MEETING OF THE POWYS TEACHING HEALTH BOARD BOARD MEETING WEDNESDAY 24 OCTOBER 2012, 12.00PM - 4.00PM, CLEWEDOG ROOM, LADYWELL HOUSE, NEWTOWN
NO ITEM ENC PRESENTER
PRESENTATION : HYWEL DDA HEALTH BOARD, “YOUR HEALTH, YOUR FUTURE”
1 PRELIMINARY MATTERS
1.1 Welcome and Apologies for Absence
1.2 Declarations of Interest All
1.3 Minutes of meeting held on 05 September 2012 and 26 1.3 Chairman September 2012
1.4 Action Review from Previous Meetings 1.4 Chairman
1.5 Chairman’s Report Verbal Chairman
1.6 Chief Executive’s Report Verbal Chief Executive
2 ITEMS FOR APPROVAL / ENDORSEMENT
2.1 Implementation of the New Model at Builth 2.1 Director of Planning
2.2 “Your Health, Your Future”: tHB response 2.2 Director of Planning
2.3 “Healthcare in North Wales is Changing”: tHB response 2.3 Director of Planning
2.4 Carers Strategy 2.4 Director of Therapies and HS
2.5 Charitable Funds Strategy 2.5 Director of Finance
ITEMS FOR DISCUSSION
3 STRIVING FOR EXCELLENCE
3.1 Integrated Performance Report 3.1 Director of Workforce & OD
3.2 Professional Nursing and Midwifery Report 3.2 Director of Nursing
4 IMPROVING HEALTH AND WELLBEING
4.1 Director of Public Health Annual Report 4.1 Director of Public Health
5 MAKING EVERY POUND COUNT
5.1 Financial Performance 2012/13 : Month 06 5.1 Director of Finance
6 GOVERNANCE & ASSURANCE
6.1 Register of Sealing Report 6.1 Chief Executive
6.2 Board Committee Reports:- Committee Chairs Audit Committee 6.2a Quality & Safety Committee 6.2b Integrated Governance Committee 6.2c
7 OTHER MATTERS
7.1 Any Other Urgent Business Verbal Chair
7.2 Date of Next Meetings: 1.00pm, 19 December 2012, Ystradgynlais Community Hospital, Ystradgynlais 1.00pm, 20 February 2013, Training Room, Bronllys Hospital
KEY: Annual Plan Themes Improving Health and Wellbeing Involving the People of Powys Ensuring the Right Access Making every Pound Count Striving for Excellence Governance & Assurance
Motion to Exclude Members of the Public and the Press To approve a motion under Section 1(2) Public Bodies (Admission To Meetings) Act 1960: “Representatives of the press and other members of the public shall be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest”.
FOR APPROVAL
BOARD MEETING 24 OCTOBER 2012
AGENDA ITEM 1.3
DRAFT MINUTES OF BOARD MEETING HELD 05 SEPTEMBER 2012 AND 26 SEPTEMBER 2012
Report of Chairman
Paper prepared by Corporate Governance Manager
Purpose of Paper To provide the Board with the draft minutes of the Board Meeting held on 05 September 2012 and 26 September 2012 for approval.
Action/Decision required The Board is asked to APPROVE the draft minutes of the Board Meeting held on 05 September 2012 and 26 September 2012.
Link to ‘Doing Well, 1. Governance and Accountability Doing Better: Standards for Health Services in Wales’:
Link to Health Board’s Improving Health & Well-Being Corporate Plan Ensuring the Right Access Striving for Excellence Involving the People of Powys Making Every Pound Count
Acronyms and N/A abbreviations
Board Minutes Meeting held Page 1 of 20 Board Meeting 05 September 2012 and 26 24 October 2012 September 2012 Agenda Item 1.3 Status: Awaiting Approval
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MINUTES OF THE MEETING OF THE POWYS TEACHING HEALTH BOARD HELD AT 1.00 PM ON WEDNESDAY 05 SEPTEMBER 2012, IN TRAINING ROOMS 1&2, TRAINING DEPARTMENT, BRONLLYS
Present: Mel Evans (ME) tHB Chair (Chair of Meeting) Andrew Cottom (AC) Chief Executive Alan Austin (AA) Associate Member (SRG Chair) Mark Baird (MB) Independent Member Joanna Davies (JD) Director of Workforce & OD Paul Dummer (PD) Independent Member Roger Eagle (RE) Independent Member Gareth Jones (GJ) Independent Member Gloria Jones Powell (GJP) Independent Member Andrew Leonard (AL) Independent Member Brendan Lloyd (BL) Medical Director Jo Mussen (JM) tHB Vice Chair Gyles Palmer (GP) Independent Member Jeremy Patterson (JP) Associate Member (CEO, Powys CC) Rebecca Richards (RR) Director of Finance Carol Shillabeer (CS) Director of Nursing Jackie Walters (JW) Independent Member
In Attendance: Sumina Azam (SA) Interim Director of Public Health Victoria Deakins(VD) Interim Locality General Manager (North) Emily Games (EG) Corporate Governance Support Officer Wendy Morgan (WM) Head of Quality and Safety Bruce Whitear (BW) Interim Director of Planning
Public Attendance: Five members of the public were present
Apologies: Rosemarie Harris (RH) Independent Member Amanda Smith (AS) Director of Therapies & Health Sciences Rani Mallison (RM) Corporate Governance Manager tHB/12/59 Declarations for Interest
There were no declarations of interest received for noting.
Board Minutes Meeting held Page 2 of 20 Board Meeting 05 September 2012 and 26 24 October 2012 September 2012 Agenda Item 1.3 Status: Awaiting Approval
FOR APPROVAL tHB/12/60 Minutes of Previous Meeting held on 27 June 2012
The minutes of the previous meeting held on 27 June 2012 were agreed as a true and accurate record with the following amendments:-
tHB/12/35: Minutes of Previous Meeting held of 18 April & 06 June 2012 Further amendment required regarding the third paragraph tHB/12/26: Director of Public Health Update report to read: GP’s would be invited to offer flu vaccinations to its patients.
tHB/12/45: Option Review of Sexual Health Services for Powys Paragraph to be reworded to reflect the degree of concern and depth of feeling regarding Sexual Health Services.
tHB/12/52 Business Case: Builth Wells September 2012 to read: September 2011 tHB/12/61 Action Review from Previous Minutes
The Board received an Action Review Grid which provided a summary of actions arising from previous Board meetings held during 2012, as at 27 June 2012, with progress outlined against the outstanding actions and noted that there were no outstanding actions for discussion.
The Board noted that regarding the proposal for Board Associate Member a response had not been received from the Minister for Health and Social Services. tHB/12/62 Chairman’s Report
Following a formal welcome to Board Members, the Chair advised the Board that:- he had undertaken a three day visit to North Powys and short report outlining the findings had been provided to the Chief Executive and also to the sites and staff visited; he had attended a number of All Wales Chairs meetings and confirmed that he had been nominated as the educational lead within the All Wales Chairs Group; the Minister for Health and Social Services had opened the Renal Unit at Llandrindod Wells and visited the Builth Wells project on the 01 August 2012. The visit was considered a beneficial and excellent event, the feedback was very positive and it provided good coverage for Powys tHB. The next visit was scheduled for 22 November 2012; a meeting had been held on 02 August 2012 with the Minister for Health and Social Services and covered areas which included organisational performance, capital funding opportunities and revenue funding; and an excellent meeting had taken place on the 04 September 2012, involving the Chief Executive and town and county councillors to discuss concerns and strategic options which provided a great opportunity to
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promote the tHB’s objectives and strategies. tHB/12/63 Financial Plan Update 2012/2013
RR presented the previously circulated paper, providing the Board with an update on the Interim Financial Plan for 2012/2013.
RR gave a brief summary and update from the last Board meetings in April and June 2012 and advised that the Board had received and approved a supplementary update to the financial plan in June 2012, which had identified further measures the Board could take to mitigate against the remaining financial challenge and indentified a further £4M measures.
RR advised the Board that Welsh Government confirmed at a meeting on the 16 July 2012 a staged repayment would not be an option for the Health Board and Welsh Government requested a further update to the financial plan from the Board, outlining the additional action necessary to ensure financial breakeven at the year end. RR advised the Board that to further reduce costs within the existing savings programme the following initiatives would need consideration;
Accelerating delivery of our Strategic Objectives RR advised that he Board had a strategy that planned to reduce costs, including reducing the cost of external provision by repatriation of activity, reducing demand and changing the way bed based care is to be provided. RR advised that these proposals were in addition to existing savings plans and increased the total savings target levied on directly provided services to 5.21%.
Waiting Times RR advised the Board that the Welsh Government had acknowledged the good performance delivered by the Health Board in managing access times, however the tHB recognised that this level of performance had been achieved at a significant cost, and that whilst an absolute commitment to a maximum access time of 36 weeks continued, utilising flexibility within the maximum waiting time could be employed.
RR assured the Board that in putting these measures in place, the tHB would: establish a process through the Medical Director to assess the clinical impact of delaying treatments, ensuring those that require urgent care are not unduly delayed in receiving treatment; establish a clear communications plan to inform General practitioners and external providers of care to the Powys population; and establish robust internal controls around preventing avoidable spend whilst maintaining the 36 week backstop.
RR advised the Board that this approach could avoid up to £2M of in-year expenditure with cost reductions manifesting in the final quarter of 2012/13. This additional measure would result in an in-year overall targeted reduction on commissioned services of 12.36%.
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Welsh Health Board Provider Premium RR advised that the tHB had recently undertaken a modelling exercise to ascertain the value of the premium being paid by the Health Board to Welsh providers when compared to the cost of providers from England. RR advised that this exercise had identified a Welsh premium in the region of 25% i.e. over £6M on our current contract values. RR asked the Board to note that the application of a 1.8% deflator and other pricing measures with Welsh Health Boards amounting to £1.4M had already been built into the tHB’s financial plan. RR advised that analysis indicated that up to a further £5M expenditure could be avoided by the Health Board on a full year basis if the Board applied Payment by Results (PbR) tariffs to Welsh Health Boards, or redirected patients away from NHS Wales providers to NHS England.
RR advised the Board that, given the current financial climate, the likelihood of a successful negotiated outcome with Welsh Providers was low and within this context the support of Welsh Government has been requested.
RR advised that, taking the above initiatives into account, the revised stretched programme was submitted to Welsh Government on the 01 August 2012. RR advised that the Welsh Government had since responded and supported the approach necessary to assist the progress and development of a robust, balanced plan and also acknowledged the further work required.
The Board held a brief discussion regarding the need to establish a clear communication plan to ensure members of the public and relevant parties were kept informed at key stages of the additional measures/initiatives being implemented. AC indicated that a handling plan, including engagement, would be developed for each initiative.
The Board APPROVED the additional measures to be included in the tHB’s Interim Financial Plan for 2012/13 and NOTED the stretch already being employed to reduce costs within the existing savings programme. The Board ACKNOWLEDGED the impact of the additional measures for the Powys population and financial challenge ahead. tHB/12/64 Mental Health –Vision for Powys
CS presented the previously circulated paper, providing the Board with the proposed vision for Mental Health in Powys.
CS informed the Board that Mental Health was a priority within the Annual Plan 2012/13 and the development of a vision for Mental Health in Powys followed by a detailed delivery plan and reviewed governance arrangements was reflective of the national direction.
CS outlined to the Board a number of national and local drivers and their impact on mental health had formed an important consideration to the vision for mental health for the people of Powys. At a local level, the One Powys Plan
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formed the key strategic plan of statutory partners in Powys and collaboration with the voluntary sector enabled people to live independently and healthy lives. The Vision therefore, had been developed through direct input of the Mental Health Planning and Delivery Group members; an extended stakeholder representation, mental health professionals and views of service users on what they wished to see from services had been coordinated by PAVO. A workshop was held in July 2012 to help bring views and ideas to develop an arrangement going forward.
CS advised that the development of a detailed delivery plan and a review of governance arrangements would take place through September to November 2012 and would be available for consideration by the Board at its meeting in December 2012. Action: Director of Nursing
The Board APPROVED the Vision for Mental Health for Powys and NOTED the development of a delivery plan and reviewed governance arrangements by December 2012. tHB/12/65 Mental Health Measure
CS presented the previously circulated paper, providing the board with the Powys Scheme for Local Primary Mental Health Support Services under Part 1, Mental Health (Wales) Measure 2010.
CS summarised to the Board Part 1 of the Measure which concerned the establishment of local primary mental health support services across Wales, which looked at the key aims of improving access to mental health services in primary care which ensured the availability and consistent range of services for delivery. Part 1 sets out:
• the responsibility of Local HB’s and Local Authorities, ,working in partnership, for the provision of these services • defines the meaning of local primary mental health support services (assessment, treatment, intervention and the provision of information and advice to individuals and their carers and to primary care practitioners) • and sets out provisions in relation to duties to carry out primary mental health assessments, the conduct of such assessments and follow-up action
CS outlined to the Board and reported on progress made to date in the following areas; geographical area of the scheme, key components of the scheme, stakeholder involvement, implementation of the scheme and legal advice.
CS noted to the Board that guidance from Welsh Government concerning Cross border issues between England and Wales and regulations in relation to vulnerable children from other local authorities had been received and was more complex than originally expected.
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JM welcomed the report and acknowledged the efforts and progress made by all involved after a complicated start.
CS confirmed to the Board that the scheme needed to be submitted to the County Council for formal approval but was unsure of a date at this stage.
The Board APPROVED the Powys Scheme for Local Primary Mental Health Support Services, as required under Part 1, Mental Health (Wales) Measure 2010. tHB/12/66 Health & Safety Annual Plan
WM presented the previously circulated paper, providing the Board with a progress report in relation to the management and further development of Health and Safety.
WM advised the Board that in March 2011 each Health Board had to submit Corporate Health and Safety Acton Plans to the HSE. The HSE issued feedback on format and best practice before the plan was agreed by the Board in October 2011.
WM outlined to the Board key areas of the Health and Safety report which aimed to:- • Provide an annual report of Health and Safety for 2011-2012 • Summarises progress against the key aims of the strategic action plan in 2011-2012 • Indicate the key areas of work within the Strategic Action plan for 2012- 13 which would note key drivers, aims and achievements and would look forward at the key areas of work over the next 12 months
The Board acknowledged the steady progress being made in health and safety as indicated in the report and noted achievements to date with particular reference to the recent management of Asbestos. WM informed the Board that a greater focus had been put on supporting managers at all levels within the organisation to manage risk and implement local monitoring and auditing.
The Board welcomed the report and held brief discussion regarding the delivery of the revised timescales as outlined in the strategic plan. WM noted to the Board that this area would be monitored through the Health and Safety Committee and escalated to Risk Management Committee to provide further assurance that action was being delivered.
The Board noted the importance of embedding health and safety management as a core part of day to day business and further NOTED progress made in implementing the Strategic Action plan 2011-2013 and annual report of 2011/12. The Board APPROVED the direction of travel for the Strategic Action plan for 2012-13 to form the basis of Health and Safety reporting in the future.
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FOR APPROVAL tHB/12/67 Therapies and Health Science Strategy
VD presented the previously circulated paper, providing the board with the strategic direction of Therapy and Health Science Services together with the Annual Report for 2011/12 and the Delivery Plan for 2012-15.
VD summarised to the Board the aim of the strategy which identified key actions to ensure delivery of both professional and organisational objectives as described in the Powys tHB’s Annual Plan. VD advised the Board that it also demonstrated how Therapy and Health Sciences were committed to adopting advances in clinical leadership in order to provide high quality, evidence informed practices to manage the demand presented by the changing needs of patients, carers and other service users.
VD briefly outlined to the Board sections of the annual report which demonstrated outcomes evident over the last 12 months for Therapy and Health Science Services in Powys. VD also reported on the aims and outcomes which would be addressed through the Delivery Plan aims over the next three years.
The Board welcomed the paper for its coherent and uncomplicated presentation which demonstrated the benefit of sharing patient stories. VD confirmed to the Board that an action plan would be implemented going forward.
The Board held brief discussions regarding the action plan and agreed that the actions identified required an outcome focused approach but acknowledged the efforts made in respect of its first approach. The Board welcomed the idea of patient stories and pain management stories to be presented at future Board development sessions in order to demonstrate improving the quality of patient experience through effective and efficient delivery of services by Powys tHB.
Board NOTED the progress made by the Therapy and Health Science services in 2011/12 and APPROVED the Therapy and Health Science Strategy for 2012/15. tHB/12/68 New Directions: South East Powys
BW presented the previously circulated paper, providing the Board with the New Directions: Improving Healthcare Services for South East Powys consultation document.
BW outlined to the Board the current position to date following the initial stakeholder engagement events, which considered the future provision of healthcare services in South East Powys in 2010 which involved working with GPs from Brecon, Hay on Wye/Talgarth and Crickhowell and as a result produced a Vision for Health Care Services in South East Powys discussion document which was approved by the Board in October 2011.
BW reported to the Board that following further local engagement events the
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CHC had advised that there remained broad support for the proposed outlined vision. BW confirmed that the tHB was now in a position to consult with local communities in depth on proposals to extend and improve health services in the area and to formally consult with stakeholders on its proposals to improve the future provision of rehabilitation services for patients who had suffered a stroke.
BW briefly outlined the proposals to the Board which would ; • Strengthen community services • Improve access to GP supported care • Increase the number of outpatients clinics and day case operation activity • Enhance services for stroke patients • Develop a transport plan to ensure the best access to the services
The Board welcomed the document and noted all information gathered had been transferred and produced in a clear and coherent style. The Board acknowledged the specific reference made to the transport element of the paper as it was felt this was a key issue for Powys residents which could not be overlooked. The Board also welcomed the opportunity to strengthen the role of the CHC in light of the national guidance for engagement and consultation for Changes to Healthcare Services and further noted the positive consultation process which had been undertaken with Powys staff.
The Board held a brief discussion on minor amendments to the paper in terms of accuracy and it was suggested that the inclusion of a local map to clarify the GP localities would be beneficial. BW confirmed to the Board that the paper would be reformatted by the commencement of the consultation process on the 14 September 2012.
The Board NOTED the progress achieved to date and APPROVED the consultation document to improve healthcare services in South East Powys. tHB/12/69 Civil Contingencies
BW presented the previously circulated paper, providing the Board with the revised Civil Contingencies Plan 2012/13.
BW outlined to the Board the teaching HB’s responsibility to ensure that its emergency plans were updated regularly, and were consistent with the Civil Contingencies Act (2004). BW advised the Board that whist the HB was referred to as a Category 1 responder under the Civil Contingency Act, the tHB did not provide any acute care and therefore could only provide a supporting role in the event of a major accident. BW summarised to the Board the 3 areas which posed the most likely risk to services and had been prioritised in the following order;
1. Pandemic Flu preparedness 2. Business Continuity planning 3. Major Incident planning
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The Board noted in relation to business continuity an opportunity to test and demonstrate the emergency preparedness had been experienced over the last 12 months following a series of industrial action events and the potential of fuel disruption. BW reported that the overall outcome of the preparation was positive and lessons identified was an on going process.
The Board acknowledged the amendments required to the Civil Contingencies Plan which would provide necessary actions needed to support the Executive Directors role at a multi-agency strategic level of command which had not been previously included.
The Board noted the key priorities identified to ensure the delivery of the 2012/2013 going forward which included the following;
• Continued participation in training and exercising programmes at the local and multi-agency level • Completion of a full review of three supporting Hospitals Major Incident plans and procedures (commenced June 2012) • Scheduled revision of Powys Pandemic Flu Plan in line with new guidance (October 2012) • Further development of tHB’s Business Continuity • Roll out of e-learning package to raise awareness of major incident procedures
The Board APPROVED the revised Civil Contingencies Plan. tHB/12/70 Delivery of Strategic Objectives 2012/13
AC presented the previously circulated paper, providing the Board with an update on the progress across the components of the programme of transformation to ensure delivery of strategic objectives 2012/13.
