, designing, developing and securing delivery of primary, community and secondary care services for its area and in order to meet identified local needs within the national policy for standards framework.
The Standing Orders are the Terms of Reference for the Board and its business and, together with the Scheme of Decisions reserved to the Board, Scheme of Delegation to Officers and others, and the Standing Financial Instructions, form the regulatory framework for the business conduct of the Health Board.
The Board holds 6 public meetings a year which take place every other month at venues accessible to the public and across the geographical area. The Annual General Meeting of the Hywel Dda Health Board will take place on 30th September 2010.
The Board membership of Hywel Dda Health Board consists of the Chairman, 10 Independent Members and 10 Executive Directors/Officer Members (detailed on page 5).
Board members who made up the legacy organisations are detailed here:
Former CARMARTHENSHIRE LHB to 30th September 2009 Mrs Janet Hawes Chairman
Non-Officer Members Mr Bruce McLernon Local Authority Member Mr Chris Burns Local Authority Member Mr Jake Morgan Local Authority Member Cllr. Pat Jones Local Authority Member Dr Chris John Non-Officer Member (GP) Dr Alan Scourfield Non-Officer Member (GP) Dr Rob Lewis Non-Officer Member (GP) Mr Chris James Non-Officer Member (Pharmacy) Mr Edward Lloyd-Jones Non-Officer Member (Dental) Dr Michael Thomas Director of Public Health Mrs Jane Jeffs Non-Officer Member (Community) Mrs Margaret Rees Hughes Non-Officer Member (Nurse) Mrs Deris Williams Non-Officer Member (Community) Mr Jon Pearson Non-Officer Member (Therapy)
Page 51 Hywel Dda Health Board Annual Report 2009/10
Executive Directors Mrs Bernardine Rees Chief Executive Ms Rhian Davies Director of Finance Ms Jill Paterson Nurse Director Dr Terry Davies Medical Director Mr Peter Llewellyn Acting Director of Planning & Primary Care
Associate Members Mr Martin Turner Associate Member (Trust Chief Executive) Dr Alan Axford Associate Member (Trust Medical Director) Mr Dewi Owen Associate Member (CHC Chairman) Mr John Skipper Associate Member (CHC Chief Officer) Mr Paul Davies Associate Member (Trade Union)
Former PEMBROKESHIRE LHB to 30th September 2009 Mrs Janet Hawes Chairman
Non-Officer Members Mrs Bernardine Rees Chief Executive Cllr Sian James Non Officer Member (Local Authority) Dr Ian Jones Non Officer Member (Dental) Mr Chris LeBreton Non Officer Member (Voluntary Sector) Dr Sam Lewis Non Officer Member (GP) Mrs Caroline Mason Non Officer Member (Carer) Mrs Julia Ritchie Non Officer Member (Therapies) Mr Jon Skone Non Officer Member (Local Authority) Cllr David Wildman Non Officer Member (Local Authority) Mr Robin Baker Non Officer Member (Optometry) Mr Phil Parry Non Officer Member (Pharmacy) Mrs Mollie Roach Non Officer Member (Community) Mrs Julie Hughes Non Officer Member (Nursing) Mr Peter Irvine Non Officer Member (Voluntary Sector)
Executive Directors Mrs Karen Miles Director of Finance & Commissioning Ms Sarah Williams Director of Primary Care Mrs Helen Williams Nurse Director Dr June Picton Medical Director Dr Lyn Harris Director of Local Public Health
Page 52 Hywel Dda Health Board Annual Report 2009/10
Associate Members Mrs Christine Roberts Community Health Council Mr Ashley Warlow Community Health Council Dr David Roberts Co-opted Member Mr Dorian James Wales Ambulance Trust Mrs Caroline Oakley Hywel Dda NHS Trust
Former CEREDIGION LHB to 30th September 2009 Mrs Jan Hawes Chairman
Non Officer Members Mr Parry Davies Non-Officer Member (Local Authority) Cllr Hag Harries Non-Officer Member (Local Authority) Cllr Paul Hinge Non-Officer Member (Local Authority) Dr Ian Jones Non-Officer Member (Dental) Mr Alasdair Kentwright Non-Officer Member (Community) Dr Carl Langley Non-Officer Member (GP) Cllr Alun Lloyd-Jones Non-Officer Member (Local Authority) Cllr Mair Morris Non Officer Member (Voluntary Sector) Mr Robert Hughes-Jones Non Officer Member (Pharmacist) Mr Robin Baker Non Officer Member (Optometry) Mrs Julie Hughes Non Officer Member (Nursing) Mrs Kathy Giles Non Officer Member (Therapies) Mrs Ann Walker Non Officer Member (Voluntary Sector) Mrs Fiona Aldred Non Officer Member (Community)