AC outlined to the Board that the evolving programme had been articulated formally to the Board through the Annual Plan which was approved in April and updated in June 2012. AC reported to the Board that the programme had 3 related components to it, those being;-
• Accelerated organisational development • Accelerated clinical change • The right financial regime
AC updated the Board on progress across the 3 areas of the programme of transformation which would aim to secure significant service improvement and financial sustainability and to ensure an organisation best fit for purpose.
PD requested an update on the Programme Management position and JD confirmed that interviews had been scheduled on the 11 September 2012 where an appointment for the Head of Programme Management would be
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made.
The Board held brief discussion regarding the experience required and that expected from the Programme Management position and it was noted that strong programme management expertise was key and core skills would be looked at. A further discussion was held with reference to the candidate suitability with particular reference to those who did not have prior knowledge and experience of working with the NHS. RR confirmed to the Board that the important factor was the approach aspect of candidate experience and not necessarily the knowledge of working with the NHS when selecting an appropriate candidate.
BW updated the Board on the improvement of the information capability and capacity with had been commissioned by NWIS, on behalf of the tHB, which had reported a number of areas of good practice but had indicated that the current arrangements and resources did not adequately support the tHB’s objectives. The Board noted further work required on this area and the need for clarity on this key area to improve.
The Board NOTED that the progress made to date and continued progress needed to accelerate organisational development, clinical change and financial management to allow significant service improvement and financial sustainability to ensure delivery of the programme. tHB/12/71 Integrated Performance Report
The Board received the Integrated Performance Report 2012/13.
JD outlined the purpose of the report to the Board and advised that its aim provided an update on progress being made to further develop the Health Board’s integrated performance management framework and it also provided an update and assurance on the progress being made on the delivery of the high level objectives included in the Annual Plan.
JD advised the Board that there would be continued work to build the performance infrastructure of the paper and clarification on its direction of travel needed to considered going forward. The Board noted that the paper would be reported to the Board at future meetings.
The Board held a brief discussion regarding the depth of information within the report and JW noted that more focus on the changes of models of care needed to be included. A further discussion by the Board was held with regards to delayed transfers of care and JM requested further information regarding the increased mental health cases. CS advised the Board that the slow increase was attributed to an access issue when trying to facilitate specialist services within Care homes and AMI settings and further discussions with the housing and social sector to support the delivery of care was needed.
GJP requested the total numbers of LAC cases coming into Powys and CS informed the Board that the issue required further exploration and a further
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comparison of numbers to other areas needed to be assessed. CS noted to the Board that overall, the approach and tangible measures of improving life challenges in vulnerable areas was in place.
JM noted to the Board that with regards the provision of Sexual Health a resolution to the access of services needed to be made. JM advised the Board that it was of significant concern as it was a longstanding issue which had not been addressed. JM requested that a deadline had to be set around this issue. CS confirmed that in terms of out of hours service provision and resolution for the North and South of Powys an update on this would be provided by the end of December 2012.
The Board NOTED the Integrated Performance and work underway to strengthen the performance management arrangements and reporting mechanisms. tHB/12/72 Corporate Risk Register
WM presented the previously circulated paper, providing the Board with update of organisational risks via the Risk Register.
WM outlined to the Board the purpose of the paper which was to enable the Board to consider the highest organisational risk through the risk register. WM advised the Board that the risks register contained the highest risks across the organisation and provided a summary of controls in place and reported on progress made in managing those risks.
WM reported on the current work underway with Localities and Service Directorates to review their risk registers to ensure they were up to date. In addition, further work was underway to ensure that all risks were recorded on the Datix system, Datix training had also been arranged for staff. WM confirmed that the risk registers would be published on the Powys tHB website following the meeting.
As Audit Committee Chair, GJ welcomed the report as this area had been a focus by the Audit Committee last year. GJ noted the progress to date and advised it was beneficial to receive the risk register at Board level and suggested an additional column should be inserted to reflect the accountability of the individual committees.
The Board held brief discussion regarding the control measures, reporting and monitoring of risk and the need for risks to be more explicit. In response, WM advised the Board that further assurance could be taken from work underway which monitored the trends of risks and more emphasis had been put on the prompts of risks to try and embed the culture within the Organisation.
The Board NOTED the movement in the corporate risk register during the past 6 months which demonstrated that risks had been identified managed.
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FOR APPROVAL tHB/12/73 Setting the Direction Progress Report
BW presented the previously circulated paper, providing the Board with an update regarding the progress in the delivery of Welsh Government Strategy, Setting Direction and to demonstrate the Joint Maturity Matrix.
BW reported to the Board that at the Integrated Care Pathways Project Board meeting in October 2011, it had been agreed that work should be undertaken to develop a Joint Maturity Matrix. BW advised the Board that the joint maturity matrix provided a framework for the implementation of an integrated model of health and social care services. The framework is owned equally by Powys tHB and PCC.
BW summarised examples of service development which included the joint communications hub and the Builth Health and Social Care facility model and a series of programmes which had been rolled out across Powys which included integrated care pathways for fall prevention and reablement services.
The Board held brief discussions regarding the recruitment issues surrounding the North locality and VD advised the Board that recruitment issues had been a challenge as demand in the North had been underestimated and these issues would be resolved soon. JW noted to the Board that the inconsistency of band grading for those staff employed by Health Social and Social Care services and those by Powys tHB did not encourage, motivate or enthuse Powys staff. The Board noted that CS and JD welcomed the information and agreed further discussions were necessary to address this issue.
The Board NOTED the progress to date regarding the delivery of Setting the Direction. tHB/12/74 Director of Public Health Update Report
SA presented the previously circulated paper, providing the Board with an update of Public Health team structures and work undertaken by the Local Public Health Team on behalf of Powys tHB.
SA advised the Board that improved staffing capacity had taken place within the core Public Health Team and a number of substantive posts recruited and as a result had strengthened the team.
SA summarised to the Board work undertaken by the Powys Public Health team on three work streams areas:
• World Mental Health Day and Powys Mental Health Week World Mental Health Day would take place during Powys Mental Health Awareness week which involved the PPH team working with the Mental Health Planning and Delivery sub-group to develop awareness and to change the stigma associated with Mental Health.
• Veterans Health and Wellbeing
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A strong drive from WG had taken place and a number of actions had been taken to improve the situation for ex-service personnel and their families in Powys and in particular mental health issues that may affect ex-service personnel. The Powys action plan would be updated to ensure the management of the issues raised.
• MEND (Mind, Exercise, Nutrition, Do It) A community based 10 week programme had been designed to support overweight and obese children (aged 7-13 years) to make life changes that would improve their health and well being. This had been monitored through after school sessions. The Powys MEND steering group consists of representatives from Public Health, CYPP and Leisure services.
The Board held brief discussion regarding Veterans Health and Wellbeing and noted the significance for GP’s to record patient information at the earliest opportunity due to the length that symptoms can manifest in some cases 20-30 years ahead.
The Board NOTED the update of three work streams and progress to date. tHB/12/75 Screening Services Within Powys
SA presented the previously circulated paper, providing the Board with an update of population based national screening programmes run by the Screening Division, Public Health Wales NHS Trust.
SA outlined to the Board of 4 main screening programmes across Wales which included; • Breast Test Wales • Cervical Screening Wales • Bowel Screening Wales • Newborn Hearing Screening Wales • Wales Abdominal Aortic Aneurysum Screening (in development) • Newborn Bloodspot Screening Wales (in development)
SA advised the Board of the local issues concerning Newborn Hearing and how it was provided. SA reported that Newborn Hearing Screening Wales had an SLA with all Health Board except Powys, to provide audiology and paediatric services. Within Powys services were provided differently in the North and South. In North Powys Betsi Cadwaladr HB provided a comprehensive service to North Powys and following diagnosis of a hearing impairment, family received multi disciplinary support. SA advised that In South Powys, Aneurin Bevan although provided an initial assessment no paediatric audiology service and no multi disciplinary support for families was provided.
The Board NOTED the contents of the report for Information and ACKNOWLEDGED the local issues raised through the report.
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FOR APPROVAL tHB/12/76 Financial Performance 2012/13 - Month 04
RR presented the previously circulated paper, informing the Board of the financial performance of the Powys tHB at Month 04 of 2012/13. RR advised that:- • The tHB had identified an overspend of £3.818.M to month 4 • The tHB had projected an overspend of £4M to month 12 with associated risks identified • The tHB was on track to achieve its capital resource limit target • The tHB was on track to achieve the Public Sector Payment Policy • The tHB was reporting savings achieved of £1.335M against a plan of £2.658M to month 4, representing slippage of £1.323M to date
RR advised the Board that the CEO had established a series of mid year reviews with primary budget holders in order to assess current performance to determine further measures to improve the trajectory to year end. In addition, a number of capacity issues had been reviewed at local and corporate level and additional support from central teams had been introduced.
The Board NOTED the organisation’s financial performance at Month 04 of 2012/13. tHB/12/77 Board Committee Reports
The Board received and noted for information:-
an update from the Audit Committee Chair which outlined key developments via the Audit Committee in July 2012 GJ gave a verbal update regarding the pragmatic solution which had been reached with Internal Audit regarding the ways forward to deliver the 3 year audit plan with a total resource cover of 245 days.
an update from the Quality & Safety Committee Chair which outlined key developments via the Quality & Safety Committee in July 2012 GJP confirmed that Q&S Committee meetings would be extended by half an hour to accommodate the increased agenda.
an update from the Integrated Governance Committee Chair which outlined key developments via the Integrated Governance Committee in July 2012; .
No issues of concern were raised by Committee Chairs.
The Board RECEIVED the reports from the: Audit Committee Chair; Integrated Governance Committee Chair tHB/12/79 Any Other Urgent Business
The Chair advised on the following dates for noting;
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Board Meeting 26 September 2012 Teaching HB Status Workshop, 25 October 2012 tHB/12/80 Date and Time of Next Meeting
24 October 2012, 1.00pm, Clywedog Room, Ladywell House, Newtown
Board Minutes Meeting held Page 16 of 20 Board Meeting 05 September 2012 and 26 24 October 2012 September 2012 Agenda Item 1.3 Status: Awaiting Approval
FOR APPROVAL
MINUTES OF THE MEETING OF THE POWYS TEACHING HEALTH BOARD HELD AT 1.00 PM ON WEDNESDAY 26 SEPTEMBER 2012, IN BASIL WEBB, BRONLLYS
Present: Mel Evans (ME) tHB Chair (Chair of Meeting) Andrew Cottom (AC) Chief Executive Alan Austin (AA) Associate Member (SRG Chair) Mark Baird (MB) Independent Member Joanna Davies (JD) Director of Workforce & OD Rosemarie Harris (RH) Independent Member Gloria Jones Powell (GJP) Independent Member Gyles Palmer (GP) Independent Member Rebecca Richards (RR) Director of Finance Carol Shillabeer (CS) Director of Nursing Amanda Smith (AS) Director of Therapies & HS Jackie Walters (JW) Independent Member Roger Eagle (RE) Independent Member Brendan Lloyd (BL) Medical Director
In Attendance: Sumina Azam (SA) Interim Director of Public Health Andrew Evans (AE) Locality General Manager (South) Emily Games (EG) Corporate Governance Support Officer Rani Mallison (RM) Corporate Governance Manager Bruce Whitear (BW) Interim Director of Planning
Public Attendance: There were no members of the public present
Apologies: Paul Dummer (PD) Independent Member Gareth Jones (GJ) Independent Member Andrew Leonard (AL) Independent Member Jo Mussen (JM) tHB Vice Chair Jeremy Patterson (JP) Associate Member (CEO, Powys CC)
tHB/12/81 Declarations for Interest
There were no declarations of interest received for noting.
Board Minutes Meeting held Page 17 of 20 Board Meeting 05 September 2012 and 26 24 October 2012 September 2012 Agenda Item 1.3 Status: Awaiting Approval
FOR APPROVAL tHB/12/82 Proposals for Engagement on the South Wales Programme
AC presented the previously circulated paper with supplementary documentation to seek the Boards approval for the programme of engagement in respect of the South Wales Programme.
AC noted to the Board that following extensive engagement with clinical staff across South Wales, Health Boards were in a position to engage with the local population in discussion around the future of health services in South Wales. This in line with Welsh Government Guidance on Consultation and Engagement for Changes to Healthcare Services.
At the outset of the meeting, AC noted to the Board the importance of informing Powys tHB’s involvement to the plan to ensure all Board members and the Powys population had the opportunity to voice their opinions and allow concerns to be raised regarding the programme and subsequently would be considered to assist the Programme Board to further develop its proposals.
AC outlined to the Board options on the possible scenarios for concentrating 24/7 consultant-led patients, obstetrics, neonatal and A&E care on four or five hospitals sites as identified below:
Scenario 4.1 Scenario 4.2 Scenario 4.3 UHW/University Hospital UHW/University Hospital UHW/University Hospital Llandough Llandough Llandough SCCC* SCCC* SCCC* Morriston Hospital Morriston Hospital Morriston Hospital Prince Charles Hospital Princess of Wales Hospital Royal Glamorgan Hospital Scenario 5.1 Scenario 5.2 Scenario 5.3 UHW/University Hospital UHW/University Hospital UHW/University Hospital Llandough Llandough Llandough SCCC* SCCC* SCCC* Morriston Hospital Morriston Hospital Morriston Hospital Prince Charles Hospital Prince Charles Hospital Prince Charles Hospital Princess of Wales Hospital Royal Glamorgan Hospital Royal Glamorgan Hospital
*The Specialist and Critical Care Centre (SCC) is planned near Cwmbran to replace a specialist services provided at the Royal Gwent and Nevill Hall hospitals
The Board noted that the sustainability of Nevill Hall Hospital would need to be reviewed once the SCC was in place.
The Board noted the geographical options which would serve as the most practical option for Powys patients and it was suggested that Prince Charles Hospital would be the nearest and that Royal Glamorgan would be the second nearest.
The Board held detailed discussion on one of the key issues raised which was transport access for the Powys population and how vital it was for patients and their families to have good and reliable transport links to the preferred option. The Board recognised that transport would be a big concern for those patients/carers and families who could not drive. The Board agreed that the
Board Minutes Meeting held Page 18 of 20 Board Meeting 05 September 2012 and 26 24 October 2012 September 2012 Agenda Item 1.3 Status: Awaiting Approval
FOR APPROVAL
options for the rural areas required further thought and development to allay any fears and instil confidence in the Powys population. The Board noted that further discussion would take place between Powys tHB and Powys County Council to address the transport issues identified via transport schemes. BL advised the Board that in addition, the up-scaling of the Ambulance Service would provide assurance that an efficient service would be in place and therefore on-going engagement with WAST was vital.
The Board held discussion regarding further information regarding the engagement process. BW advised the Board that for people who required the technical information, further information was available. The Chair noted to the Board the necessity to make the consultation process meaningful and comprehensible to ensure the Powys population felt involved and knew what could be expected for their future healthcare.
The Board NOTED the South Wales Programme Engagement Document and APPROVED the Powys Engagement Plan for the South Wales Programme. tHB/12/83 Legionella Verbal Update
SA advised the Board that issues with water temperatures had been brought to the attention of the estates management team by the new renal unit at Llandrindod Wells Hospital and subsequent water tests, returned on 13 September 2012, showed that two of the 24 samples sent were positive for Legionella pneumophila bacteria Group1 strain, the most serious strain. In total, twenty samples were found to be positive for Legionella.
SA advised that a Health Emergency Coordination Centre (HECC) was activated immediately on 13 September with the aims of: reducing the risk of patients and staff contracting Legionella infection; ensuring early identification of any infection and early access to advice and treatment; and ensuring communication with key stakeholder agencies, staff, patients and families and the wider community.
SA advised that a number of actions to protect patient and staff safety had been put in place:- • Access to water had been initially restricted, with bottled water and boiled water being used as an interim measure; • The water system was sanitized and filters were fitted on taps and showers to allow use of mains water; • the hospital was closed to further admissions and patients on the ward were reviewed to see if they could be safely discharged from the hospital. All other services were risk assessed to determine whether they should remain open. Services such as MIU and the Renal Dialysis Unit remained open, due to the low level of risk to patients. A few outpatient clinics were cancelled, due to the need for mains water access. The birthing centre was closed; • Staff were provided with information on the signs and symptoms of Legionnaires disease to allow rapid detection of any cases amongst both staff and patients. Initial discussions revealed that there were was one
Board Minutes Meeting held Page 19 of 20 Board Meeting 05 September 2012 and 26 24 October 2012 September 2012 Agenda Item 1.3 Status: Awaiting Approval
FOR APPROVAL
staff member with a flu like illness.
SA confirmed that there had been no confirmed deaths as a result of Legionella pneumophila at Llandrindod Wells Hospital.
The Board NOTED that a further update would be presented at the next Board meeting in October 2012. tHB/12/84 Any Other Business
No further items for discussion were noted. tHB/12/85 Date and Time of Next Meeting
24 October 2012, 1.00pm, Clywedog Room, Ladywell House, Newtown
Board Minutes Meeting held Page 20 of 20 Board Meeting 05 September 2012 and 26 24 October 2012 September 2012 Agenda Item 1.3 Status: Awaiting Approval
FOR DISCUSSION
BOARD MEETING 24 OCTOBER 2012
AGENDA ITEM 1.4
ACTION REVIEW FROM PREVIOUS MEETINGS 2012/13
Report of Chairman
Paper prepared by Corporate Governance Manager
Purpose of Paper To provide the Board with a summary of actions arising from previous Board Meetings held (2012/13), as at 05 September 2012.
Action/Decision required The Board is asked to DISCUSS progress against the actions arising from previous Board Meetings (2012/13).
Link to ‘Doing Well, 1. Governance and Accountability Doing Better: Standards for Health Services in Wales’:
Link to Health Board’s Improving Health & Well-Being Annual Plan Ensuring the Right Access Striving for Excellence Involving the People of Powys Making Every Pound Count
Acronyms and N/A abbreviations
Action Review Page 1 of 2 Board Meeting 05 September 2012 24 October 2012 Agenda Item 1.4
FOR DISCUSSION
BOARD MEETINGS ACTIONS ARISING OUTSTANDING
Board Minute Board Date Action Responsible Progress Completed tHB/12/64 05 Mental Health Strategy to be presented Director of Nursing 24/10/12: Strategy development Mental Health Vision for Powys September to Board in December 2012, for approval. underway. 2012 tHB/12/39 27 June 2012 Review of effectiveness of Agreement to Director of Finance Overarching Section 33 be reported to Board in July 2013. Agreement tHB/12/47 27 June 2012 Request for approval of proposal to be Corporate 05/09/12: Proposal sent to Proposal for Board Associate sent to Minister for Health and Social Governance Manager Minister for Health and Social Member Services. Services for consideration.
24/10/12: Ongoing
COMPLETED tHB/12/44 27 June 2012 Outcome of review of Powys Chief 24/10/12: Complete. Presentation 9 Powys Public Health Strategic Partnerships to be presented at a future Executive/Corporate held 13 September 2012. Framework Board Development Session. Governance Manager 05/09/12: Board Development Session Programme to be established for 2012/13. tHB/12/19 18 April 2012 An update report in respect of Setting the Director of Strategic 05/09/12: Included on Board 9 Annual Plan 2012/13 Direction (including the maturity matrix) Planning/Director of Meeting agenda. to be presented to the Board in Therapies & Health September 2012. Sciences
Action Review Page 2 of 2 Board Meeting 05 September 2012 24 October 2012 Agenda Item 1.4
FOR APPROVAL
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 2.1
IMPLEMENTATION OF THE NEW NURSING MODEL IN BUILTH WELLS
Report of Interim Director of Planning
Paper prepared by Planning Manager
Purpose of Paper To inform the Board of plans to develop the nursing team in Builth Wells to support delivery of the new model of health and social care
Action/Decision required The Board is asked to:
1. NOTE the plans to retrain staff in delivery of a new nursing model in Builth Wells; 2. APPROVE the temporary transfer of the in- patient unit at Builth Wells Hospital to Llandrindod Wells Hospital from January 2013.