Executive Members Mrs Bernardine Rees Chief Executive Mrs Karen Miles Director of Finance & Commissioning Ms Sarah Williams Nurse Director Mrs Helen Williams Director of Primary Care Dr Stephen Griffiths Medical Director (until 01/04/2009) Dr June Picton Medical Director (from 01/04/2009) Dr Rachel Russell Director of Local Public Health
Associate Members Mr Lyndon Lloyd Associate Member Dr Alan Axford Hywel Dda NHS Trust
Co-opted Members Mrs Gill Davies Hywel Dda NHS Trust Dr David Roberts Co-opted Member Mr Emlyn Thomas Independent Chairman of Tregaron Project
Page 53 Hywel Dda Health Board Annual Report 2009/10
Former HYWEL DDA NHS TRUST to 30th September 2009 Mr Chris Martin Chairman
Non Officer Members Mr Eifion Griffiths Non Executive Director (Design/Environment) Mr Peter Jackson Non Executive Director (Community) Professor Gareth Morgan Non Executive Director (University) Mr Martin Morris Non Executive Director (Community) Mr Don Thomas Non Executive Director (Finance) Reverend Randolph Thomas Non Executive Director (Community) Mr John Thomas-Ferrand Non Executive Director (Community)
Executive Directors Mr Martin Turner Chief Executive Dr Alan Axford Medical Director Mr Ian Bellingham Director of Performance & Operations/Deputy CEO Mr Nigel Morris Director of Finance Mrs Caroline Oakley Director of Nursing
Associate Members Mrs Margaret Barnaby Director of Planning Ms Janet Wilkinson Director of HR Mrs Bernardine Rees Chief Executive, Pembrokeshire and Ceredigion Local Health Boards
Trade Union Representatives Mrs Wendy Evans Carmarthenshire Mr Neil Sandford Pembrokeshire Ms Ann Taylor-Griffiths Ceredigion
Page 54 Hywel Dda Health Board Annual Report 2009/10
Committee Structure
Page 55 Hywel Dda Health Board Annual Report 2009/10
Patient Safety and Risk Management We continually strive to improve the quality of services and deliver a high standard of safe patient care. A new Quality Improvement Strategy was introduced in 2009, placing patient safety at the very top of everything we do. This strategy sets out the systems and processes that are in place to ensure the principles of Clinical Governance are embedded within the Health Board.
In 2009, we engaged in the All-Wales 1000 Lives Campaign (which has now evolved into the 1000 Lives Plus Programme). The programme is designed to make the safety of patients the highest priority for all hospital staff in order to reduce cases of avoidable harm. Results indicate that significant improvements are being achieved and that good practice has been shared within the organisation and with the NHS in Wales (more information on what we have done can be found on page 15 and page 19).
As a result of incident reporting, the following are examples of changes to practice and service improvements:
Use of antibiotic prophylactic stickers on medication charts was successfully piloted in orthopaedic joint replacement patients. The introduction of these stickers improves the administration/timeliness of prophylactic antibiotics and there are plans to introduce stickers for other specialities. An Interim Positive Patient Identification Policy for Acute and Community Hospitals has been developed to ensure the accurate identification of patients, minimising medical errors and patient harm. Pharmacy is addressing drug administration in the Medical Staff Paediatric Induction Programme. The process for preparing and checking infusions has been reviewed and strengthened, which is reflected within revised guidelines. Nursing staff have undergone intravenous administration updates and competency assessments. A significant amount of work has been undertaken in the Ophthalmology Service to reduce delays in patient care in the emergency referral system and reduce risk to patient safety. A Transient Ischemic Attack Rapid Access Neurovascular Clinic has been established in Gerontology Day Hospital at Prince Philip Hospital. This out-patient service offers a prompt specialised assessment and aims to significantly decrease stroke incidence, provide patients with the same first rate care they would receive as an inpatient while they remain in the familiar surroundings of their home and community, reduce emergency admission to hospital and improve functional outcomes of stroke survivors.
Page 56 Hywel Dda Health Board Annual Report 2009/10
Health and Safety Management Policies In recognising that effective risk management is a key component of corporate and clinical governance, and in order to sustain a robust risk management process during a time of organisational restructuring, the Quality & Safety Committee approved a number of interim Risk Management Policies, including:
Health & Safety Policy; Risk Management Strategy & Policy; Risk Assessment & Risk Profiling Guidelines; Incident & Hazard Reporting Policy; Guidance on Incident Investigation.
Incident Reporting Staff are trained on using the web based Datix incident reporting form to report both health and safety issues, as well as clinical incidents. GP practices are able to access health and safety on line training via the HOWIS website. All staff are actively encouraged to examine the contents of the risk register and to contribute to the process.
New Legislation/Health and Safety Executive (HSE) Interest The most recent visit by the HSE was in February 2010 as part of the all Wales audit/inspection of violence and aggression at 24 hour Accident and Emergency Departments. The HSE visited our three main A&E Departments, and interviewed senior staff and trade union safety representatives. Following HSE feedback, we produced an action plan and asked for the HSE’s comments.
Serious Incidents Involving Personal Data A memory stick containing patient identifiable information was lost in transit between a General Practice and the Business Services Centre, Swansea, in March 2010. The memory stick was sent by recorded delivery but was not password protected or encrypted by the practice.
Actions taken:
Information Commission and Welsh Assembly Government informed and subsequent investigation carried out Letters sent to all patients to advise them of what had happened A helpline was opened at both the practice and the Health Board for patients to direct any questions Letter sent to all primary care contractors to request they review their Information Governance policies and procedures Internal staff message send to Health Board staff to remind them of their duties in regard to data protection.
Page 57 Hywel Dda Health Board Annual Report 2009/10
Financial Statements
Introduction Hywel Dda LHB is required, and indeed has met, the two key statutory financial targets in the financial year 2009/10, which are:
Not to exceed the LHB’s notified resource limit ; and Not to exceed the LHB’s cash limit.
An abridged set of accounts for the LHB is set out below. Full copies of the LHB’s annual accounts can be obtained from LHB’s website - www.hywelddahb.wales.nhs.uk
Summary Financial Statements Summary OCS Operating Cost Statement and Achievement of Operational Financial Balance for the year ended 31st March 2010 2009 £(000) £(000)
Expenditure on Primary Healthcare Services 168,197 167,865
Expenditure on Healthcare from other Providers 94,203 82,217
Expenditure on Hospital and Community Health 406,675 373,346 Services
Total Expenditure 669,075 623,428
Less : Miscellaneous Income 56,190 64,702
LHB Net Operating Costs Before Interest 612,885 558,726 and Other Gains and Losses
Investment Income 35 660
Other (Gains) / Losses 1 0
Finance Costs 3,644 7,172
Net Operating Costs for the Financial Year 616,495 565,238
Page 58 Hywel Dda Health Board Annual Report 2009/10
The LHB’s accounts are prepared using Government Resource Accounting principles as stipulated by Welsh Assembly Government in the ‘LHB Manual for Accounts 2009/10.
The LHB receives over 93% of its income from Welsh Assembly Government in the form of a resource limit amounting to £615.895m.