Link to ‘Doing Well, This paper supports the following Standards for Health Doing Better: Standards 1. Governance and accountability framework for Health Services in 5. Citizen Engagement and Feedback Wales’: 7. Safe and Clinically Effective Care 18. Communicating Effectively 22. Managing Risk and Health and Safety 25. Workforce Recruitment and Employment Practices 26. Workforce Training and Organisational Development
Link to Health Board’s Ensuring the Right Access Corporate Plan Involving the People of Powys
Acronyms and CHC – Community Health Council abbreviations
Implementation of the New Model at Page 1 of 18 Board Meeting Builth 24 October 2012 Agenda Item 2.1
FOR APPROVAL
IMPLEMENTATION OF THE NEW NURSING MODEL IN BUILTH WELLS Background
The introduction of the new model of care for Builth Wells and the surrounding area includes a plan to integrate the existing hospital and community nursing teams into a single team able to work across all settings, including the new facility, on a twenty four hour basis. Delivery of this model requires the existing staff at Builth Wells Hospital to undergo a substantial level of retraining to further develop their skills to enable them to work in a broader community setting. If the timetable for occupation of the new facility is to be met it is estimated that staff will need to commence their retraining from the end of January 2013.
The in-patient unit at Builth Wells Hospital currently has 12 G.P. managed beds whose occupancy varies but averages at around 65%. The intention is that the new model of service will be delivered from September 2012, including the opening of the first floor unit of the new facility.
Construction of the Builth Integrated Health and Social Care Centre is well underway. The building is due for completion in May 2013, with services provided on an outpatient basis transferring from June 2013. Arrangements for the re- commissioning of residential care across the existing care home and the new unit will be completed in June 2013 with a view to implementation from September 2013.
Current capacity for in-patient nursing care at Builth Hospital
There are a series of factors that are affecting the tHB’s ability to release staff for the training that is required to deliver the new model.
• The recruitment and retention of nursing staff to work at the hospital remains a challenge. Uncertainty around change and the new model for service delivery is likely to have contributed to this. Recruitment channels have remained open, however no additional qualified staff have come forward.
• There is a relatively low occupancy of the in patient area at Builth Hospital (usually 6 -8 occupied beds) but as the ward is on the first floor of an older building fire regulations require a level of staff that is able to manage an evacuation in the case of fire;
• The staffing difficulties are exacerbated by some long term sickness among the existing team.
Action to address the issues
On 4 October the teaching Health Board (tHB) hosted a workshop with key stakeholders to consider the approach to be taken to facilitating the release of staff to enable them to access training. The workshop considered the issues the tHB faces in maintaining local services and delivering the new model simultaneously, and considered options for a temporary alternative model. As a consequence of this
Implementation of the New Model at Page 2 of 18 Board Meeting Builth 24 October 2012 Agenda Item 2.1
FOR APPROVAL workshop it is proposed that the in-patient unit at Builth Wells is transferred to Llandrindod Hospital on a temporary and phased basis from the beginning of January 2013. The community nursing team in Builth Wells will also be strengthened at this time as part of the implementation of the new model and to strengthen capacity to manage patients in the community. The option appraisal carried out at the workshop is attached as appendix 1.
It is a requirement within the Engagement and Consultation Guidance to consider, with the Community Health Council, contingency plans around urgent service changes (appendix 3). Officers from the CHC participated in the option appraisal workshop on 4 October and discussions have been held with them on the subsequent engagement regarding these temporary changes. This is detailed in appendix 2.
Conclusion
A new service model is planned for the Builth Wells area associated with the opening of the new Health and Social Care Centre. This requires the release of nursing staff for training to deliver the new model. There are challenges in releasing staff due to the need to maintain the existing service at Builth. It is therefore proposed to temporarily transfer the in-patient unit at Builth Wells Hospital to Llandrindod Wells Hospital. Once approved by the Board a transfer plan will be prepared to ensure a safe and efficient transfer of services.
Recommendation
The Board is asked to:
1. NOTE the plans to retrain staff in delivery of a new nursing model in Builth Wells; 2. APPROVE the temporary transfer of the in-patient unit at Builth Wells Hospital to Llandrindod Wells Hospital from January 2013.
Report prepared by: Presented By: Pat Tempest Bruce Whitear Planning Manager Planning Director
Background Papers Model of Care for Builth Wells Guidance on Engagement and Consultation on Changes in Health Services Financial Consequences This paper brings forward the financial plans set out in the Builth Wells BJC previously approved by the Board Other Resource Implications Management capacity will be required to plan and deliver this service change: additional resource has been allocated to the Builth Wells Project Consultees CHC; Powys Council Officers, Builth Wells GP Practice
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APPENDIX 1
Provision of safe in-patient services at Builth Wells Hospital
OPTION APPRAISAL
Background
Builth Wells Hospital has 12 G.P managed beds whose occupancy varies but averages at around 65%. The intention is that these beds will transfer to the new integrated health and social care centre in 2013.
Construction of the new centre is well underway. Although the building is due for completion in May 2013 arrangements for the commissioning of the in patient area may not complete until late summer 2013.
The in-patient unit at Builth Hospital is currently experiencing difficulties with maintaining a safe staffing level.
There is a requirement to retrain staff currently working in the in-patient unit for new roles when the revised model of care becomes operational on the opening of the new unit. The training will take place over a period of six months and therefore staff will need to be released from normal duties in line with the training requirements not later than the end January 2013.
Problems with the Status Quo
Nurse staffing requirement
Although there is a relatively low occupancy on the ward (usually 6-8 occupied beds) there is nevertheless a requirement to maintain a full staffing level due to the first floor location of the ward, in order to be able to safely manage an evacuation.
Difficulties in recruiting to nurse vacancies at Builth Hospital
An open recruitment process has been in place in Builth Wells for some time, but there has been difficulty in attracting qualified nursing staff to the facility. The difficulties with recruitment is thought to be partly due to the perceived uncertainty about the nursing role in the new model of care and the possible eventual closure of the existing hospital.
Sickness levels The sickness rate for Builth Hospital Nursing in 2011 was 3.41% compared to 8.57% so far in 2012. The sickness absence rate is calculated as the % of wte calendar days lost over the wte available days.
Two wte Band 5 staff nurses have been on long term sick leave from October and March respectively. Although these two staff have returned to the workplace, they are on a phased return under review with Occupational Health and are not able to fulfil all
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FOR APPROVAL of their duties. Four Band 5 staff nurses are also under Occupational Health for long term review due to on-going health issues.
While every effort is being made to maintain a safe staffing level at Builth Hospital, the service is extremely fragile and the situation may become critical at the end of January due to the lead in time required for retraining for the new model of care. It is therefore imperative that plans are put in place as soon as possible to ensure safe care for patients whilst allowing for the necessary re-training of nursing staff so as to deliver the new model of care in a timely manner.
Objectives
• To ensure access to safe in- patient care for patients from the Builth catchment area and to maintain out-patient services (Patient Safety)
• To ensure that patients are looked after as close to home as possible (Access)
• To ensure that there is sufficient capacity to allow for the re-training and development of staff on or around the end of January 2012
Option Appraisal Methodology
On 4 October 2012 a workshop was held to work through the objectives and to appraise all available options for addressing the current difficulties. The attendees at this workshop are listed at the end of Appendix 1. The workshop followed recognised practice for carrying out an option appraisal. Attendees identified a long list of options, shortlisted those to be taken forward for more detailed appraisal; identified and weighted relevant benefit criteria and then scored each of the shortlisted options.
Available Options – Long List
The long list of options and the initial outcome of their consideration is shown below:
Option Description Shortlisted/Discounted with reasons Do nothing Status Quo Shortlisted as the comparator option only Resolve the staffing This would involve an Discounted- significant difficulties and maintain intensive human resource efforts have been made the Builth unit effort to tackle recruitment over recent months to and sickness issues and resolve the staffing issues to supplement any and have proved shortfalls through use of unsuccessful. bank staff Intensive use of bank staff and/or use of external recruitment specialists would prove very
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expensive and are unlikely to be resolve the situation
‘Buy in the service from This would involve Discounted – this would another provider’ contracting out the care to be prohibitively expensive another NHS or private and is likely to be highly provider unpopular with all stakeholders Temporary transfer all This would involve the Shortlisted current care as in-patients transfer of all in-patient to Llandrindod Hospital care to Llandrindod Wells until new Builth opens Hospital
Temporary transfer all This would require the Shortlisted current care as in-patients transfer of Builth in- to another South or Mid patients to another Powys Powys hospital until new Community Hospital other Builth integrated care than Llandrindod Wells centre opens Temporary transfer all This would require the Discounted – this option current care to a local transfer of patients to a would require a number of Residential Care Home facility registered as a complex funding issues to residential care home by be resolved and there Powys County Council would be difficulties associated with the caring from medical patients in a residential care home Temporary transfer all This would require the Discounted – this option current care to a local transfer of patients to a would require a number of Residential Care Home facility registered as a complex funding issues to residential nursing home be resolved and there by Powys County Council would be difficulties associated with the caring from medical patients in a residential nursing home Care for people currently This would mean that no Discounted –Although a in Builth at home in-patient care (other than key aim is to provide more urgent cases) would be care in the community and provided for in a hospital less hospital based care, it setting. It would require would be impossible at extensive provision of this stage mobilise clinical support in the sufficient resources and community procedures to guarantee safe care for Provide on the job training This would result in the Discounted – it would be for Builth staff by external Builth ward remaining impossible to provide specialist trainers open as normal with staff appropriate community receiving on-the job experience through this training by a number of type of arrangement. In
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specialist trainers addition the availability of employed on short term local expertise to carry out contracts this training is no assured. Temporarily transfer all in This would involve the Discounted. DGH’s are patient care to a District transfer of all in-patient unlikely to have sufficient General Hospital care to a neighbouring capacity to incorporate the DGH such as Hereford Builth in-patients who Hospital would in any case be inappropriately placed in a DGH
Use a combination of care This would involve a highly Shortlisted methods individualised package of support for each patient, who would then be cared for in a variety of ways including some in-patient care at another local Powys community hospital, local care home, greatly enhanced care in the community, etc Transfer staff between This would involve the Discounted. This would Powys Hospitals transfer of Builth staff to not be highly disruptive, Llandrindod and vice and would cause versa difficulties in both hospitals. The logistics and organisation required would be unachievable within the time frame
Close Builth Hospital This would involved the Discounted. This would complete closure of Builth still require patients to be Hospital at the end of transferred as outlined in January to allow for other options and would appropriate retraining be unnecessarily disruptive and highly unpopular
Shortlisted Options
Option 1 Status Quo Option 2 Use a combination of care methods Option 3 Temporarily transfer all current in-patient care to Llandrindod Wells Hospital Option 4 Make temporary arrangements to support in-patients at home
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Benefit Criteria
Drawing on the objectives outlined above, the following benefit criteria were agreed and weighted to reflect the relative importance. Weights were apportioned out of 100
Criteria Weight Explanation Patient Safety and Quality 35 This reflects the requirement to ensure of Care patients are cared for safely at all times through the maintenance of nurse staffing levels and mix . It includes issues relating to the continuity of medical and nursing and therapeutic care.This was accorded the highest weight Access 20 This refers to the geographical ease of access to in-patient services for both patients are visitors Timing 20 This refers to the ease with which the option can be implemented and in particular whether the option will allow staff to be released for retraining by the required date Acceptability 25 How far each option is acceptable to the public (including patients and carers), staff and other stakeholders. The level of stakeholder involvement in the larger Builth project has been crucial to date. The acceptability of the option to stakeholders including GPs is vital and as such this option was accorded the second highest weight
Assumptions and Constraints
The following assumptions and constraints were identified:
• there is an expectation amongst stakeholders that there will be no change to the current configuration of services in Builth Wells until the opening of the new unit • options must achieve revenue neutrality as a minimum • the preferred option must allow for staff to be released for re-training by the end January 2013
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Benefits Matrix (non-financial)
Each shortlisted option was scored out of 10 against each criteria with 1 being the lowest and 10 the highest score. The scores were then multiplied by the weight to give the total weighted score
Option Safety Access Timing Accept- Total (35) (20) (20) ability Weighted (25) Score) 1. Status Quo 3 (105) 8 (160) 3 (60) 4 (100) (425)
2. Combination 7(245) 6 (120) 3 (60) 5 (125) (550)
3. Move to 7 (245) 6 (120) 9 (180) 7 (175) (720) Llandrindod 4. Move to another 6 (210) 4 (80) 7 (140) 3 (75) (505) Powys Hospital
Explanation of Scoring
Option 1 Status Quo
This option was given very high scores on access . The current location of Builth Hospital is very convenient for the catchment area. It was however given very low scores against the remaining criteria since it would not meet any of the objectives
Option 2 – Combination of Care Methods
This option scored reasonably well against the safety and quality criterion, but low against timing . It would be very complex to implement within the required timescale and the availability of experienced staff required to implement the option is in doubt. It scored averagely against access and acceptability since there is likely to be a considerable divergence of opinion depending on the individual care package required.
Option 3- Move to Llandrindod Wells Hospital
This option scored reasonably well against all criteria although there is likely to be access issues for some patients.
Option 4 – Move to Another Powys Hospital
This option scored moderately well against safety and timing but since any other Powys Hospital (other than Llandrindod) would be further away from the catchment area it was given a low score on access. There are likely to be acceptance issues
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FOR APPROVAL amongst stakeholders not least amongst staff, while GP support for this option is uncertain.
Sensitivity Analysis In order to test the sensitivity of the option appraisal a further analysis was conducted where all options were apportioned a similar weight (25)
Option Safety Access Timing Accept- Total (25) (25) (25) ability (25) Weighted Score) 1 Status Quo 3 (75) 8 (200) 3 (75) 4 (100) (450) 2 Combination 7(175) 6 (150) 3 (75) 5 (125) (525)
3 Move to 7 (175) 6 (150) 9 (225) 7 (175) (725) Llandrindod 4 Move to another 6 (150) 4 (100) 7 (175) 3 (75) (500) Powys Hospital
This shows that there is no sensitivity between the ranking of the options.
Economic Appraisal of Options Given the uncertainty of the potential costs with some of the options, and the timescales involved, it is not possible to provide a precise costed analysis of all the options. It is however possible to provide a reasonable assessment of the relative financial impact on each option for the period in question.
The financial impact on each option will be a balance between the ability to release costs from the current systems of care, and assessing and limiting additional costs. The majority of costs involved are staffing. There will be a marginal saving available in reducing any bank and overtime costs currently employed in running impatient facilities in Builth, but this is not significant. Given the current site will remain in use for the duration of the period; this will continue to incur facilities costs.
Option 1: Status Quo: This is not an option from a service perspective, given the staffing difficulties being experienced. In reality this will require not insignificant investment in staff to maintain safe services, and risks incurring additional costs as the service transfer would be delayed. However for the purpose of the financial appraisal, it is assumed to be revenue neutral.
Option 2 – Combination of Care Methods: This option as with the subsequent two, will provide a marginal saving on bank staff costs and facilities costs from not having a 24 hour facility on the Builth Hospital site. This option will however introduce new costs into the system that are not currently being incurred, including additional investment in Communality Nursing service and Care Home/CHC packages. This would be the most costly of the four short-listed options and likely to exceed the cost of the Do Nothing Option.
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Option 3- Move to Llandrindod Wells Hospital: This option would allow marginal savings on bank costs and facility costs in Builth Wells, but also in providing services on one site it will allow greater efficiencies to be achieved in Llandrindod Wells. By having more staff working on one site it will also allow additional savings on bank and overtime costs within the current Llandrindod services as well as allowing more flexibility should staff leave the service. These savings will be mitigated slightly by increased travel costs associated with a change in base. This option would be the most cost affective option.
Option 4 – Move to another Powys Hospital: This option would provide identical benefits as option 3, however additional costs will be incurred given the greater travel distances involved in using another Powys hospital. This therefore would rank behind option 3 in terms of financial assessment.
The relative economic ranking is:
Option Economic ranking 1. Status Quo 3 2. Combination 4 3. Move to Llandrindod 1 4. Move to another Powys Hospital 2
Preferred Option Based on the non-financial and financial option appraisal Option 3, to transfer the in- patient care from Builth Wells to Llandrindod Wells Hospital, is the preferred option.
Attendees at Builth Option Appraisal Workshop 4 October 2012
Andrew Powell Locality General Manager, Mid Powys (Chair) David Adams Chief Officer Brecknock and Montgomery CHC Marion Baker Senior Nurse, Mid Locality Dawn Docherty Team Leader Powys Social Services Dena Jones Locality Business Manager Sue Jones Locality Lead Nurse, Mid Powys Jan Lawrence Locality Lead Therapist, Mid Powys Jayne Thornhill Deputy Chief Officer Montgomery CHC Jackie Walters Staff Side Representative Claire Nicholas Human Resources Manager Pat Tempest Planning Manager
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APPENDIX 2
ENGAGEMENT PLAN
by When Initial consideration of Board of Directors 5 September handling plan by Exec Team Informal discussion with Bruce Whitear 29 August and 2 October key stakeholders Andrew Powell September Bruce Whitear September
Andrew Cottom September
Option appraisal workshop • HR Andrew Powell/Pat 4 October • Finance Tempest/Sian Tudor Smith • Therapies • Staff Side • Nursing • CHC • Community Support Office • Other Locality Managers • Social Service Manager
Further discussion with Andrew Powell 5 October GP clinical lead on outcome of workshop
Board consideration of Bruce Whitear 24 October issue and option appraisal
Letter to CHC Bruce Whitear By end October
Letter to wider range of Andrew Powell By end October stakeholders outlining progress with Builth project and plans. Pat Tempest/Sian Tudor (This letter will also offer Smith to arrange drop in further discussions at a sessions number of drop in sessions to be held in November/December)
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Utilise existing meetings to Andrew Powell November update on proposals including: • Staff meetings • Locality Staff partnership meeting 16 October • Builth Hospital League of Friends • Builth Stakeholder event (potentially) • Regular GP meetings • Health Focus Group meeting Press release/Key Brief Tin Wheeler Agree details November etc (details to be agreed Issue December with Communications Manager)
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Provision of in-patient services at Builth Wells Hospital
Situation The tHB is proposing to bring forward the closure of the ward area at Builth Wells Community Hospital to the first week in January to enable staff to be retrained to deliver care in the new unit and extend the range of care provided in the community.
This is a positive step in enabling the tHB to be able to open the new unit, currently being built, on time with a fully trained staff team in place to provide services in new ways that support healthcare in more remote rural communities.
We are not going back on previous commitments – closure of the ward is part of our commitment to the people of Builth Wells in the transition to the opening of the new unit and the delivery of a modernised health service for this rural community.
Builth Wells Hospital has 12 GP managed beds whose occupancy varies but averages at around 65%. The intention is that GP beds will transfer to the new integrated health and social care centre in 2013.
Construction of the new centre is well underway. Although the building is due for completion in May 2013 arrangements for the commissioning of the first floor area may not be complete until late summer 2013.
In the new arrangements a different model of nursing is to be implemented. This will bring together the two currently separate community and hospital nursing teams into a single community based team able to care for patients in any setting. It is anticipated that, through training, the scope of services this team will be able to offer with expand, increasing the numbers of people whose care can be provided within Powys.
There are some ongoing difficulties with maintaining a safe staffing level for the current unit as follows:
• the relatively low occupancy of the unit (usually 6 -8 occupied beds);
• the requirement to maintain full staffing level for all 8 beds. As the ward is on the first floor a safe level of staff is required to be able to manage an evacuation in the case of fire;
• the recruitment and retention of nursing staff to work at the hospital remains a challenge. Uncertainty around the new model for service delivery will inevitably contribute to this. Adverts have been continuously placed, but recruitment has not proved possible. Due to its isolation Builth is recruiting from a relatively small pool of potential staff;
• The staffing difficulties are exacerbated by some long term sickness amongst the nursing staff;
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• To enable the hospital staff to work in the community and take on new roles, an extensive programme of training with a six month lead in time is required. Currently the tHB is unable to release staff for this training due to the staffing difficulties. The tHB needs to be able to release staff for training by the beginning of January to enable them to be trained in time.
The tHB will continue to work with local stakeholders including the Community Health Council and the GP practice to prepare for the closure of the ward. Patients will continue to be cared for locally either at home or in Llandrindod Wells Hospital depending on their health care needs. The outpatient departments at the hospital will remain open and will transfer directly to the new facility in 2013.
FREQUENTLY ASKED QUESTIONS
Why have you not planned to train staff earlier in the process? The service model of an integrated hospital and community nursing team has only recently been firmed up. In the meantime staffing levels have been falling at the hospital and there has not been an opportunity to release them. The training programme is likely to be extensive and the issue of sufficient nursing staff to provide cover would have been raised no matter when the training was being undertaken.
Why do you need to train staff, aren’t they already trained? A different way of caring for patients will be delivered by the new arrangements. This will bring together the two currently separate community and nursing teams into a single community based team. Patients will be able to be cared for in any setting and staff require training on this expanded range of services. Staff who have traditionally worked in a hospital setting also require additional training to work in the community setting.
Does this mean that you will close the hospital? No, it does not. Builth Wells Hospital also provides a wide range of services on an outpatient basis. These services are not affected by these changes and will continue to be provided at the hospital until they transfer to the new facility in 2013. The Health Board is also planning to extend the services available once the improved facilities are available.
Once you have closed at Builth Hospital, will beds ever re-open in the new facility? Yes, most certainly so. The Health Board, along with Powys County Council are totally committed to providing beds in the new centre, as significant investment has been made by them and the Welsh Government.
Are you closing the ward to save money? The reason for closing the ward is for clinical safety reasons and to enable nursing staff to be fully trained to deliver the new model of care.
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FOR APPROVAL for the Health Board and, following the completion of the training programme, in the nursing team covering the Builth Wells area.
Will any non-nursing staff lose their jobs? No. All non-nursing staff who currently have substantive contracts of employment with the Health Board and work at Builth Wells Community Hospital, supporting the in-patient beds will continue to work for the Health Board. As the hospital itself is not closing until the new centre opens, there will still be a need for many of them to work on the hospital site. For some, however, there may be a need to be redeployed elsewhere, mainly to Llandrindod Wells Hospital.
Why is the Health Board having particular difficulties in staffing Builth Wells Hospital at the moment? It is generally difficult for the NHS across the UK to recruit staff and particularly when significant changes to service delivery are being planned. Builth Wells Hospital is a small unit which makes it more vulnerable and subject to staffing difficulties such as long term sickness. The new model of a single community based team provides for a more attractive option for staff.
Do you have the capacity to deliver care in Llandrindod Wells and in the community in Builth Wells. Yes. We will re-deploy the staff who currently work in Builth Wells to work in these centres, and will temporarily increase staff in Llandrindod Wells Hospital if we need to. Additional beds in an existing unit can be opened with smaller marginal increases in staff than are required for a stand alone unit.
Do the Builth Wells GPs support the plans to close the ward? We are working with the GPs to consider the full range of options available to us and the practice to ensure patients’ needs are met as we move forward.
GPs support the training of staff during the transition to the new arrangements for delivering care to patients, and understand that the hospital ward needs to close to achieve this.
Will the GPs continue to provide the medical care for Builth patients in other hospitals? The GPs are making arrangements to overcome the practical difficultie for them in caring for patients in Llandrindod Wells.
Will you be providing transport for relatives to visit if they are being looked after in another hospital? This is a temporary arrangement and the numbers of patients affected will be small. The health board does not believe that asking relatives to travel to Llandrindod Wells is unreasonable in the circumstances. We are in discussion with Builth Community Support about how we can help people who have specific difficulties in visiting Llandrindod Wells Hospital.
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When will patients stop being admitted to Builth Wells Hospital? There is no set date but at this stage but it is expected to be early January. Outpatient services at the hospital will continue until the new facility is opened.
What’s actually going to happen? A new integrated health and social care centre is being built which will deliver a new approach to care in Builth Wells and extend the range of patient care provided in the community.
This new service will bring together the two currently separate community and hospital nursing teams into a single community based team able to care for patients in any setting. To achieve this, staff require an extensive programme of training as they move towards the new healthcare service. It is proposed that the closure of the ward area at Builth Wells Hospital is brought forward so that staff can be retrained to deliver care in the new unit and in the community.
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APPENDIX 3
Guidance on Engagement and Consultation for Changes in Health Services
This guidance re-iterates the requirement on the NHS to ensure “that safe sustainable services are available for the citizens of Wales, within the resources made available by Government”. Section 6 of the guidance relates to urgent service changes and allows for immediate decisions to be taken without engagement or consultation if there is a risk to the safety and welfare of patients. However it urges NHS bodies to take precautionary action to prevent difficulties arising from emergency decisions by assessing services that may be considered to be at risk as follows:
• “ contingency plans should be prepared for services viewed as at high risk and shared at an early date with relevant NHS organisations, the CHC….., the CVC….the local Partnership Forum and the local authority where relevant……… • Information that services may be a “high risk” should be shared ……. at the earliest possible stage, risk analysis should be comprehensive and weighted appropriately; • In responding to unforeseen service change the tHB should take urgent steps to bring the change process in line with the requirements that normally apply and put in place a comprehensive consultation process. The expectation would be that the service changes should be dealt with as public business on the Board agenda… where a report on the change and its impact should be given and on any actions planned to mitigate any potential adverse impact”
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BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 2.2
“YOUR HEALTH, YOUR FUTURE” CONSULTATION DOCUMENT HYWEL DDA HEALTH BOARD (HDUHB)
Report of Director of Planning
Paper prepared by Planning Manager
Purpose of Paper To report on the consultation events held in Powys in relation to the Hywel Dda Consultation Document and to present the draft tHB response
Action/Decision required To APPROVE the tHB response to “Your Health, Your Future”
Link to ‘Doing Well, Supporting the following Standards for Health Doing Better: Standards Governance and accountability framework for Health Services in Wales’: 5. Citizen Engagement and Feedback 7. Safe and Clinically Effective Care 8. Care Planning and Provision 18. Communicating Effectively
Link to Health Board’s Ensuring the Right Access Corporate Plan Involving the People of Powys
Acronyms and HDUHB – Hywel Dda University Health Board abbreviations
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“YOUR HEALTH, YOUR FUTURE” CONSULTATION DOCUMENT HYWEL DDA UNIVERSITY HEALTH BOARD (HDUHB)
Background
In August 2012 Hywel Dda University Health Board issued its formal consultation on proposals for changes in health service provision within their area. “Your Health, Your Future (the consultation document), is HDHB’s response to the Welsh Government’s Strategy “Together for Health”.
It states that HDHB aims to:
• improve the health and wellbeing for all; • move from a sickness service to a wellness service; • deliver quality healthcare in the most appropriate setting; • have person-centred, high quality, safe and sustainable hospital services that meet the needs of the population; • be recognised as Wales’ leading integrated rural health and social care system
HDHB wishes to provide integrated healthcare with 80% of NHS services provided locally, through primary, community and social care teams working together. Care will be provided either at home or close to home, within the community. The document states that delivering this vision will support care for the frail and elderly, whilst allowing hospitals to concentrate on providing planned and emergency care when it is needed.
All the hospitals in Hywel Dda Health Board will operate as one to ensure best use of staff and resources.
The document sets out proposals for various changes in the configuration of community hospitals, the future vision for mental health and learning disability services, and for hospital services (in particular cancer, women and children’s services, emergency care and planned care). It also deals with the issue of transport and access to transport services for patients and families.
The Consultation and Engagement Process in Powys HDHB’s engagement on the proposal began well in advance of the publication of the formal consultation document. In Powys two listening events were held on 5 March 2012 in Machynlleth and Llanidloes, jointly organised by Powys tHB with Montgomeryshire Community Health Council (CHC), in order to engage with the local communities and to better understand their concerns regarding health care provision in the area. 128 members of the public attended the meeting in Machynlleth and 59 in Llanidloes. Hywel Dda Health Board and Shrewsbury and Telford Hospital Trusts were also invited to be in attendance.
In terms of the formal consultation, events were held at the same venues on 18 September in Machynlleth and 19 October in Llanidloes respectively. Directors from
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Hywel Dda HB, and Powys tHB were present at all events, to listen to the issues and concerns being expressed.
The draft Powys tHB response to “Your Health, Your Future” is attached and is based on the discussions which took place at both the engagement and consultation events (Appendix 1). This response will be reviewed in light of the Hywel Dda presentation to the Powys Board and the subsequent discussion.
Conclusion Hywel Dda HB has issued its formal consultation document on changes to health services in its area. The consultation closes on 29 October 2012. Two engagement events and two consultation events have taken place in Powys. The Powys tHB response to the consultation has taken into account comments raised at these meetings.
Recommendation
The Board is asked to discuss and approve the response to the consultation document. . Report prepared by: Presented By: Pat Tempest Bruce Whitear Planning Manager Director of Planning
Background Papers Together for Health Your Health, Your Future Financial Consequences Not specifically identified Other Resource Implications None Consultees As described in the paper
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DRAFT APPENDIX 1
Mr Trevor Purt Chief Executive Hywel Dda Health Board Freepost Hywel Dda Health Board
28 October 2012
Dear Trevor
“Your Health, Your Future”
Thank you for the opportunity to comment on the proposals for change outlined in your consultation document ‘Your Health, Your Future’. Powys Health Board welcomed your LHB’s participation in our listening events held in Machynlleth and Llanidloes earlier in the year, in response to your five year framework ‘Right Care, Right Place, Right Time, Every Time. We also shared a platform at meetings chaired by the Montgomery Community Health Council on the 18 September in Machynlleth and 19 October in Llanidloes respectively. The presentation on your proposals that your team made to my Board in Newtown earlier this week was also very much welcomed.
From the attendance of your officers at these events you will be aware that the concerns of Powys residents related mainly to the future scope of services to be provided at Bronglais and to safety concerns relating to travel to other centres for emergency and urgent care, to the ease of travel and transportation for patients and visitors for more routine care and to the request that Powys, Hywel Dda and Betsi Cadwalldr Health Boards work actively together to secure equitable access to the provision of comprehensive health care for mid-Wales.
Why things have to change Your document clearly sets out the case for change and the issues documented are also the key issues that face Powys in securing services for its population. We share your commitment to ensure that standards and quality should be at their highest across Wales. We also understand the challenge of delivering services to an ageing population in a highly rural area and this is a challenge we face together. We would certainly wish to work with you to make rural healthcare in Wales an attractive and demanding employment option for clinical and medical staff and to maximise the use of new technologies to support the delivery of healthcare. We value the relationship we have built with Hywel Dda in supporting the roll-out of video-conferencing telemedicine as part of our shared healthcare system. Value for money is clearly an absolute issue for the NHS across Wales and we share the challenge of ensuring a sustainable financial future for the NHS.
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Working with other Health Boards There is a clear request, from the engagement and consultation process that we have shared with you in Powys, that the three Health Boards in mid-Wales should enhance and make more open and transparent our approach to joint planning and delivery of healthcare across North Ceredigion, North Powys and South Gwynedd. There should be no surprise that there is much synergy between the plans of Hywel Dda, Powys and Betsi Cadwalladr Health Boards in respect of the approach to community service development and delivery that we propose that will see more care provided locally and in the community. We view our community hospitals in Machynlleth and Llanidloes as essential components of that community model from which a range of community services are delivered. It is important to the residents across the three counties that these services are provided in an overall system of care that includes Bronglais Hospital and that these public services are seen to be working together and working together well across organisational boundaries. I have already made the commitment to the North Powys community that Powys teaching Health Board will lead joint working to plan and deliver services across this area. Our officers also made this commitment in the public meeting in Machynlleth and I am seeking, through this response, your formal commitment to that process also. Powys tHB is committed to leading this to ensure that we are all able to deliver a sustainable model of healthcare in North Powys that is fit to meet the demographic challenge that faces us.
Transport You will have heard directly what the communities of Powys have to say about access to services and the transport issues that people face in rural Powys and you have put forward a number of proposals that Powys tHB actively supports and will want to see delivered. Powys has its own responsibilities in enhancing access, through making improvements to our own non-emergency patient transport and supporting local community transport systems, and we are committed to this moving forward across the County. The tHB would also like to see a more definite commitment to ways in which Hywel Dda HB can facilitate access to low cost accommodation for patients and relatives travelling long distances. For example accommodation either side of day surgery where this needs to be provided in hospitals other than Bronglais or where the most appropriate location for higher risk obstetric or neonatal care is deemed to be West Wales Hospital, Carmarthen.
There is a key element of service delivery that is missing from your proposals that will also assist patients who may need to travel long distances. For some care pathways we will wish to see active consideration of how patients will be routinely offered alternative pathways for specialist services that enables an individual’s personal domestic and transport arrangements to be taken into account, rather than automatically assume that the pathway of care will be to South Wales.
We fully support your proposals to reduce unnecessary follow-up outpatient appointments, increasing day case surgery and delivering chemotherapy locally to reduce the burden of travel. This is very much in line with our plans. In support of this Hywel Dda Health Board should make a commitment to increasing the range of services of this type that are to be provided on a direct outreach basis within Powys
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FOR APPROVAL facilities, through the use of telehealth and through extending the availability of clinical advice and support to GPs in managing care locally.
The tHB supports your statements in respect of the need to ensure that, in critical situations, patients receive specialist care delivered by staff with the right skills and support at the earliest opportunity – in some critical cases this may mean bypassing Bronglais to ensure patients are taken straight to an appropriate specialist centre. For the most rural parts of Powys the proposed Emergency Retrieval Service will be one of the means by which we will be able to provide residents with the confidence that they can access services in a timely manner in a critical emergency. We will therefore expect your support along with other Health Boards to support the delivery of this model across Wales.
Care Closer to Home Your plan is to deliver as full a range of NHS services as close to home as possible. This is very much aligned to our own plans to develop the role and scope of community services in Powys to manage people’s health care needs as far as possible within local communities. In Machynlleth, in particular, its geographical isolation from the rest of Powys provides us with additional logistical challenges in delivering this model and we would wish to see a commitment from Hywel Dda HB to take forward a joint approach to community service delivery for this area that resolves some of these challenges. The availability of consultant advice and support in innovative ways to GP practices to assist them to manage this care is vital.
Hospital Services Powys residents are particularly anxious and vocal about what they view as any diminution of services at Bronglais Hospital. A number of residents expressed the view that Bronglais should not only remain as an important secondary care centre, but also that it might be developed as a centre for service delivery to serve the whole of rural mid- Wales. We welcome therefore the proposals to invest in new facilities at Bronglais, as Powys teaching Health Board views Bronglais as an important strategic centre for the delivery of health-care for residents of North West Powys, and fully supports the direction of travel of the Hywel Dda Health Board in delivering as full a range of services as possible safely at the site.
Cancer Services Powys teaching Health Board welcomes your proposed approach both to meet cancer standards and to provide as much as possible of the care pathway for cancer locally. Powys would like to see the provision of chemotherapy specifically provided to our population, where appropriate, within North Powys and will want to work with you and Betsi Cadwaladr Health Board to determine how this can be achieved.
Obstetric and Maternity Services and Children’s Services Powys tHB recognises the challenges Hywel Dda faces in continuing to deliver safe services for maternity and children’s services into the future. We welcome the retention of a consultant led obstetric unit at Bronglais Hospital, paediatric assessment and a short stay unit. Clarity on the pathway of care from the consultant led obstetric unit are crucial to ensuring that women make the appropriate choices and the Health Board will want to be involved in developing those pathways through
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FOR APPROVAL our midwifery service. Pregnant women in Powys are guided through a risk assessment to help them decide the most appropriate place to deliver their baby. Based on this process we would expect Hywel Dda HB to support the choice and convenience of women who need specialist obstetric care not available in Bronglais such that Wales or Telford should be considered for Powys residents rather than an assumed pathway to Swansea. Similarly for acutely unwell children not able to be cared for at Bronglais these options should also be considered with parents.
Emergency Departments and Unplanned Care Powys understands the dilemma facing Hywel Dda HB in delivering a comprehensive emergency department service to a smaller rural population. As I have stated, our residents are very concerned at the access arrangements to services. We believe we can support Option B, i.e. adapting the standards to meet the local geography and needs, if assurances are provided that the quality of service as measured by outcomes for patients in this model will be the same or better as through strict application of the standards.
We have previously shared with you our Commissioning Framework which outlines that we consider Hywel Dda HB as a strategic partner in the delivery of health care for our population. This framework also sets out the standards and measures by which we will commission services from you. This document clearly sets out that we will base our commissioning decisions on the quality of care delivered by our providers, and we welcome the fact that your consultation document has a key aim to continue to improve the quality of the services you provide through the changes that you propose.
I have already highlighted that Powys tHB is seeking to lead the development of a planning and delivery forum that covers the North Powys, North Ceredigion and South Gwynedd area. Our response to ‘Your Health: Your Future’ clearly sets out an agenda for that forum and I would wish to involve local representatives of the community to ensure that we are able to demonstrate progress and support the delivery of change in an open and transparent way. We already share much joint working across Hywel Dda and Betsi Cadwaladr but there is a need to step up this approach. I will be in contact shortly to outline my specific proposals to take this forward.
The formal consultation process is only the start and there is a need for continuous engagement across our communities to maintain and build confidence in local services and provide assurance to the public that they will be able to access services in a timely manner when they need them. Powys Health Board seeks that commitment also from Hywel Dda HB and I look forward to working with you as our shared plans develop.
Yours sincerely
Andrew Cottom Chief Executive
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BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 2.3
“HEALTHCARE IN NORTH WALES IS CHANGING” CONSULTATION DOCUMENT BETSI CADWALADR UNIVERSITY HEALTH BOARD (BCUHB)
Report of Interim Director of Planning
Paper prepared by Interim Director of Planning
Purpose of Paper To report on the consultation event held in Powys in relation to the Betsi Cadwaladr University Health Board Consultation Document and to present the draft tHB response
Action/Decision required To APPROVE the tHB response to “Healthcare In North Wales Is Changing”
Link to ‘Doing Well, Supporting the following Standards for Health Doing Better: Standards Governance and accountability framework for Health Services in Wales’: 5. Citizen Engagement and Feedback 7. Safe and Clinically Effective Care 8. Care Planning and Provision 18. Communicating Effectively
Link to Health Board’s Ensuring the Right Access Corporate Plan Involving the People of Powys
Acronyms and BCUHB – Betsi Cadwaladr University Health Board abbreviations
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“HEALTHCARE IN NORTH WALES IS CHANGING” CONSULTATION DOCUMENT BETSI CADWALADR UNIVERSITY HEALTH BOARD (BCUHB)
Background
In August 2012 Hywel Betsi Cadwaladr University Health Board issued its formal consultation on proposals for changes in health service provision within their area. “Healthcare in North Wales Is Changing” (the consultation document), is BCUHB’s service change plan in response to the Welsh Government’s Strategy “Together for Health.” Excluding mental health services, the tHB’s investment in BCUHD is approximately £1.9M. This covers mostly outreach services provided with Powys facilities for audiology, radiology, ENT and ultrasound.
The document states that BCUHB’s Vision is that:
“people will enjoy health, wellbeing and independence equal to the best”
BCUHB want to help people to take responsibility for maintaining their own well- being, with family doctors, community nurses and other staff working closely with voluntary and community groups to achieve this. They want to make sure primary and community services are close to people’s homes where possible, are available at convenient times and are consistent and reliable. The same level, range and quality service should be available to all. Hospital services must deliver the highest quality clinical care with the best results. The three acute hospitals will continue to provide core services, each playing an important role within the healthcare system.