Statement of Financial Position as at 31 March 2010 31March 31March 1April 2010 2009 2008 £’000 £’000 £’000 Non-current assets Property, plant and equipment 229,630 225,088 221,036 Intangible assets 208 244 213 Trade and other receivables 48 0 224 Total non-current assets 229,886 225,332 221,473
Current assets Inventories 6,010 5,607 5,065 Trade and other receivables 22,436 25,510 21,148 Cash and cash equivalents 1,332 10,586 3,793 Non-current assets Held for Sale 235 235 320 Total current assets 30,013 41,938 30,326 Total assets 259,899 267,270 251,799
Current liabilities Trade and other payables 59,976 63,768 56,630 Provisions 16,515 16,931 16,065 Total current liabilities 76,491 80,699 72,695 Net current assets/ (liabilities) (46,478) (38,761) (42,369)
Non-current liabilities Trade and other payables 0 218 984 Other financial liabilities 0 0 0 Provisions 3,215 0 0 Total non-current liabilities 3,215 218 984 Total assets employed 180,193 186,353 178,120
Financed by : Taxpayers' equity General Fund 164,496 176,125 173,431 Revaluation reserve 10,827 5,892 1 Donated asset reserve 4,870 4,336 4,688 Total taxpayers' equity 180,193 186,353 178,120
Page 59 Hywel Dda Health Board Annual Report 2009/10
Statement of Cash flows for year ended 31 March 2010 2009-10 2008-09 £’000 £’000 Cash Flows from operating activities Net operating cost before interest (612,885) (558,726) Movements in Working Capital 367 2,561 Other cash flow adjustments 33,844 18,966 Provisions utilised (3,667) (5,721) Interest paid (8) 0 Net cash outflow from operating (582,349) (542,920) activities
Cash Flows from investing activities Purchase of property, plant and equipment (27,732) (19,972) Purchase of intangible assets (22) (72) Interest received 42 748 Non-current assets Held for Sale 235 235 Net cash inflow/(outflow) from (27,712) (19,296) investing activities Net cash inflow/(outflow) (610,061) (562,216) before financing
Cash flows from financing activities Welsh Assembly Government funding (including capital) 601,133 569,012 Capital grants received 0 147 Capital element of payments in respect of finance leases and on-SoFP (326) (150) Net financing 600,807 569,009 Net increase/(decrease) in cash and cash equivalents (9,254) 6,793 Cash and cash equivalents at 1 April 2009 10,586 3,793 Cash and cash equivalents at 1,332 10,586 31 March 2010
Page 60 Hywel Dda Health Board Annual Report 2009/10
NHS Managers Pay The LHB can confirm that pay rises for NHS senior managers in 2009/10 did not exceed 2.25%.
Pensions Details of the LHB’s pension costs can be found in Note 5 of the LHB’s Annual Accounts.
External Audit The LHB’s external auditor is the Wales Audit Office. The auditor was remunerated £1,075,000 for the statutory audit work, including Value for Money audits, carried out during the year.
Public Sector Payment Policy –Measure of Compliance Welsh Assembly Government requires the LHB to pay non–NHS trade creditors in accordance with the CBI prompt payment code and NHS bodies in accordance with Government Accounting rules. The target is to pay 95% of creditors within 30 days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed with the supplier. No amounts have been included in the accounts arising from claims made by small businesses under the Late Payments of Debts Commercial (Interest) Act 1998.
Public Sector Payment Policy Number of Value of Invoices Invoices £’000 NHS Total bills paid 2009-10 5,249 392,194 Total bills paid within target 4,693 389,507 Percentage of bills paid within target 89.4% 99.3%
Non-NHS Total bills paid 2009-10 280,473 236,803 Total bills paid within target 273,577 230,748 Percentage of bills paid within target 97.5% 97.4%
TOTAL Total bills paid 2009-10 285,722 628,997 Total bills paid within target 278,270 620,255 Percentage of bills paid within target 97.4% 98.6%
Page 61 Hywel Dda Health Board Annual Report 2009/10
Financial Position for 2009/10 During the year the LHB spent £669.075m on services. Of this £168.197m was spent on primary healthcare serviced. £94.203m spent on healthcare from other providers. £406.675 spent on hospital and community health services. The following diagrams provide further explanation of the expenditure.
Primary Healthcare Services
General Medical Services £59,475,000
Pharmaceutical Services £67,508,000 General Dental Services
General Ophthalmic Services Other Primary Health Care expenditure Prescibed drugs and £14,804,000 appliances £3,721,000
£3,515,000 £19,174,000
Healthcare from Other Providers
£2,437,000 £970,000 £2,371,000 Goods and services from other NHS Wales Health Boards £28,990,000 £1,968,000 Goods and services from other NHS Wales Trusts Goods and services from other non Welsh NHS bodies Local Authorities
Voluntary organisations
NHS Funded Nursing Care £399,000
Continuing Care £2,001,000 £46,644,000 £3,606,000 Private providers
£947,000 National Public Health Service / Public Health Wales £3,870,000 Business Services Centre / Business Services Partnership Other
Page 62 Hywel Dda Health Board Annual Report 2009/10
Hospital and Community Health Services
£4,609,000 £30,380,000 £5,728,000 Services from other NHS Bodies
Salary costs £22,684,000 Supplies and services
Establishment, transport and premises
Depreciation and £52,031,000 impairments
Other £291,243,000
Page 63 Hywel Dda Health Board Annual Report 2009/10
Making the Connections
With the increasing pressure on public finances and the finite amount of resources available, it is vital that all public bodies be as efficient as possible in the delivery of services to the people of Wales. The identification of value for money improvements requires a reassessment and challenge of existing processes and services to consider whether anything can be undertaken differently to achieve improvements, and whether better use can be made of resources.