The proposals are consistent with other plans across Wales and include:
• Helping people to stay at home when its safe and appropriate • More care closer to home – consistent and reliable • Getting the best results from specialised services – better services on fewer sites: for example establishing cancer surgery in one hospital as a centre of excellence • For most care substantial changes to the main hospital sites are not proposed • Each hospital will have an emergency department, midwifery led unit supported by a special care bay unit and consultant led maternity service. It is proposed that neonatal intensive care will be provided from Arrowe Park Hospital. • Each hospital will have hospital services for children led by consultants, trauma and orthopaedic services, gynaecological services and non-elective general surgery • Patients will continue to use services from other NHS organisations from outside of Wales where appropriate • A number of community hospitals will become ‘hubs’ for services which will provide o In-patient beds o Minor injuries service seven days a week o Outpatient services o Therapy services BCUHB Consultation Page 2 of 6 Board Meeting 24 October 2012 Agenda Item 2.3
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o X-ray five days a week • Hospitals that are not hubs will continue to provide inpatient, outpatient and therapy services. It is proposed that through this process the x-ray facility at Tywyn will close although there is planned investment in the hospital infrastructure.
• The document makes references to improvements to older people’s mental health services; however no reference is made to health services provided within Powys.
• Vascular services will be provided from one specialist centre across North Wales, and the UHB is seeking views on this. This will potentially affect Powys residents as the new Aortic Aneurysm Screening Service is implemented for men aged 65.
The Consultation and Engagement Process in Powys The Health Board has hosted one event in Llanfyllin to consider the proposals and ensure that residents of Powys are able to comment on the plans. In addition the events held in Machynlleth around the Hywel Dda consultation provided some feedback relevant to the Betsi Cadwaladr plans.
The draft tHB response to “Healthcare in North Wales Is Changing” is attached and is based on the discussions which took place at both the engagement and consultation events (Appendix 1). This response will be reviewed in light of any additional comments made by the Board
Conclusion BCUHB has issued its formal consultation document on changes to health services in its area. The consultation closes on 28 October 2012. Two engagement events and two consultation events have taken place in Powys. The tHB response to the consultation has taken into account comments raised at these meetings.
Recommendation
The Board is asked to discuss and approve the response to the consultation document. . Report prepared by: Presented By: Bruce Whitear Bruce Whitear Director of Planning Director of Planning
Background Papers Together for Health
Financial Consequences Healthcare in North Wales is Changing
Other Resource Implications None Consultees As described in the paper
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APPENDIX 1
DRAFT
Mary Burrows Chief Executive Betsi Cadwaladr Health Board Freepost RSZZ-SGXY-TSEZ LL17 0JA
28 October 2012
Dear Mary
HEALTHCARE IN NORTH WALES IS CHANGING
Thank you for the opportunity to comment on the proposals for change outlined in your consultation document ‘“Healthcare in North Wales Is Changing”. We shared a platform at meetings chaired by the Montgomery Community Health Council on the 18 September in Machynlleth and held a specific event in Llanfyllin on 25 October to hear the public of Powys views on your proposals for change. Excluding mental health services Powys tHB’s investment in BCUHB is approximately £1.9M, just over 1% of your total budget. This covers mostly outreach services provided within Powys facilities for audiology, radiology, ENT and ultrasound.
From your attendance at these events you will be aware that in the West of Powys the concerns of Powys residents relate mainly to the future scope of services to be provided at Bronglais Hospital and the request that Powys, Hywel Dda and Betsi Cadwalldr Health Boards work actively together to secure equitable access to the provision of comprehensive health care for mid-Wales.
Why services need to change You set out the Triple aim of balancing population health, improving quality, safety and patient experience and controlling or reducing costs and that at the moment the balance across these three domains is not right. These are issues that we face across the NHS in Wales. An ageing population is a challenge that also faces Powys and the challenges of delivering services to this population in a highly rural area are the challenges we face together. We would certainly wish to work with you to make rural healthcare in Wales an attractive and demanding employment option for clinical and medical staff, and to maximise the use of new technologies to support the delivery of healthcare. We value the efforts that your team currently make to provide outreach services to Powys residents within Powys facilities, a model that we would like to see extended for example pregnancy ultrasound and consultant clinics. There is also an appetite among local GPs to be able to access consultant support via telephone or e-mail or other means and avoid outpatient appointments and unnecessary journeys for patients. Whilst we do not directly commission renal services from you, we value the partnership working through which we have
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Working with other Health Boards There has been a clear request from the engagement and consultation process that we have shared with you in Powys that the three Health Boards in mid-Wales should enhance and make more open and transparent our approach to joint planning and delivery of healthcare across North Ceredigion, North Powys and South Gwynedd. There should be no surprise that there is much synergy between the plans of Hywel Dda, Powys and Betsi Cadwalladr Health Boards in respect of the approach to community service development and delivery that we propose that will see more care provided locally and in the community. We view our community hospitals in Machynlleth and Llanidloes as a key part of that community model from which a range of community services are delivered. It is important to the residents across the three main counties that these services are provided in an overall system of care that includes Bronglais Hospital and that these public services are seen to be working together and working together well across organisational boundaries. I have already made the commitment to the north Powys community that Powys Health Board will work to lead joint working to plan and deliver services across this area and I am seeking through this response your formal commitment to that process also. Powys tHB is committed to leading that process to ensure that we are all able to deliver a sustainable model of healthcare in the area that is fit to meet the demographic challenges that face us.
We have raised this issue with Hywel Dda through their consultation process. Specifically we would like to see a partnership approach to pathway development in mid-Wales that allows for alternative pathways to be considered for Powys residents into North Wales or England for specialist services, rather than automatically assume that the pathway of care will be to South Wales.
The tHB fully supports your statements in respect of the need to ensure that in critical situations patients receive specialist care delivered by staff with the right skills and support at the earliest opportunity – this may mean bypassing Bronglais to ensure patients are taken straight to a specialist centre. For the most rural parts of Powys the proposed Emergency Retrieval Service will be one of the means by which we will be able to provide residents with the confidence that can access services in a timely manner in a critical emergency. We will therefore wish to work with you and other Health Boards to support the delivery of this model across Wales.
Hospital Hubs Your proposals for Community Hospital Hubs provide for such a facility in the Dolgellau and Barmouth that would serve the population of south Gwynedd and mean some changes to the services provided from Tywyn Community Hospital. You will be aware of the questions raised by your residents in the Powys meetings in this respect, and this reinforces the need for us to work together to maximise the resources we share across this area.
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Neonatal Intensive Care It is a concern to Powys residents that obstetric care around all its borders is changing. Powys has clearly demonstrated that many women can safely deliver at home and in local birthing units. Some women choose an obstetric birth in Wrexham and we would wish to see this continue. Powys needs appropriate access to obstetric and more specialist care and for this specialist care would support your Board in ensuring the best possible care for the most sick babies, even if this outside of your borders. We would want BCUHB to routinely explore the options for Powys residents in terms of accessing NICU to ensure that parents are offered the most accessible option for them.
Vascular Services North Powys is within the BCUHB catchment of the planned Aortic Aneurysm screening service and will mean that more men with this condition will over time be treated in North Wales. As a consequence Powys supports your proposals to ensure the best outcome for patients through providing this service through a single centre. We would wish to have further dialogue with you and our community as you consider which site is the most appropriate for this service.
Mental Health Services The consultation document makes reference to mental health only in respect of older people. As you will be aware Powys is particularly concerned to improve the delivery of mental health services to the population of north Powys from BCUHB and we are currently engaged in a planning process to consider our options. The Health Board welcomes the focus on mental health services and we will want to see a renewed and urgent emphasis on working with us to improve mental health services. Your community approach to older people looks promising and one that we would wish to explore for Powys residents. What is clear is that improvement is urgently needed, and we would anticipate that you engage with us in developing our plans and respond to them with some urgency.
I have already highlighted that Powys tHB is seeking to lead the development of a planning and delivery forum that covers the North Powys, North Ceredigion and South Gwynedd area. Our response to ‘Healthcare in North Wales is Changing’ clearly sets out an agenda for that forum and I would wish to involve local representatives of the community in that process to ensure that we are able to demonstrate progress and support the delivery of change in an open and transparent way. The formal consultation process is only the start and there is a need for continuous engagement across our communities to maintain and build confidence in local services and provide assurance to the public that they will be able to access services in a timely manner when they need them.
I look forward to continued working with BCUHB as our shared plans develop.
Yours sincerely
Andrew Cottom Chief Executive
BCUHB Consultation Page 6 of 6 Board Meeting 24 October 2012 Agenda Item 2.3
FOR APPROVAL
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 2.4
INFORMATION AND CONSULTATION STRATEGY FOR CARERS 2012 - 2015
Report of Director of Therapies and Health Science
Paper prepared by Head of Quality & Safety
Purpose of Paper To provide the Board with the Information and Consultation Strategy for Carers 2012 -2015
Action/Decision required The Board is asked to APPROVE the Information and Consultation Strategy for Carers 2012 -2015 for submission to the Minister for Health & Social Care.
Link to ‘Doing Well, This paper supports: Doing Better: Standards for Health Services in Standard 1: Governance and accountability framework Wales’: Standard 2: Equality, diversity and human rights Standard 3: Health promotion, protection and improvement Standard 5: Citizen Engagement and feedback Standard 8: Care planning and provision Standard 9: Patient information and consent Standard 10: Dignity and respect Standard 11: Safeguarding children and vulnerable adults Standard 18: Communicating effectively
Link to Health Board’s Striving for Excellence Corporate Plan
Acronyms and ADSS Associate Directors of Social Services abbreviations NHS National Health Service PAVO Powys Association of Voluntary Organisations tHB Teaching Local Health Board WGLA Welsh Local Government Association
Information and Consultation Strategy Page 1 of 6 Board Meeting for Carers 2012-2015 24 October 2012 Agenda Item 2.4
FOR APPROVAL
INFORMATION AND CONSULTATION STRATEGY FOR CARERS 2012 - 2015
Purpose
The purpose of this paper is to request the Board to APPROVE the Information and Consultation Strategy for Carers 2012 -2015 for submission to the Minister for Health & Social Care.
Background
The Carers Strategies (Wales) Measure 2010 (the ‘Measure’) placed a requirement on the National Health Service (NHS) and Local Authorities in Wales (the ‘Organisations’) to work in partnership to prepare, publish and implement an ‘Information and Consultation Strategy for Carers’ (the ‘strategy’). The Carers Strategies (Wales) Regulations 2011 (the ‘Regulations’), made under the Measure, reinforced the need for organisations to work together.
“Carers” are defined as ‘unpaid carers in Wales who consider or are considered to provide, or intend to provide a substantial amount of care on a regular basis’ (Welsh Government 2012).
In preparing the strategy, Powys Teaching Health Board and Powys County Council has been required to consult with appropriate voluntary organisations within the Powys area. The first version of the strategy is to be submitted to Welsh Ministers by 31 October 2012, after which Ministers will respond to organisations to inform them of their approval or rejection within 8 weeks. The strategy must cover a 3-year period, but will be subject to review after an 18-month period.
Annual reports on the implementation, evaluation and progress of the strategy must be prepared and submitted to Welsh Ministers.
Development of the Information and Consultation Strategy for Carers
The Information and Consultation Strategy for Carers 2012-2015 (Appendix 1) has been developed in conjunction with Powys County Council, a range of voluntary organisations and Carers Powys-wide, based on the template provided by Welsh Government. The attached strategy is the final version for approval by the Board.
Consultation
Powys tHB, Powys County Council and voluntary organisations have worked together to involve carers throughout the development of the strategy. Four events have been held between Mid April and early September. These have proven to be a rich source of information, the analysis of which has been used to underpin the development of the strategy.
An Adult Carer questionnaire undertaken by Powys Carers Service on behalf of Powys tHB and Powys County Council has recently been completed. The results of
Information and Consultation Strategy Page 2 of 6 Board Meeting for Carers 2012-2015 24 October 2012 Agenda Item 2.4
FOR APPROVAL the survey will inform the provision of information and services over the next three years.
A gap analysis has been undertaken looking at information and services already provided and what needs to be considered for provision in the future. PAVO has been pivotal in helping to complete the analysis.
A short consultation was held for a 4-week period from Monday 30 July – Friday 24 August, this was accessible via Powys tHB internet and intranet. Carers were given the opportunity to participate in the Adult Carers Survey, the gap analysis work, an opportunity to view the draft strategy in development and to share with Powys tHB and Powys County Council their experience of caring. Only one request was received for a copy of the draft strategy.
A survey for Young Carers has been developed and this will be issued in October through our educational colleagues.
Developments
Within Powys tHB work has already taken place to include a question in the nursing care plan documentation to ask Carers if they have received a Carer’s needs assessment. Identified Carers will be notified to the relevant agency for an assessment to be completed, either via Powys County Council or Powys Carers Services. Initial discussions have already taken place with the relevant organisations to ensure they are aware of the potential in increased demand for Carers assessments.
Training
Powys tHB and Powys County Council have been working with a range of Health Boards and local authorities to develop a Carer Awareness e-learning programme for staff. The proposed date for implementation is November 2012. Powys tHB, Powys County Council and voluntary organisations are part of a mid-Wales consortium to procure the e-learning for a one-year period in the first instance. The training will be available to all staff and Carers.
Welsh Translation
Once the strategy has been approved by the Minister for Health & Social Care, it will require translation into Welsh. Arrangements have been made with Powys County Council for this to take place.
Funding Allocation
The legislation underpinning the Carers Strategy (Wales Measure) 2010 requires the Health Board to work in partnership with the local authority and other relevant bodies. On this basis a joint budget of £16,184 was allocated to Powys tHB and Powys County Council for the purposes of delivering training and raising awareness
Information and Consultation Strategy Page 3 of 6 Board Meeting for Carers 2012-2015 24 October 2012 Agenda Item 2.4
FOR APPROVAL amongst relevant staff. A breakdown of the budget to date can be found at Appendix 2. A second allocation will be made following Ministerial sign-off of the strategy.
Approving the Information and Consultation Strategy for Carers
Powys tHB Board are required to approve and sign-off the strategy for submission to the Minister for Health & Social Services by 31 October. Approval will also be sought through the relevant Powys County Council Cabinet meeting.
Implementation of the Information and Consultation Strategy for Carers
An implementation plan has been developed alongside the completed strategy to enable Powys tHB, Powys County Council and voluntary organisations to meet the set targets identified within the strategy. This will be monitored through the existing Powys Multi-Agency Carers Forum alongside Powys tHB internal monitoring through the Board of Directors.
Monitoring of the Information and Consultation Strategy for Carers
The development of an outcomes framework has been taken forward with health boards and local authorities across Wales, facilitated by the Carers Officers of the learning network and with support from the NHS Confederation, WGLA, SSIA and ADSS Cymru. The first All Wales iteration is now complete and provides four headline performance measures, covering areas such as training and assessment. Further work is planned on its development throughout 2012-2013.
All Wales Work
Following on from the successful multiagency partnership developed through the National Awareness Raising Programme (NARP), an executive carers group is being set up to oversee the coordination of the Carers Measure and other key strategic work streams. The group will offer guidance, direction and leadership on key issues relating to carers, such as the further development of the outcomes framework. A representative of the Health Board will be part of this group.
The Carers Learning Network will sit beneath the new executive group. A relevant representative from the Health Board will be included in the membership of the learning network. An initial timeline for work has been developed.
Recommendations
The Board is asked to APPROVE the Information and Consultation Strategy for Carers 2012 -2015 for submission to the Minister for Health & Social Care.
Report prepared by: Presented By: Wendy Morgan Amanda Smith Head of Quality & Safety Director of Therapies and Health Science
Information and Consultation Strategy Page 4 of 6 Board Meeting for Carers 2012-2015 24 October 2012 Agenda Item 2.4
FOR APPROVAL
Background Papers Welsh Government (2010) The Carers Strategies (Wales) Measure 2010
Welsh Government (21) National Health Service, Wales: Social Care, Wales: The Carers Strategies (Wales) Regulations 2011
Financial Consequences See attached Appendix 2
Other Resource Implications None at present
Consultees Adult and Young Carers throughout Powys Powys Teaching Health Board Powys County Council Powys Association of Voluntary Organisations Members of the Public
Information and Consultation Strategy Page 5 of 6 Board Meeting for Carers 2012-2015 24 October 2012 Agenda Item 2.4
FOR APPROVAL
Appendix 2
FUNDING ALLOCATIONS FOR 2012-13
Spend Balance £ £ ALLOCATION 16,184.00
Luke Clements Study 500.00 15,684.00 Day Carers Awareness Week 70.00 15,614.00 Adult Carers Survey 1,340.33 14,274.00 E-learning programme 5,000.00 9,274.00 (approx) Optometrist – awareness 1,000.00 8,274.00 training (proposed spend) Carers needs 1,000.00 7,274.00 assessment training for Powys tHB staff (proposed spend) Young Carers Survey 1,350.00 5,924.00 (proposed spend) Current Balance £5,924.00
Information and Consultation Strategy Page 6 of 6 Board Meeting for Carers 2012-2015 24 October 2012 Agenda Item 2.4
Carers Strategies (Wales) Measure 2010
Information and Consultation Strategy for Carers 2012 – 2015
Information and Consultation Strategy for Carers Page 1
September 2012
Information and Consultation Strategy for Carers Page 2
September 2012
Title Page(s)
2 Foreword 5
3 Executive Summary 6
SECTION 1: THE LOCAL CARERS POPULATION 7
4 Powys Area 7-8
5 Why Carers in Powys need support 8-9
6 Statistics 10-18
SECTION 2: CURRENT ORGANISATIONAL 19 ARRANGEMENTS
7 Joint Working Arrangements 19-21
SECTION 3: INFORMATION AND CONSULTATION 21 STRATEGY
8 Joint Working and Strategy Development: 21-23 Information – Identifying and Signposting
9 Setting the Strategy in Context with Other Policies 23-28
10 Objectives of the Information and Consultation 28-32 Strategy for Carers
11 General Principles of the Information and 33-35 Consultation Strategy for Carers – Treating Carers as Partners in Care and Accessibility
12 Content of the Information and Consultation 36-37 Strategy for Carers – Information
13 Content of the Information and Consultation 37-38 Strategy for Carers – Communication
Information and Consultation Strategy for Carers Page 3
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Title Page(s)
14 Content of the Information and Consultation 38-42 Strategy for Carers – Consultation
15 Content of the Information and Consultation 43 Strategy for Carers – Priorities
16 Content of the Information and Consultation 44-45 Strategy for Carers – Carer Involvement
17 Delivery of the Information and Consultation 45-46 Strategy for Carers – Implementation and Dissemination
18 Delivery of the Information and Consultation 46-47 Strategy for Carers – Staff Responsibilities
19 Delivery of the Information and Consultation 47-48 Strategy for Carers – Staff Responsibilities
20 Delivery of the Information and Consultation 48-49 Strategy for Carers – Staff Training
21 Delivery of the Information and Consultation 49-50 Strategy for Carers – Carer Training
22 Reviewing the Information and Consultation 50-52 Strategy for Carers – Involving Carers and Others
23 Information and Consultation Strategy for Young 52-57 Carers
Sign Off 58
24 References 59-61
25 Appendix 1 62-64
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2 Foreword 2.1 The purpose of this strategy is to ensure that Carers receive appropriate information, systematically throughout the journey of being a Carer. The processes identified must become embedded within Powys Teaching Health Board, local authority and the voluntary sector organisations to enable Carers to become recognised and acknowledged as key partners.
2.2 In order to deliver this agenda, as the Welsh Government (2011) rightly point out in respect of Social Services, we have to recognise that the people who use our services are the ones driving it forward and to this end, Carers have to be involved in order to get it right. These principles apply to the preparation and publication of this strategy.
2.4 There is no such thing as a typical Carer and hence our challenge is to develop a strategy that identifies and responds to Carers’ specific individual needs and one that remains relevant and reacts to change.
2.5 In partnership with our Carers, Powys Teaching Health Board, local authority and the voluntary sector organisations, commend this strategy to Welsh Government. This demonstrates our commitment to supporting Carers and providing them with information and advice.
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3 Executive Summary 3.1 The vision of a statutory obligation for Health Boards and local authorities to work in partnership with third sector organisations across Wales and to meet Carers’ needs as recommended by the “Law Commission’s review of social care law” became a reality when the Welsh Government published its final guidance (December 2011) on the development, publication and implementation of the “Carer Strategies (Wales) Measure 2010” (the Measure).