During 2009/10 the LHB identified efficiency gains as set out in the table below.
Making the Connections Efficiency Gains 2009/10 Cash Non-Cash Total Investment Releasing Releasing Costs £’000 £’000 £’000 £’000 Smarter Procurement 3,986 3,986 Streamlining Support 3,726 3,726 2,437 Functions Shaping Public Services 4,933 4,933 1,310 Making Better Use of Staff 6,928 6,928 2,371 Time, Skills and Expertise Total 19,573 19,573 6,118
Statement of Internal Control The Statement of Internal Control is published in full as part of the LHB’s Annual Accounts, and can be found on the LHB’s website.
Page 64 Hywel Dda Health Board Annual Report 2009/10
Remuneration Report
Remuneration and Terms of Service Committee The members of the LHB’s Remuneration and Terms of Service Committee were as follows:
Hywel Dda Local Health Board (from 1st October 2009) Chris Martin Chair Eifion Griffiths Independent Member Jan Hawes Independent Member Neil Sandford Independent Member Don Thomas Independent Member
Hywel Dda NHS Trust (to 30 September 2009) Chris Martin Chair Mr E Griffiths Non exec Mr P Jackson Non exec Mr M Morris Non exec Mr D Thomas Non exec Venerable R Thomas Non exec Mr J Thomas-Ferrand Non exec
Carmarthen Local Health Board (to 30 September 2009) Mrs Janet Hawes (Chair) Chair of Carmarthenshire LHB Mr Chris James Chair of Audit & Risk Committee Mrs Jane Jeffs Vice Chair of Carmarthenshire LHB Mrs Margaret Rees-Hughes Nurse Member Mrs Bernardine Rees Chief Executive Mr Ed Lloyd-Jones Dental Member Dr Alan Scourfield GP Member
Pembrokeshire Local Health Board and Ceredigion Local Health Board (to 30 September 2009) Mrs Janet Hawes LHB Chair Mrs Bernardine Rees LHB Chief Executive Cllr David Wildman Vice Chair, Pembrokeshire LHB Mr R Hughes-Jones Chair, Ceredigion Audit Committee Mr C LeBreton Chair, Pembrokeshire Finance, Audit & Contracting Committee Cllr Alun Lloyd-Jones Vice Chair, Ceredigion LHB Mair Morris Voluntary Sector Member, Ceredigion LHB Julia Ritchie Therapies Member, Pembrokeshire LHB
Page 65 Hywel Dda Health Board Annual Report 2009/10
Policy for the Remuneration of Senior Managers From October 2004, the NHS Agenda for Change process was introduced to achieve consistency in contracts and terms and conditions across NHS Wales. New all Wales contracts are issued to all staff and managers (excluding Executive Directors) upon appointment.
Executive Directors are not part of this process and a Very Senior Manager payscale has been introduced by the National Assembly for Wales.
Pay awards for both Executive Directors and managers and staff on Agenda for Change are determined nationally and applied locally upon receipt of instructions from the Assembly.
Notice periods fluctuate depending on the type of contract from one month to three months. Very senior manager’s have to provide 3 months notice, and the notice period for staff on other contracts are dependent upon the payband.
No termination payments were made during the year 2009/10.
As previously reported, pay rises for NHS senior managers in 2009/10 did not exceed 2.25%. In addition, no directors waived their right to remuneration during the year and no directors were paid allowances in lieu of remuneration. No directors received performance related bonuses during the year.
Service Contracts of Non Executive Directors Non officer members are appointed for a term of between 3 and 5 years, the term is staggered to ensure consistency in LHB Board decision-making. Non officer members are required to sign an accountability agreement, which is the agreed contract between the Board and its members for the purposes of their employment.
Page 66 Hywel Dda Health Board Annual Report 2009/10
Salary and Pension Entitlements of Senior Managers
Salary Benefits Benefits 2009-10 in kind Salary 2008-09 in kind Other £5k rounded Other rounded Remuner bands to Remuner to ation Nearest ation Nearest £5k £100 £100 bands Name £000 £000 £00 £000 £000 £00 Executive Directors Mr T Purt (from 95-100 0 6 0 0 0 14/09/09) Dr S Fish 70-75 0 0 40-45 0 0 Mr IR Bellingham (to 75-80 0 30 45-50 0 28 31/12/09) Dr S Mahon (from 60-65 0 0 0 0 0 26/11/09) Mr T Chambers 30-35 0 30 0 0 0 (from 01/01/10) Mrs B Rees 145-150 0 0 105-110 0 0 Mrs CA Oakley 110-115 0 0 75-80 0 0 Mr K Miles 100-105 0 0 70-75 0 0 Ms J Wilkinson 50-55 0 0 0 0 0 Ms K Davies (from 5-10 0 0 0 0 0 01/03/10) Executive posts to 30/09/09 Mr M Turner 115-120 0 0 170-175 0 0 Mr N Morris 55-60 0 44 60-65 0 28 Dr A Axford 50-55 0 0 100-115 0 0 Mrs R Davies 40-45 0 0 70-75 0 0 Ms J Patterson 50-55 0 24 105-110 0 51 Dr T Davies 35-40 0 0 55-60 0 0 Ms S Williams 15-20 0 0 65-70 0 0 Ms S Hurds 45-50 0 0 40-45 0 0 Ms H Williams 15-20 0 0 40-45 0 0 Ms J Picton 45-50 0 0 85-90 0 0
Page 67 Hywel Dda Health Board Annual Report 2009/10
Salary and Pension Entitlements of Non Officer Members
Salary Benefits Benefits 2009-10 in kind Salary 2008-09 in kind Other rounded Other rounded £5k Remuner bands to Remuner to ation Nearest ation Nearest £5k £100 £100 bands Name and Title £000 £000 £00 £000 £000 £00
Mr C Martin - Chair 55-60 0 0 25- 30 0 0 Ms J Hawes, Vice 50-55 0 0 35-40 0 0 Chair Mr EW Griffiths 10-15 10-15 0 0-5 0 0 Mr DK Thomas 10-15 0 0 0-5 0 0 Mrs J Jeffs 10-15 0 0 10-15 0 0 Mrs M Rees Hughes 10-15 0 0 5-10 0 0
Professor M Jasper 5-10 0 0 0 0 0 Former Hywel Dda Trust to 30/9/09 Mr P Jackson 0-5 0 0 5-10 0 0 Professor G Morgan 0-5 0 0 5-10 0 0 Mr MP Morris 0-5 0 0 5-10 0 0 Mr DK Thomas 0-5 0 0 5-10 0 0 Rev AJR Thomas 0-5 0 0 5-10 0 0 Mr JMA Thomas – 0-5 0 0 5-10 0 0 Ferrand Former Carmarthenshire LHB to 30/9/09 Dr C L John 0-5 0 0 5-10 0 0 Dr R Lewis 0-5 0 0 5-10 0 0 Dr A Scourfield 0-5 0 0 5-10 0 0 C J James 0-5 0 0 5-10 0 0 Mrs Patricia Weeden 0-5 0 0 5-10 0 0 Mr Edward Lloyd 0-5 0 0 5-10 0 0 Jones Mr. Jon Pearson 0-5 0 0 5-10 0 0 Mrs Deris Williams 0-5 0 0 5-10 0 0
Page 68 Hywel Dda Health Board Annual Report 2009/10
Former Pembrokeshire LHB to 30/9/09 Mr I Jones 0-5 0 0 0-5 0 0 Dr S Lewis 0-5 0 0 5-10 0 0 Mr EP Parry 0-5 0 0 5-10 0 0 Mrs CL Mason 0-5 0 0 5-10 0 0 Mr C Le Breton 0-5 0 0 5-10 0 0 Ms J Ritchie 0-5 0 0 5-10 0 0 Mr R Baker 0-5 0 0 0-5 0 0 Ms M Roach 0-5 0 0 5-10 0 0 Ms P Irvine 0-5 0 0 5-10 0 0 Mrs J Hughes 0-5 0 0 5-10 0 0 Former Ceredigion LHB to 30/9/09 Dr RC Langley 0-5 0 0 5-10 0 0 Mr R Hughes-Jones 0-5 0 0 5-10 0 0 Mrs A Walker 0-5 0 0 5-10 0 0 Mr A Kenwright 0-5 0 0 5-10 0 0 Mrs F Aldred 0-5 0 0 5-10 0 0 Mrs S Morris 0-5 0 0 0-5 0 0 Mrs J Hughes 0-5 0 0 0-5 0 0 Mr R Baker 0-5 0 0 0-5 0 0 Mr I Jones 0-5 0 0 0-5 0 0