3.2 The Carers Strategies (Wales) Regulations (2011) made under the Measure places a statutory duty on “designated authorities”, that is, Local Health Boards and local authorities, to prepare, publish and implement a strategy for the benefit of unpaid Carers demonstrating how they do or will do in the future meet the requirements of the Measure.
3.3 Involving Carers in the development of the strategy, the strategic aim of Powys Teaching Health Board and local authority alongside its partner organisations is to ensure that Carers in Powys are properly engaged and acknowledged as partners in the delivery of care. In realising the vision, each caring organisation will work in partnership with Powys Teaching Health Board and local authority to meet the needs of Carers.
3.5 The strategy will also sit alongside and complement the requirements within all relevant statutory plans and particularly those that deal with the requirements around care and treatment planning under Part 2 of the Mental Health (Wales) Measure 2010.
3.6 This strategy will:
Set out how information and guidance will be provided to Carers that will assist them in carrying out their caring role effectively; and
Set out how Carers will be consulted and involved in decisions affecting them and those they care for.
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Section 1: The Local Carers Population
4 Powys Area 4.1 Powys covers the historic counties of Montgomeryshire, Radnorshire, most of Brecknockshire and a small part of Denbighshire – an area of 5,179km, making it the largest county in Wales by land area. It is bounded to the north by Gwynedd, Denbighshire and Wrexham, to the west by Ceredigion and Carmarthenshire, to the east by Shropshire and Herefordshire and to the south by Rhondda Cynon Taf, Merthyr Tydfil, Caerphilly, Blaenau Gwent, Monmouthshire and Neath Port Talbot.
4.2 Most of Powys is mountainous, with north-south transportation by car being difficult. The majority of the Powys population is made up of villages and small towns.
4.3 The 2011 Census First Release (Powys County Council, 2011) reported the population of Powys as an estimated 133,000 people. The Welsh Government (June, 2010) reported an estimated population of approximately 131,313 people with 99.3% white ethnicity and 30.1% known Welsh speakers. Overall, Powys makes up over 25% of the area of Wales but has only 4.3% of its population (Powys County Council, 2011).
4.4 Powys Carers Service (2011) reported there are an estimated 350,000 adult Carers in Wales and this figure does not include a breakdown of the total number of Young Carers. It is recorded (Census, 2001) that Powys has in excess of 14,000 Carers, out of a population of 126,000. Of the 1,673 registered Carers in Powys (Powys Carers, July 2012), a total of 350 are reported Young Carers under 18 years of age.
4.5 The strategy for older people in Wales (2003) vision is that a higher profile is given to older people’s issues throughout Wales in all aspects of life. The population in Powys in the age groups 60–69 is 20,000, 70-79 is 12,800 and 80-89 is 6,900, a total of 39,700 equating to 29.85% of the total population (Powys County Council, 2011). It is predicted that over the next 20 years the number of people of current retirement age in Wales will increase. If we reflect upon research quoted a high percentage of those retired people will become Carers.
4.6 Future strategies, policies and programmes must reflect the needs of an ageing society in Powys. Powys Carers Strategy (2010) reiterates the objective “to improve the health and wellbeing of Carers and those they care for” as previously articulated by the Government in their national strategy for Carers (1999) and their ‘Carers Strategy Implementation Plan’ (2000). Information and Consultation Strategy for Carers Page 7
September 2012
4.7 Powys Teaching Health Board, local authority and third sector organisations endorse the view that ‘as partners in care, it is recognised that Carers should be supported in their caring role, be given assistance to maintain their own health and wellbeing and should be involved in contributing towards further improvement and raising standards of service’. Hence the need to develop, publish and implement a Carers Information and Consultation Strategy.
5 Why Carers in Powys need support 5.1 It was reported (The Princess Royal Trust for Carers and Cross Roads Care, 2011) at the “future of Carers services” symposium that there are five common occasions in a Carers pathway as a Carer when their needs for targeted support from services should be identified by statutory and voluntary bodies, for example information provision, respite and/or skill needs.
5.2 An Ipsos MORI report reveals for the first time ever the number and profile of the 1.1 million people currently caring for someone with cancer in the UK. It was found that only 5% have received a local authority Carer’s assessment which enables them to access practical, emotional and financial support in their caring role.
5.3 Carers Wales (2011) state that local authorities should be mindful that they are obliged to provide carers needs assessments under the Carers rights to under the auspice of the Carers and Disabled Children Act 2000 and The Carers (Equal Opportunities) Act 2004. Currently Powys Carers Service is using nominated and trained staff to work in partnership with Powys local authority to perform “Carer’s assessments”.
5.4 New research by the Macmillan Cancer Support Service (2012) describes how over a million people who look after a loved one with cancer are potentially missing out on vital support and benefits. They inform us that 49% of Carers surveyed received no support whatsoever either formally or informally to help them look after their family member or friend with cancer. This lack of support may explain why 46% of reported Carers suffer with mental health problems, such as stress, anxiety and depression.
5.5 Powys Citizens Advice Bureau (PCAB, 2011) indicated in their annual report that there is strong evidence to link low income and debt to clinical symptoms.
5.6 Carer friendly employment policies are essential to maintain a work-life balance to enable Carers to remain in work or return to work whilst caring for the person they support. Without proper support some Carers have no choice
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but to resign from their employment so that they can continue to care for the person they support.
5.7 Respite care, planned and emergency, needs to be available so that Carers can gain maximum benefit from the breaks that this affords them, particularly at times of crisis and that those they care for are supported should the Carer need to go into hospital.
5.8 Carers need information and to be involved in decision making about treatment for the person they care for. Carers need to be aware of the expected outcome of treatments and medication, and in the latter to know the side effects and adverse reactions. Information must be provided in a format that is developed and provided specifically aimed at patients, Carers and their families. An example is hospital discharge advice (Welsh Assembly Government, 2005) which is patient-centred and involves the Carer and whereby the provision of a documented discharge date (agreed with the Carer) enables them to plan the discharge for the person they care for.
5.9 It must be acknowledged that the Multi-agency Reference Group for Carers ‘Carers Strategy in Powys’ (2010) is already promoting greater recognition and support for Carers in Powys. This Information and Consultation strategy now provides an opportunity to further progress this work. Working with Carers, Powys Teaching Health Board, local authority and third sector organisations have identified:
the information that Carers need;
how it will be provided; and
by which lead agency.
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6 Statistics 6.1 Powys Carers (2012) reports a total number of 1,673 Carers registered as at July 2012.
All Carers Registered 1,673 July 2012 (1,564 March 2012)
MSOA YC/YAC < 11 11-15 16-18 19-25 26-49 50-54 55-64 65+ AC Total 1 6 10 4 3 14 7 20 27 7 98 2 2 2 2 3 1 13 6 7 12 6 54 3 3 4 2 7 17 3 5 15 3 59 4 0 4 3 1 10 9 11 21 6 65 5 1 5 1 1 13 4 6 13 10 54 6 2 11 2 3 20 6 9 19 7 79 7 5 3 3 0 15 3 6 5 6 46 8 7 5 7 4 19 10 10 7 6 75 9 8 18 2 10 26 7 11 7 5 94 10 3 0 3 2 2 18 6 10 11 4 59 11 2 15 10 10 27 9 20 46 17 156 12 3 6 3 3 18 5 20 38 13 109 13 15 21 7 11 28 10 6 20 12 130 14 0 10 3 3 15 3 14 21 8 77 15 5 7 6 5 17 9 11 28 19 107 16 1 4 4 4 6 5 12 22 18 76 17 4 15 5 12 22 6 14 21 23 122 18 5 2 3 2 14 4 8 23 16 77 19 5 9 4 4 30 5 24 39 16 136 5 74 154 74 86 342 117 224 395 202 1673
Figure 1: Carers Registered by Powys Carers
Middle Super Output Area’s (MSOA’s) (most deprived areas highlighted in grey)
01 Llanfyllin, Llansantffraid, Llanrhaeadr-ym-Mochnant, Llansillin, Meifod and Llanfihangel 02 Guilsfield, Llandrinio and Llandysilio 03 Welshpool 04 Machynlleth, Glantwymyn, Banwy and Llanbrynmair 05 Montgomery, Berriew, Forden and Trewern 06 Llanfair Caereinion, Caersws and Rhiwcynon 07 Churchstoke, Kerry and Dolforwyn 08 Newtown East, North and Llanllwchaiarn West 09 Newtown Central and South 10 Llanidloes, Llandinam and Blaen Hafren 11 Knighton, Presteigne, Beguildy, Llangunllo and Old Radnor 12 Rhayader, Nantmel, Llanbadarnfawr, Llanyre, Disserth and Trecoed Information and Consultation Strategy for Carers Page 10
September 2012
13 Llandrindod 14 Builth, Llanwrtyd, Llanafanfawr and Llanelwedd 15 Hay, Talgarth, Glasbury, Gwernyfed and Bronllys 16 Talybont-on-Usk, Felin-Fach, Yscir, Maescar and Llywel 17 Brecon 18 Crickhowell, Llangynidr, Talgarth, Llangors and Bwlch 19 Ystradgynlais, Ynescedwyn, Cwm-twrch, Aber-craf and Tawe-uchaf
6.2 Reason for Caring and age of Carers referred Jan-March 2012
Total One third of new referrals are Physical Under 18 15 of Carers over 65 and caring 18-34 10 for somebody with a physical 35-65 15 disability or illness and nearly 65+ 33 20% are over 65 and care for Mental Health Under 18 5 somebody with Dementia. 18-34 5 35-65 14 65+ 3 There are a larger number of Dementia Under 18 0 referrals of carers aged under 18-34 0 18 caring for somebody with a 35-65 0 physical disability or illness but 65+ 19 these do not appear to all come from the Children with Learning Disability Under 18 7 Disabilities team making it less 18-34 0 likely that these young carers 35-65 5 are only caring for siblings. 65+ 0
EOL/Palliative Under 18 0 18-34 0 35-65 0 65+ 2 Please note that the number of ASD Under 18 7 reasons given for caring is 18-34 2 greater than the total, of 35-65 1 referrals. This is because 65+ 0 carers care for people with
Substance Misuse Under 18 0 multiple care needs. 18-34 0 35-65 2 Thus somebody with dementia 65+ 1 may also have physical needs.
Figure 2: Reason for Caring and age of Carer (Powys Carers, 2012)
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6.3 The rate of increase in referrals to Powys Carers (Powys Carers Service, 2011) appeared to be levelling off in the first quarter of 2011but remain at a new and higher rate than previous years data. Referrals in July 2012 increased by 60% compared to the previous quarter. Self referrals (31%) were the most common source with health referring approximately 6% and social services 29%.
Referrals 08/09 09/10 10/11 11/12 12/13
Adult Carers (AC) April- 49 67 70 68 121 June
July – 55 74 40 89 Sept
Oct-Dec 39 49 67 61
Jan- 37 44 69 78 March
Young Adult Carers April- 2 4 6 (YAC’s) (16-24) June
July – 3 3 Sept Included in YC and AC Oct-Dec 3 3
Jan- 11 3 March
Young Carers (YC) April- 25 11 17 19 21 June
July – 19 16 19 16 Sept
Oct-Dec 5 15 17 8
Jan- 20 18 26 27 March
TOTAL 249 294 344 379
Annual increase in referrals 18% 17% 10%
Cumulative increase 18% 38% 52%
Figure 3: Referrals to Powys Carers (Powys Carers, 2012)
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6.4 Carers of people with Substance Misuse problems registered with Powys Carers Service.
Under 16 YAC 26-49 50+ TOTAL
1 2 1 3 2 0 3 1 1 4 0 5 0
6 0 Powys Carers (2012) report 7 0 nearly half of the carers registered with them as caring 8 1 1 for somebody with a 9 3 1 4 substance misuse problem are 10 1 1 under 16. 65% (9) of these live in one of the three most 11 1 1 deprived areas of Powys. 12 1 1 13 2 1 1 4 14 0 15 1 1 2 16 0 17 2 1 3 18 1 1 19 4 2 2 3 11 Total 14 6 5 8 33
Figure 4: Carers of people with Substance Misuse problems (Powys Carers, 2012)
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6.5 Carers of people with Learning Disabilities registered with Powys Carers Service
Under 11 11-15 16-18 19-25 26-49 50-64 65+ AC age TOTAL unknown
Carers of > 14's 3 7 2 8 42 49 23 6 140
Carers of < 14's 4 13 4 3 26 4 0 3 57
Figure 5: Carers of people with Learning Disabilities (Powys Carers, 2012)
6.6 Carers in Paid Employment
6.6.1 Many Carers face barriers to remaining in employment, the main barrier being the difficulty Carer’s face in obtaining support and services for the person they care for (National Institute for Health Research [NIHR] School for Social Care Research, 2011). The NIHR (2012) reported approximately 315,000 Carers aged 16 to 64 in England left employment to provide unpaid care and were currently out of employment, of which 120,000 are men and 195,000 are women. Of Carers in employment, NIHR suggest approximately 66% of Carers of working age are in part time of full time employment.
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Figure 6: Age of Carer and employment status (Powys Carers, 2012)
6.6.2 The figures (Powys Carers, 2012) provided for Carers in employment in Powys must be treated with caution because employment status changes. Carers do not always report their changed employment status and for 28% of Carers their economic status is not recorded.
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Figure 7: Employment and/ or Education Status (Powys Carers, 2012)
6.7 Carers Health
6.7.1 A survey1 (Powys Carers, 2011) comparing the health of Carers in Powys to the Welsh Health Survey of all citizens (2009) identified that the health of Carers suffered as a result of their caring responsibilities.
Figure 8: Comparing health of Carers against all citizens (Powys Carer, 2012)
1 10% of carers responded in Powys
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6.8 Statistics currently available demonstrates ethnic background of Carers in Powys (Crossroads August 2012) as:
British including English, Welsh, Scottish and Northern Irish = 264
White & black African (mixed) = 2
Any other white = 2
Not asked = 1
Not disclosed = 10
Not Set = 82
6.9 Data on the number of Carers who are not co-resident but look after someone from a distance, for example, living near or living in a Welsh county or other country has been difficult to source. Crossroads (August 2012) were able to compare 350 records by postcode for client and their Carer on behalf of Powys Teaching Health Board. The results indicate:
In County but not close = 5
Near Neighbour = 13
Out of County = 2
Same Postcode = 330
This confirms the majority of Carers are co-located. It is recognised that better information on both ethnicity and location of Carers needs to be captured.
6.11 Information on Carers of people with dementia has proven difficult to collect as demonstrated by figures quoted by Alzheimer's Society (August 2012). In Powys they currently only hold information on those supported, which is considered a small number of those the Alzheimer’s Society estimate are Carers of people with dementia.
6.12 The figures quoted by Alzheimer's Society (August 2012) are based on the fact that there are an estimated 2,319 people living with dementia in Powys based on demographics and prevalence of dementia within the age groups as indicated below. The diagnosis rate in Powys Teaching Health Board area is 35.4% and so, only 820 will have a diagnosis. This equates to, at best, only 820 Carers knowing they are Carers and officially recognised as such and in receipt of appropriate support both in terms of information but also in terms of finance, benefits, etc. This is one of the
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major implications of diagnosis as it impacts on funding, Continuing Health Care and even entitlement to a blue badge for the car.
From the prevalence of .009% of 30-34 yr olds there would be 1 in Powys
.0077 of 35-39 1 in Powys
.014 of 40-44 1 in Powys
.030 of 45-49 3 in Powys
.058 of 50-54 5 in Powys
.13 of 55-59 13 in Powys
.155 of 60-64 17 in Powys
The majority 2,278 people are 65 and over
Source: Alzheimer’s Society August 2012
.
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Section 2: Current Organisational Arrangements
7 Joint Working Arrangements 7.1 The Multi-agency Reference Group (MARG) is a collaborative group which has existed for approximately 6 years, continuing to meet quarterly. The MARG for Carers has a consulting and developmental role. The group receives and shares information with their respective organisations and networks.
Membership of the MARG comprises: Carer representatives Powys County Council (PCC) (Adults, Children Services, Accountancy, Commissioning) Powys Teaching Health Board (tHB) Community Health Council (CHC) Provider Network/Voluntary Sector (Health and Social Care Network) Speakers and one off invitations as and when required The group receives and will report on such things as new legislation, regulations, policies, guidance and reports. Members of the MARG will share information as appropriate with their respective organisations and networks.
7.2 A commissioning group exists and its purpose includes:
monitoring value for money of services provided to Carers;
the performance of voluntary organisations providing services to Carers;
produce and continually review the Carers Strategy;
take responsibility for commissioning appropriate services for Carers;
ensure active engagement of key stakeholders in the development and delivery of services to Carers.
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The constitution of the committee comprises officers from Powys County Council and Powys Teaching Health Board.
7.3 In fulfilling the aim of this strategy, Powys Teaching Health Board, local authority and third sector organisations will work together to identify all Carers in Powys at an early stage, to enable them to provide information at the earliest opportunity, intervene effectively and provide services that best meet their needs. This will need to take account of the significant number of Carers becoming a Carer for the first time each year and the number ceasing to be Carers. Powys Carers Service identifies approximately 400 new Carers each year. This will allow Carers to be actively engaged in care management processes and at key stages of the patient/ Carer healthcare journey. Education departments for Young Carers and housing departments in respect of all Carers will work alongside all parties to ensure that Carers’ needs are met.
7.4 It is known (Davidson, 2011) that populations live longer where there has been joint working in health and social care services and this is essential reflecting the demographic changes in Powys and the increase in an ageing population - more people are likely to seek access to health and social care support over the next 10-20 years,
7.5 Future Health, Social Care and Wellbeing Strategies may need to focus more on improving health and wellbeing and reducing inequalities to reduce the inequalities that Carers may experience in terms of ageism, lack of employment opportunities and the inability to drive in an area like Powys that has limited transport schemes. These can all have a detrimental effect on the health and wellbeing of Carers, but the emphasis on working together as organisations can improve the provision, quality, integration and sustainability of services for Carers and avoid duplication of effort by all parties concerned.
7.6 Building Bridges (2002) recognises the role that third sector organisations have in supporting Carers and the added value (Welsh Government, 2008) Information and Consultation Strategy for Carers Page 20
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they bring to health and social care. An evaluation of the Social Return on Investment in Carers support (Baker Tilley April 2011 – Carers Trust) showed that for every £1 of investment, the value of the social return is in excess of £10 (Powys Carers Service, Project Management Board Report April-June 2011).
7.7 Carers must be actively engaged in the planning, development and delivery of services and in making change happen. Involving Carers in raising standards is critical to sustainability of services and will drive change and innovation (Welsh Assembly Government 2007) and lead to a reduction in the difficulties people report in getting support.
Section 3: Information and Consultation Strategy
8 Joint Working and Strategy Development: Information – Identifying and Signposting
8.1 Powys Teaching Health Board, local authority and voluntary organisations have identified through workshops, consultation events and surveys information Carers need (Appendix 1). A gap analysis has been undertaken listing current information and services available and what needs to be put in place and this will be used to inform the provision of information and services going forward. It is important that information is appropriate and timely and tailored to the needs of the individual. Carers need to know where to source information, advice and support and this information is of most important.
8.2 Carers along with a wide range of professionals and representatives from local authority and voluntary organisations have suggested information on local Carer support agencies and appropriate national organisations supporting patients, users and Carers should be available via a variety of sources, such as:
Powys Carers Service website www.powyscarers.org.uk ;
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Accessed through Social Workers, Libraries, Dentists, Pharmacies (Emergency card and icare card scheme) ;
From hospitals, particularly at the time of discharge;
From professionals, e.g. District Nurses;
Following on from identification of Carers through multidisciplinary team meetings; and
Powys County Council public website – www.powys.gov.uk and other websites.
8.3 The information will be provided in a variety of ways:
Leaflets and posters;
Verbal (and documented);
Meeting other sensory needs on request, e.g. Braille; and
During 1:1 meetings, telephone, email with a Carers Support Worker.
8.4 Focusing on the needs of Carers, information will be provided by Powys Carers Service as the lead agency and via the Health Board, local authority or voluntary organisations dependent on the time, place and the nature of the need identified. Working collaboratively to meet the information needs of Carers will require communication to be an essential requisite of this activity between all participants.
Year 1 NHS staff in their day to day duties will signpost Carers that they come across to a local Carer support agency. For specific conditions where it is deemed appropriate and with consent from the Carer, staff will signpost Carers to relevant national organisations, e.g. Alzheimer’s Society Wales.
Carers will be proactively identified by multidisciplinary team’s (MTD’s) and referred to a Carer Support Service.
General Practitioner’s (GPs) will continue to proactively identify Carers who visit GP Practices (on behalf of themselves or those they care for) and refer them to Carers Support Services.
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Other contractor professions, for example, Optometrists, will be provided with appropriate information and requested to signpost Carers that they come across to a local Carer support agency.
Carers attending Memory Assessment Clinics will be offered information packs supplied by the Alzheimers Society.
Year 2 Review information leaflets for Carers to ensure they remain ‘fit for purpose’ and up-to-date.
Organisations jointly fund regular Carer forums to consult on current issues affecting Carers.
Identify gaps in service provision for Carers and put steps in place to address them.
Provide a combined Carers and Protection of Vulnerable Adults training for Powys Optometrists – April 2013.
Year 3 Promote the ongoing evaluation of services and information to Carers.
9 Setting the Strategy in Context with Other Policies
9.1 The key policies that influence and sit alongside this strategy are many and varied. The Labour Government (2011) in addition to referencing Carers throughout their manifesto document pledged actions to support Carers going forward, namely:
Free bus travel for pensioners and disabled people and their Carers, an action advocated in 2003 (Welsh Assembly Government) when it was espoused that a large number of Carers were over the age of 60 and the free bus pass for women and men over 60 would reduce costs for all Carers who use public buses. This same strategy identified 5 major priorities focusing on Carers, namely health and social care, information, support, Young Carers and Carers and employment, all of which are still relevant today. Information and Consultation Strategy for Carers Page 23
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Provide every patient in mental health/ dementia services with an individual care plan, informed and approved by them and their Carers. This serves to compliment the Older People National Service Framework (2006) which advocated for Carers views to be incorporated into the Unified Assessment process ensuring that older people and their Carers felt that they had choice and control over their lives and how their needs were managed.
To fulfil their commitment to supporting Carers through the full implementation of the Carer’s Measure.
Ensuring the provision of accessible, relevant and up-to-date information and support to help individuals and families in their caring role, alongside a refresh of the Carers Strategy for Wales to ensure it remains fit for purpose.
Develop and introduce simplified and portable’ assessment processes for all users of social care and social work services to ensure that care planning is of the highest standard.
Ensure that veterans and their Carers will be given information on other services and support that they are entitled to, in an effort to improve their health and quality of life.
9.2 The Strategy compliments and sits alongside the Health, Social Care and Wellbeing Strategy for Powys.
9.3 Building upon the Multi-agency Reference Group for Carers ‘Carers Strategy in Powys’ (2010) this information and consultation strategy compliments the actions already being taken forward, such as:
. Information and choice;
. Carer’s assessments;
. Range and quality of services; Information and Consultation Strategy for Carers Page 24
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. Having a voice/ Carer participation;
. Flexible employment / work opportunities;
. Service monitoring/ resource allocation; and
. Young Carers.
9.4 In supporting Carers in their roles, key strategies, policies and guidance such as the Strategy for Older People in Wales (2003), the Carers Implementation Plan (2000) and the Carers Strategy for Wales: Action Plan 2007, underpin and promote improvement to the quality, quantity and responsiveness of services available. All reinforcing the need to ensure that Carers have access to information, relevant flexible services and support at a local level, particularly where they live in a rural community such as Powys where they often face difficulties. In resetting the direction for Carers, the Carers Strategy for Wales (2007) set out to ensure that Carers were not disadvantaged, were listened to and treated with respect and that they received recognition for the important role they play in supporting people to sustain independence alongside leading a normal life as much as possible outside of their caring role.
9.5 The need for information and advice for Carers has been echoed throughout other policies, more recently Part 1 of the Mental Health Measure (2010) which requires information and advice to be provided to Carers about treatment and care, including the options available to them and signposting Carers to other means of support, such as the third sector. The importance of the third sector in supporting Carers is further advocated in Together for Health (Welsh Government, 2011) which recognises that they can help people to live more independently and speak up for those in need.
9.6 It is estimated (National Dementia Vision for Wales, 2011) that family Carers of people with dementia save the UK over £6 billion a year. The number of people across Wales affected by dementia is expected to increase by 31% by 2021 and in rural areas such as Powys the increase will reach 44%. To support this increase this policy demands a good quality of life for Carers that reflects the Information and Consultation Strategy for Carers Page 25
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approaches within the Measure, again community support, information and training packages for Carers.
9.7 Powys Teaching Health Board will continue to work with its partner organisations in implementing improved information and support to Carers as outlined in the Intelligent Targets for Dementia (Annual Quality Framework, 2011).
9.8 It is important to involve Carers in service monitoring and evaluation to obtain feedback that can be integrated into future planning and performance management of services in order to support Carers effectively.
9.9 Where NHS staff identifies a Young Carer to be at risk or a ‘child in need’, they can make a referral under the Framework for Assessment of Children in Need (this is a statutory framework in place across agencies including the NHS). There is an agreed multiagency referral process in place, of which Social Services are the lead agency for carrying out an assessment. Other agencies then contribute to the assessment.
9.10 In Powys, in addition to the framework explained in para 9.9, there is also an early intervention process agreed under the Children and Young People’s Partnership (CYPP). A referral can be made to a Local Resource Solution Panel by any agency, using the Common Assessment Framework (CAF). Local solutions can be put in place for emerging needs. Through the CYPP Emotional Health and Wellbeing Group Powys Teaching Health Board provide funding to Powys Carers Service to help address the needs of Young Carers.
9.11 Consent is an important issue. In order to give the Carer the help and information they need at the right time it may necessitate passing their personal details, such name, address and contact number, to other partner agencies. Consent must be sought from the Carer before their personal data is shared, ensuring the Carer understands where information can be accessed, how it can help them as a Carer, what personal details are being passed on to another agency and what they can expect from the contact.
9.12 Within Powys Teaching Health Board where it is identified a patient has a Carer, patient consent is always sought before sharing information. This extends to Information and Consultation Strategy for Carers Page 26
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providing information about medication, treatment, available advocacy services and advice about practical issues such as when care is provided in the home. A common example of this is the sharing of information for moving and handling patients in their own home, this enables the Carer to ensure the correct approach is taken to reduce the risk of harm to both the patient and the Carer.
9.13 Where the patient lacks capacity to consent staff adhere to Powys Teaching Health Board guidance on consent to treatment. During a Carer and multiagency combined workshop held in May 2012, one Carer stated:
“Parent Carers cannot step away from the child but can give consent to treatment. Adult Carers can step away but cannot give consent (this can leave the Carer feeling disempowered).”
9.14 All organisations are committed to the principles of equality and diversity. The key legislation that requires local authorities to carry out certain functions on behalf of Carers includes:
The Carers (Recognition and Services) Act 1995;
The Carers and Disabled Children Act of 2000;
The Carers (Equal Opportunities) Act 2004; and
Equality Act 2010.
9.15 Powys Teaching Health Board, local authority and third sector organisations are committed to their role in implementing Race Equality Schemes. They recognise and treat Carers as key partners in the provision of care, ensuring that information and support is available and accessible to all. This extends to Carers of all ages and sections of the community, particularly Young Carers who assume responsibility for parents and siblings and Carers from Black and Minority Ethnic (BME) communities.
Year 1 Powys Teaching Health Board, local authority and voluntary organisations will work together to develop a mechanism for joint action when a Young Carer is identified at risk or identified as a
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‘child in need’ because of their caring role, or other associated factors.
Organisations will develop and review joint agreements on issues of consent to ensure that Carers experience of referral for information and help to other agencies is problem free.
Identify Young Carers through more effective working in Schools and regular presence of Young Carers Service (YCS) Outreach Workers in Schools, through Personal SE Classes and teacher training (can be done by Young Carer’s).
Year 2 Powys Teaching Health Board, local authority and voluntary organisations will continue working together to empower Carers.
Powys Teaching Health Board, local authority and voluntary organisations will work together to identify existing and new black and minority ethnic Carers.
Powys Teaching Health Board, local authority and voluntary organisations will identify male Carers and hold regular support groups to assist them in their day-to-day caring activities.
Year 3 Powys Teaching Health Board, local authority and voluntary organisations will review current activity on equality and diversity impact assessments and identify areas for further work.
10 Objectives of the Information and Consultation Strategy for Carers
10.1 Within Powys Teaching Health Board staff can access training to enable and support them in identifying Carers of all ages. It is recognised that occasionally Senior Managers will need face to face training provided by Carers to increase their awareness and understanding of Carers and their needs. Currently, as demonstrated by the statistics in para 6.3, health refer only 6.5% of Carers to Powys Carers Service. Hence, action is needed to increase the number of referrals.
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10.2 The key objective of this strategy is the provision of information to Carers at every point of their journey through the patient/Carer journey. This will be provided at key stages, once the Carer has been identified, including:
Hospital admission;
Diagnosis;
Transfers of care;
The start of treatment programmes and significant changes to treatment or medication;
Hospital discharge/ other transfer of care and out of hours support;
Contact with social services;
Contact with Carers support organisations; and
Contact through schools and youth services.
10.3 Consent is sought, where appropriate, in line with local and national consent processes as a basis for providing information to Carers. Where tension is evident or arises, mediation must be fully explored in an attempt to resolve any issues and support the provision of the right information at the right time, in the right place and to the right people.
10.4 If consent is withheld, staff will provide Carers with as much information as possible without breaching patient confidentiality. This will include information on:
Medication, where a Carer has to dispense medication;
Treatment, particularly in respect of side-effects on the health and behaviour of the person cared for that may impact on the Carer;
The provision of advocacy services provided by a range of organisations;
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Any practical issues that may relate to care at home and long-term care; and
Referral to a Carer Support Service and information about having a Carers Assessment.
10.5 Where patients/ people are unable to consent through incapacity, practitioners work with partners and/or immediate family, share information as appropriate taking account of the requirements under the Mental Capacity Act 2005.
10.6 Consultation with Carers or the person they care for will be carried out by staff before decisions are made to ensure that:
staff providing services listen to and respect the knowledge a Carer has of the cared for person and use the information appropriately;
Carers are made aware of their right to a needs assessment by the local authority and of their right to provision of services;
Carers have assistance in understanding the decisions being made by those providing treatment or services to persons cared for and are encouraged to contribute to the decision making process;
Where a decision is taken in the absence of a Carer that he/she is provided with an explanation of the decision. Consultation with Carers occurs at regular intervals and includes consideration of when Carers need support at short notice – this will need to be joint working with Social services to ensure seamless services;
staff consider Carers needs during consultation having regard to any disability they may have, the age of the Carer, their ability to care without risk to their own health, recreational, educational and employment needs, cultural background and language needs; and
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Carers and those persons cared for are made aware of the assistance and support that may be available to them from voluntary organisations and Carers are always signposted to Carer support agencies.
10.7 Powys Teaching Health Board, local authority and voluntary organisations are taking steps in the first year to raise staff awareness of Carers. Participation in the development of the strategy, information on and engagement of staff during Carers week and the introduction of an e-learning caring awareness training programme on Carers are approaches adopted. All 17 Medical Practices within Powys have identified Carer’s champions which are used as a source of reference for Carers to access further support and information.
10.8 Measurable outcomes for Carers are delivered which identify how much better informed Carers are able to access appropriate support. A mechanism will need to be developed to capture data on how many Carers are identified and referred to other agencies. The baseline measure of 6.6% referrals to Powys Carers Service can be used for future reference.
Year 1 Inclusion of the need for nursing staff to refer identified Carers for a Carers needs assessment in the revised care planning documentation for in-patients in Powys community hospitals.
Participation of Powys Teaching Health Board staff in the development and implementation of the strategy.
Powys Teaching Health Board need to develop a mechanism to capture data on how many Carers are identified and referred to other agencies.
Baseline within Powys Teaching Health Board of information available for Carers at every point of their journey through the NHS.
Introduction of an e-learning Carers awareness course for Heath Board and local authority staff on Carers.
Carers will be better engaged in the discharge arrangements for people with dementia.
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Raise Health Board and local authority staff awareness of the Mental Capacity Act and consent.
Consideration needs to be given to staff at all levels within all organisations having Carers awareness training delivered by Carers to promote greater impact and understanding of Carers issues.
Ensure consistent coding within the GP clinical systems to ensure accurate identification of Carers and the number referred to other agencies are captured.
Year 2 Inclusion of the need for District Nursing staff to refer identified Carers for a Carers needs assessment in the revised care planning documentation for patients cared for in the community.
All Health Board staff are able to signpost indentified Carers for appropriate support.
Powys Teaching Health Board and local authority monitor the number of staff working with children and Young people who access Carers awareness training.
Carers champion’ refresher course for existing (and new) Carers champions within the primary care setting.
Year 3 Gain an insight to the number of Young Carers who benefited from support in their caring role.
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11 General Principles of the Information and Consultation Strategy for Carers – Treating Carers as Partners in Care and Accessibility 11.1 The strategic aim of Powys Teaching Health Board, local authority and third sector organisations is to ensure that Carers across Powys are properly engaged and acknowledged as partners in the delivery of care. It must never be assumed that Carers can or will provide care. Carers have a right to choose whether or not they will care and the level of support they are prepared to offer. It is important that practitioners and their partners negotiate with the Carer what care they can and are willing to provide.
11.2 Powys Teaching Health Board, local authority and third sector organisations recognise and treat Carers as key partners in the provision of care, ensuring that information and support is available and accessible to all. This extends to Carers of all ages and sections of the community, particularly Young Carers who assume responsibility for parents and siblings and Carers from Black and Minority Ethnic (BME) communities. This will include the provision of and facilitation of both verbal and written communication with Carers to ensure they have access to knowledge and understand the condition of the individual they care for. This will enable them to carry out their caring role effectively.
11.3 Staff working at all levels of Powys Teaching Health Board will work in partnership with Carers and annual information and data collection reflecting this activity will be reported on.
11.4 All Carers will be informed of their legal right to a Carers Needs assessment via the Carers Recognition and Services Act 1995 and the Carers and Disabled Children’s Act 2000. Where Powys Teaching Health Board staff identifies Carers who have not been assessed, they will refer them to the local authority representatives or Powys Carers requesting an assessment.
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11.5 All organisations will ensure that information and advice is widely available and available in a variety of different formats to meet the varying needs of Carers, taking into account all accessibility requirements such as:
. Face-to-face;
. Hard copy;
. Other languages, Non-written forms, e.g. DVD and video, Braille, in audio, in large print; and
. A variety of locations, e.g. libraries, General Practitioner (GP) surgeries, dentists, pharmacies, opticians, community centres, places of worship, schools and colleges, supermarkets, organisation websites and social networking websites and at home via voluntary organisations.
11.6 All organisations are committed to the principles of equality and diversity. The key legislation that requires local authorities to carry out certain functions on behalf of Carers includes:
The Carers (Recognition and Services) Act 1995;
The Carers and Disabled Children Act of 2000;
The Carers (Equal Opportunities) Act 2004; and
Equality Act 2010.
11.8 The focus of the legislation has been aimed at raising the awareness of Carers of their right to a Carer’s assessment. It goes one step further in putting the onus on local authorities to inform Carers of their rights to have their needs assessed, independent of the person they care for. This will enable them to continue with their caring role, to maximise outcomes for the Carer and the person cared for. Furthermore, whether a Carer works or wishes to work, is training or intending to
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undertake training, education and leisure activities must be taken into account as part of the assessment.
Year 1 Powys Teaching Health Board will collate annual data on partnership work with Carers for onward reporting to their Board.
Powys Teaching Health Board staff will refer Carers who have not had Carers needs assessment to the local authority representative or Powys Carers Service.
All organisations will undertake a baseline assessment of information available in the variety of formats identified.
All organisations will ensure that information and support is available and accessible to Carers of all ages and all sections of the community.
A multi-agency leaflet to give to Carers will be developed, NHS staff will provide a copy of the leaflet to Carers they identify.
Year 2 Carers will be provided with verbal and written communication to enable them to understand the condition of the individual they care for.
Organisations will involve Carers in the review of the information and consultation strategy.
Year 3 Organisations will involve Carers in the review of the information and consultation strategy.
12 Content of the Information and Consultation Strategy for Carers – Information
12.1 All organisations, Carers and patients will develop a shared implementation plan reflecting the overall objectives and principles listed within this strategy. The plan will outline the minimum requirements for delivery and identify roles and responsibilities for meeting their delivery throughout 2012-2015.
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12.2 Carer information packs will be developed taking account of the baseline measure of information available and accessible to Carers. The packs will be provided to Carers at the start of the patient journey. The packs will be made available on hospital wards, in GP surgeries and via community staff (district nurses, health visitors, midwives, therapists, etc). The packs will include information to signpost Carers to additional sources of support and information. Of particular importance is the availability of information to Carers at the point of discharge from hospital or prior to discharge from multidisciplinary team meetings. Alternatively, via a Carers Support Worker who could identify situations where a Carer is involved and make sure that they are informed and involved. Comments received during a workshop held during May 2012 about the discharge process from Powys Community hospitals, which the development of information packs need to take account of include:
“Lack of communication”
“Lack of planning”
“Inappropriate discharge”
“Transport issues”
“Lack of co-ordinating process (Discharge Nurses/Staff)”
“Discharge process must involve Carers”
”Monitor discharge planning & multidisciplinary teams”
“Guidance/training for staff”
Year 1 Development of a shared implementation plan reflecting the content of this strategy for delivery.
Organisations, patients and Carers will develop Carers Information Packs for use tailored to the needs of the Carer and situation.
Organisations will identify forums on an ongoing basis for Carers to share their views.
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Year 2 Review and update the implementation plan.
Review of Carers Information Packs to ensure they remain ‘fit for purpose’ (see above).
Year 3 Review and update the implementation plan.
Review of Carers Information Packs to ensure they remain ‘fit for purpose’ (see above).
13 Content of the Information and Consultation Strategy for Carers – Communication
13.1 Recognition of the needs of Young Carers and the information they require has been addressed in Section 23 of this strategy.
13.2 Carers needs assessments are shared with Carers approval with partner agencies and organisations.
13.3 Primary Care colleagues have been engaged in the development of the strategy through the various workshops and discussions held. Existing protocols are in place with all Powys General Medical Practices to identify Carers and their referral to appropriate agencies. All practices have trained Carers Champions, namely members of the administration team who provide Carers with appropriate signposting to information to support their needs. Practice managers have been made aware of the development of the strategy through the Powys Practice Managers Forum.
13.4 Carers and professionals highlighted at the workshop in May 2012 what would be useful to Carers who access primary care services, it was indicated:
“Primary care counselling is not appropriate for Carers”
“Understanding deprivation of liberty. What it means - rights, responsibilities, etc.”
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“GPs need to network with voluntary organisations”
“Information is generally too disparate; too many organisations; too much to do to access what is needed”
“Assisting Carers to identify themselves as Carers. GP’s should play a major part in this”
Year 1 Powys Teaching Health Board will provide training to selected staff in completing a Carers needs assessment.
Year 2 Demonstrating improvement in outcomes for Carers through GP surgeries.
Develop a good practice guide in relation to the Quality Outcome Framework (QOF), Practice Management 9, Carers indicator.
Year 3 GPs networking with voluntary organisations to raise Carers awareness.