Page 69 Hywel Dda Health Board Annual Report 2009/10
Pensions
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Name and Title £000 £000 £000 £000 £000 £000 £000 £00
Mr T Purt (From 0-2.5 5-7.5 15-20 50-55 408 303 57 0 14/9/09) Dr S Fish 5-7.5 15-17.5 20-25 65-70 388 276 112 0 Mr I R Bellingham (to 2.5-5 12.5-15 40-45 125-130 1,012 861 151 0 31 Dec 09) Mr S Mahon 0-2.5 5-7.5 30-35 95-100 541 420 42 0 (from 26/11/09) Mr T Chambers 0-2.5 2.5-5 30-35 95-100 515 430 21 0 (From 1/1/10) Mrs B Rees 15-17.5 45-47.5 60-65 185-190 1,433 1,025 408 0
Mrs C A Oakley 2.5-5 12.5-15 30-35 100-105 633 525 108 0 Mrs K Miles 7.5-10 22.5-25 30-35 95-100 527 373 154 0 Ms J Wilkinson 2.5-5 10-12.5 20-25 60-65 338 264 74 0 Ms K Davies 0-2.5 0-2.5 15-20 55-60 286 161 11 0 (From 1/3/10) Executive posts up to 30/9/09: Mr M Turner (2.5)-0 (10)-(7.5) 85-90 270-275 0 2,239 (2,239) 0 Mr N Morris 0-2.5 5-7.5 50-55 150-155 1,222 1160 62 0 Mrs R Davies 0-2.5 0-2.5 15-20 55-60 365 341 19 14 Ms Jill Paterson 0-2.5 (2.5)-0 15-20 45-50 228 225 0 0 Ms S Williams (2.5)-0 (2.5)-0 5-10 25-30 191 194 (5) 0 Ms H Williams (2.5)-0 (5)-(2.5) 20-25 65-70 345 343 (2) 0 Ms J Picton 0-2.5 2.5-5 35-40 115-120 842 763 69 0
Signed: Date:22ndJune 2010
Mr T Purt, Chief Executive (on behalf of the Board)
Page 70 Hywel Dda Health Board Annual Report 2009/10
Report of the Auditor General for Wales to the National Assembly for Wales on the Summary Financial Statements I have examined the summary financial statements contained in the Annual Report of Hywel Dda Local Health Board as set out on pages 65 to 70.
Respective Responsibilities of the Accounting Officer and Auditor The Accounting Officer is responsible for preparing the Annual Report. My responsibility is to report my opinion on the consistency of the summary financial statements with the statutory financial statements and the remuneration report. I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or material inconsistencies with the summary financial statements.
Basis of Opinion I conducted my work in accordance with Bulletin 2008/3 ‘The auditor’s statement on the summary financial statements’ issued by the Auditing Practices Board for use in the United Kingdom.
Opinion In my opinion the summary financial statements are consistent with the statutory financial statements and the remuneration report of Hywel Dda Local Health Board for the year ended 31 March 2010 on which I have issued an unqualified opinion. I have not considered the effects of any events between the dates on which I signed my report on the full financial statements 6 July 2010 and the date of this statement.
Gillian Body Wales Audit Office Auditor General for Wales 24 Cathedral Road 6 July 2010 Cardiff CF11 9LJ
Page 71 Hywel Dda Health Board Annual Report 2009/10
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