14 Content of the Information and Consultation Strategy for Carers – Consultation
14.1 In providing appropriate information and advice to Carers, Powys Teaching Health Board, local authority and third sector organisations will provide the following information as a minimum:
Information for Carers of people with mental health problem
Information about the medication given to a patient and where appropriate its potential side effects in a form which the Carer can understand. General or specific information on medical condition/treatment in accordance with patient confidentiality, the conditions and treatment of the cared for person, including information on side effects of treatment
Information that assists children and young people to avoid taking on inappropriate levels of caring and signposts them to sources of assistance Information and Consultation Strategy for Carers Page 38
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Accessible information and signposting to information on the availability, entitlement to and sources of local and national support including:
Short breaks / Respite care;
Carers Needs Assessments;
Direct Payments;
Housing Support;
Independent Advocacy;
Counselling including bereavement support;
Guardianship (where appropriate);
The work of the Court of Protection (where appropriate);
Age appropriate support groups;
Activities for Young Carers to promote resilience;
Culturally specific support groups;
Financial advice and support, including information about the availability of financial support through the benefits and tax credits system;
Managing the financial and other affairs of cared for persons;
Any other information and support available to help support Carers in their caring role; and
Information or signposting to information and advice on employment provisions, including flexible working.
Information on:
Carers Rights;
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the range of Social Services functions available to Carers and cared-for persons;
care planning for the person cared for;
medicines management, safe handling, moving and lifting and other matters relating to the care of the person cared for;
Inform Carers of local concessionary or other transport schemes and patient transport arrangements, to enable them to attend NHS appointments with the cared for person;
Information and support on aids and adaptations including Telecare and Telehealth services and the waiting times one can expect for such items;
Information on the regulation and inspection of services, i.e. the work of Healthcare Inspectorate Wales and the Care and Social Services Inspectorate for Wales;
Signpost Carers on to a local Carer support agency and to appropriate national organisations supporting patients, users and Carers for specific conditions;
Information on hospital admission avoidance;
Information, advice and support on the availability of suitable local services, the quality and range of provision and how to choose and arrange provision of these services;
Information on the availability of crisis support and how to access it;
Information on the availability of re-ablement and intermediate care;
Help promote health and wellbeing for the Carer and person(s) cared for;
Information on the organisation’s complaints procedures and those of the Public Service Ombudsman for Wales; and
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Information for Carers who wish to stop their caring role.
Signposting to appropriate programmes of support and learning, these may include training on:
safe lifting, moving and handling appropriate to Carers;
medicines management including the safe administration of medication to the cared for person in a format easily accessible to and understandable by Carers;
relevant nursing skills;
use of aids and adaptations;
continence care;
stress management;
help with eating and drinking;
dealing with the behavioural aspects of the cared for person; and
helping Carers to look after themselves.
Information on hospital discharge and transfers of care should include as a minimum:
The Carers Rights;
information about the support and follow up available on discharge for the Carer and the patient; including the practicalities of the process, timing, medication rights to assessment etc;
personal and often sensitive information relating to the individual patient;
about the diagnosis, prognosis and treatment and management both in hospital and afterwards; and
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information that enables the Carers to perform their future role safely and with the necessary skills and knowledge to make informed choices about capacity to meet the needs of the patient who becomes the person cared for both on discharge and over time.
14.2 Where information is not already available or existing information is being updated, practitioners and their partners will involve Carers in the process. All information leaflets will follow local processes for approval and be ‘fit for purpose’ for the intended audience with regards to language, sensory needs, format, etc.
14.3 Carers information packs will be made available on hospital wards, in GP surgeries and via community health staff (district nurses, health visitors, midwives, therapists, and other professionals).
14.4 Consultation on information needs has already commenced and through a variety of workshops, a questionnaire and a short consultation, an example of key areas where information is needed and issues that require further work for Carers in Powys have been identified (Appendix 1).
Year 1 Based on gap analysis of existing information available for/ or to Carers, development of an interagency action plan for the development of further information through 2012-2015 will be put in place.
Carers will be actively engaged in the development of new information and the review of existing information.
Carer’s information packs and Carers information Notice Boards will be provided on hospital wards in GP surgeries and via community health staff.
Year 2 Information to be made available in a variety of formats.
Year 3 Review the interagency action plan.
Review the format and availability of information for Carers.
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15 Content of the Information and Consultation Strategy for Carers – Priorities
15.1 Carers as partners in the making of this strategy have been consulted as early as possible in a timely manner before any decisions on priorities were made. Feedback was provided to Carers explaining what action has or has not been taken and why. Where Carers were absent, they were provided with an explanation about the decisions made by email, through websites, such as the Powys Carers Service website and the Powys Teaching Health Board internet.
15.2 Throughout the development and consultation on the strategy, Carers have been informed:
that the knowledge they have about caring for the cared for person will be used appropriately;
about their right to have their needs identified;
they can feel confident of continued support in their caring role and know how to get support before it becomes a problem;
they will have the right information and advice on which to understand the decisions being made and are able to input to them, and
they will understand the information being provided and consulted on, what will happen and who to contact.
Year 1 Provide information for Carers on accessing support.
Involve Carers and the cared for person in decisions being made.
Year 2 Involve Carers in the review of the Information and Consultation Strategy and implementation plan.
Year 3 Review information provided to ensure it remains ‘fit for purpose’.
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16 Content of the Information and Consultation Strategy for Carers – Carer Involvement
16.1 Powys teaching Heath Board, local authority and voluntary organisations will ensure the participation of Carers before making any decisions regarding the provision of services to, or for Carers and the persons they care for. As a minimum Powys Teaching Health Board, local authority and voluntary organisations will:
Engage individuals (such as family members, advocates, individuals granted Enduring or Lasting Power of Attorney under the Mental Capacity Act and court appointed deputies) as early as possible;
Provide feedback to those involved , explaining what action has or has not been taken and why;
Organisations will act on information received;
Ongoing information will be provided. Powys Teaching Health Board, local authority and voluntary organisations recognise that Carers may need someone to explain and revisit options perhaps on several occasions;
Allow Carers sufficient time to respond and staff will ensure that adequate time is given dependent on the issue Carers need to make a decision about;
Ensure services are culturally appropriate, age appropriate and available through a variety of methods, including both written information and information in other media, such as stakeholder meetings;
Ask Carers what is important to them and how they wish to be involved; and
Work with each other throughout the consultation process.
Year 1 Powys Teaching Health Board staff will involve the Carer and the cared for, where possible, in all assessments of care and care planning activity.
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Year 2 Powys Teaching Health Board staff will facilitate forums to seek the involvement of Carers and through other forms of media, e.g. questionnaires.
Year 3 Powys Teaching Health Board staff will facilitate forums to seek the involvement of Carers and through other forms of media, e.g. face –to – face, easy read, etc
17 Delivery of the Information and Consultation Strategy for Carers – Implementation and Dissemination
17.1 Carers must be identified and provided with information at the first point of contact with professionals. Powys Teaching Health Board, local authority and voluntary organisation staff and their contractors need to be proactive in identifying Carers and signposting them accordingly. Community based staff are essential in identifying Carers and include:
General Practitioner (GP) Practices/Primary Care Teams;
hospital and community-based pharmacists;
community hospitals including those for the Elderly and Mentally Infirm;
community assessment and rehabilitation/re-ablement;
out patient clinics, particularly those dealing with chronic disease management;
psychiatrists and mental health clinics;
dieticians;
occupational therapists;
podiatrists;
community child health services;
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community health projects funded by LHBs; and
school nursing and school counselling.
17.2 An implementation plan reflecting the content of the strategy will be developed. This will be a joint plan developed and owned by all organisations.
17.3 General Practitioners will be represented in the development of this strategy through the active involvement of the Primary Care Directorate within Powys Teaching Health Board. The implementation process will engage GPs through their Local Medical Committees in addition to the Primary Care Directorate. This will ensure a focused response and involvement of GPs in taking this strategy forward over the next 3 years. This will be further supported by engagement of GPs through voluntary organisation colleagues, such as, Powys Carers Service.
17.4 Staff have been provided the opportunity of contributing to the strategy development via a 4-week short consultation. Only one staff member requested a copy of the strategy to comment on.
Year 1 Organisations will provide information for Carers on accessing support.
Organisations and their staff will involve Carers and the cared for in decisions being made.
Year 2 Review of the joint implementation plan.
Year 3 Review of systems and processes for engaging staff in the dissemination of information for Carers.
18 Delivery of the Information and Consultation Strategy for Carers – Staff Responsibilities
18.1 All hospital and service managers and frontline clinical managers are responsible for delivering the strategy within their area of responsibility, regardless of whether it is an acute or non-acute setting. This extends to both community and hospital settings and Primary Care. Information and Consultation Strategy for Carers Page 46
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18.2 Within Powys Teaching Health Board the appointment of a Carers Champion has been requested through the Board of Directors, as outlined in the Welsh Government guidance. The appointment, role and responsibilities of the champion will be progressed through 2012.
18.3 Local authority and voluntary organisation staff alongside Health Board staff will be responsible for delivering the strategy within their area of responsibility.
Year 1 Appointment of a Carers Champion for Powys teaching Health Board.
Year 2 Assess implementation of the Information and Consultation Strategy in all settings.
Year 3 Determine the effectiveness of the champion roles in both the Health Board and local authority.
19 Delivery of the Information and Consultation Strategy for Carers – Staff Responsibilities
19.1 In order for staff to deliver on their responsibilities towards Carers, organisations have a responsibility to ensure staff are trained in Carer awareness issues to support their understanding and ability to meet the needs of Carers.
19.2 Currently, staff within Powys Teaching Health Board and local authority and voluntary sector access existing training on Carer awareness issues through the local authority and voluntary organisations training sessions. Key learning outcomes of the training include; The Impact caring has on an individual’s life & Family; Being able to define the issues faced by Adult & Young Carers; Carer’s Legislation & Carer’s funding; Carers rights and services available to them; The importance of the Carer’s Needs Assessment and Young Carers self assessment; and
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How easy is it for Carers to be able to think and therefore plan ahead for things such as social activities, education, work, hospital discharge?
19.2 Primary Care practitioners, namely General Practitioners are provided training in Carers awareness, some of them through trained Carer trainers via Powys Carers Service.
Year 1 Joint awareness sessions for staff across health, local authority and the voluntary organisations to raise multi-agency awareness of the information and consultation strategy amongst local teams and department’s.
Year2 Involve staff in the review of the strategy.
Year 3 Assess staff ongoing training needs.
20 Delivery of the Information and Consultation Strategy for Carers – Staff Training
20.1 Powys Teaching Health Board, local authority and third sector organisations will be taking a proactive approach to the provision of staff development and training. The organisations view this as essential in order for staff to support Carers in their caring role. E-learning training has been procured as part of a consortium with the local authority and other Health Boards across Wales.
20.2 The e-learning training will be hosted by the local authority whose staff along with the Health Board staff, voluntary organisations and Carers will be able to access the training package. The training will be made available from November 2012.
20.3 Training provided to date has included Carers stories and experiences, and this approach will continue to be used going forward.
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Year 1 To procure and make available to staff the e-learning training to frontline clinical staff and local authority staff.
Senior managers should participate in face to face Carers Awareness training delivered by Carer Trainers.
Year 2 Monitor the number of staff who have completed the e-learning programme.
Evaluate the e-learning training programme.
Year 3 Evaluate all training programmes.
Identify ongoing training needs.
Multi-agency planning re: delivery of ongoing Carers Awareness training.
21 Delivery of the Information and Consultation Strategy for Carers – Carer Training
21.1 Better supported Carers will enable the cared for to be supported longer. To meet Carers needs Powys Teaching Health Board, local authority and voluntary organisations will work together to identify proposals for the development of a strategic approach to developing Carers to an expert level.
21.2 The approach to training for Carers will build on existing training and take account of what Carers need to enable them to fulfil their caring roles. The training will cover a range of subjects such as, physical and emotional wellbeing, safe lifting, moving and handling techniques, the use of aids and adaptations, stress management, advice on medicines management including its safe administration, advice on specific conditions such as caring for someone with dementia, mental health problems, physical disabilities, sensory disabilities, Learning Disabilities , etc. The use of IT systems and equipment will also be made available to enable Carers access to relevant training and information.
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21.3 Provision of training for Carers is reported as currently ad hoc by Powys Carers Service who provide a range of training for Carers, such as, stress management, adult protection and facilitating and signposting Carers to other training, e.g. Alzheimers. Powys County Council provides training which Carers can attend but the courses can be difficult to access for a variety of reasons (content, venue, timing etc). Due to the geographical nature of Powys, Carers also find it hard to travel to training and 50% of Carers do not want to leave the person they care for.
Year 1 Provide flexible effective replacement (acceptable to the Carer) care in order that the Carer can attend current relevant training sessions.
Year 2 Assess Carers ongoing training needs.
Provide Carers opportunities through a variety of media and formats to meet their needs.
Year 3 Review system of replacement care provided to Carers to enable them to attend training.
Review the provision of training to Carers and identify their ongoing needs.
22 Reviewing the Information and Consultation Strategy for Carers – Involving Carers and Others
22.1 An annual report on the implementation, evaluation and progress of the strategy will be prepared by Powys Teaching Health Board in partnership with the local authority and submitted to Welsh Ministers, year on year.
22.2 Powys Teaching Health Board, local authority and third sector organisations will put in place monitoring mechanisms to ensure that data on Carers, what is being done with Carers, the Carers experience and the learning from working with Carers is collated and used to inform the planning, development and delivery of future services for Carers across Powys.
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22.3 The monitoring needs to include information on the range and provision of training for Carers and data about formal referrals to other sources of Carer support, for example, referral from the Health Board to Powys Carers Service.
22.4 Data needs to be collated on sources of funding for Carers and how the funding is used. This will be used to inform future short and long term funding streams and use of resources.
22.5 The strategy will be reviewed after 18 months to ensure it remains ‘fit for purpose’ but it will take account of implementation, evaluation and progress at that time before preparing a new strategy.
22.6 The consultation events during the drafting of the strategy asked the question about ‘How do we know that what we are doing through the strategy will actually make a difference?’ The main suggested outcomes to evidence this included the list below, which the organisations need to consider collecting data on.
“Fewer re-admissions – a home based service for minor problems”
“Less unscheduled admissions”
“An increase in carer’s assessments”
“Identifying Carers when patients admitted”
“Providing quick and easy access to services”
“Reduction in need for secondary health services”
“Improvement in school attendance and achievement of Young carers”
Year 1 Agree with partner agencies the baseline data collection to demonstrate the strategy is making a difference.
Set up the Infrastructure to support data collection across agencies.
Ensure a multi-agency approach to the development of the annual report.
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Year 2 Multi-agency evaluation of data collected.
Demonstrate a multi-agency approach to using data to inform services for Carers.
Ensure a multi-agency approach to the development of the annual report.
Review the strategy after 18 months.
Year 3 Undertake a multi-agency review of systems and processes for data collection.
Demonstrate how the outcomes of the data collection have led to improvements for Carers.
Ensure a multi-agency approach to the development of the annual report.
23 Information and Consultation Strategy for Young Carers
23.1 Young Carers (Becker, 2000) are defined as ‘children and Young persons under 18 who provide or intend to provide care, assistance or support to another family member. They carry out, often on a regular basis, significant or substantial caring tasks and assume a level of responsibility which would usually be associated with an adult’.
23.2 There is no typical Young Carer (YC) and their caring needs can vary reflecting the needs of the cared for. A Young Carer may be looking after a parent with mental health or physical problems, regardless of whether one or two parents live in the household. They may be one of a number of siblings and care not just for the parent but also for other children. There may be a sibling, brother or sister, with health problems that the Young Carer is supporting. A Young Carer may share their caring responsibilities with other family members. About 30% of YC’s registered with Powys Carers Service care for a single parent with mental health difficulties.
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23.3 The impact for Young Carers of looking after one or both of their parents and/ or siblings can have a detrimental impact on their education and health, and their social exclusion should not be underestimated as they can be particularly disadvantaged through their caring responsibilities. They can feel isolated from other children because they do not have enough time to spend with friends. This can affect their emotional development and impact on their future life experience and relationships.
23.4 Young Carers may face problems at school with attendance and in completing course work. Young Carers (Challenging their Own, 2003) schools need to recognise the effect caring has on Young Carers. Teachers and staff must take time to work with them. It is recognised (ADASS/ADCS (2009) that in order to support Young Carers and families effectively that a whole family approach must be adopted to support the individual needs within the family and to support the needs of the family as a whole.
23.5 Powys Teaching Health Board, local authority and third sector organisations have to consider the best interests of the child and support their right to life, survival and development, taking account of their views on being a Carer and ensuring they are not discriminated against (Welsh Assembly Government, 2009).
23.6 To avoid Young Carers taking on inappropriate levels of caring, it is essential to assess their needs (Carers (Recognition and Services) Act 1995). Parents and their children may have differing views about caring responsibilities and hence both parties have to be given an opportunity to have their views heard. It is important to also consider alongside this whether a child is in need (Children Act, 1989) as the caring responsibilities of a Young Carer may have an adverse affect on their welfare and development needs if the proper support is not given.
23.7 In addition to the information needs set out in this strategy, consideration needs to be given to the type of information and support that Young Carers will find useful, this may include: Information and Consultation Strategy for Carers Page 53
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dealing with domestic tasks;
personal care;
emotional care;
financial support;
life experience and relationships;
educational support;
accessing social activities;
counselling services;
advocacy; and
transport.
23.8 At a Carer and multiagency combined workshop held in May and July 2012, it was highlighted that the sources of information for Young Carers needed to include:
School Nurse; School Champion; Community Nurse; Carers Champions (GP Surgeries); Youth Service; Information Leaflets; Powys Young Carers; Leisure Centres; Libraries; Social Media; Drop-in sessions;
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Shops/Community notices; Peers, Apps for mobile phones, School Assemblies; Lack of insight in key professional service, only as good as good as the deliverers; and Joining up adult & children social services re substance abuse/mental.
23.9 Some of the practical issues identified for Young Carers in accessing information were identified as:
Who to contact (Contact Details );
Team around the Family (TAF);
Acknowledgement of right of Young Carer to be involved (and not involved);
Communication & Multi-Agency working;
Working relationships between agencies;
Need help to identify themselves as a Carer;
New judgemental information;
Time-out from their caring role – information on how this can happen;
Use of common assessment framework; and the
Local Resource Solution Panel needs to be used.
23.10 It is recognised that education have a role to play in the provision of information to Young Carers and in response to what schools can do, Young Carers suggested:
“Be open to involvement from Powys Carers Service”
“Awareness raising (School Resource Park)”
“Development of e-learning package”
“Notices”
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“Link to Young Carers website via school website”
“Flexibility/Understanding”
“Facilitating communication with home”
“Sensitivity/Discretion”
“Transition Arrangements 14+, 16+”
“Identify and refer Young Carers”
“Pyramid Scheme in schools – Screen for children with problems, for example, withdrawn.”
Year 1 All organisations will provide information for Young Carers on support services available to them.
Powys Teaching Health Board staff will refer Young Carers who have not had their needs assessed to the local authority representative or Powys Carers Services.
Young Carers will be provided with verbal and written communication to enable them to understand the condition of the individual they care for.
Organisations work with Education to provide education and awareness to teachers and raise awareness of Young Carers amongst pupils.
Young Carers will be identified as early as possible – preferably in Primary Schools.
Year 2 Review the provision and content of information on support services provided to Young Carers.
Monitor the number of Young Carers identified in the first year of the strategy and the support services they access.
Involve Young Carers in the review of the strategy after 18 months.
Identify the ongoing needs of Young Carers.
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Year 3 Promote a multi-agency approach to assessing the effectiveness of information and support services available to Young Carers.
Evaluate level of increased awareness of Young Carers amongst teachers and pupils.
Determine the ongoing needs of Young Carers to inform an updated implementation plan.
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Sign off
LHB Chief Executive Director of Social Services
Date of Submission: 26 October 2012
Date of Annual Reviews: The first month of each Calendar Year - 2014; 2015; 2016
Planned process for Review after 18 months: The review will take place through the Multi-agency Review Group and reported to Powys Teaching Health Board ‘Board of Directors’ and Powys County Council ‘Cabinet’.
Review scheduled for June 2014 and reported in September 2014.
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24 References
ADASS/ADCS (2009) Working Together to Support Young Carers – A Model Local memorandum of Understanding between Statutory Directors for Children’s Services and Adult Social Services
Becker, S (2000) Young Carers in the UK: research, policy and practice, Research, Policy and Planning, Vol 8, no 2, pp13-22
Conachie, G. (2010) Supporting Carers: The Case for Change, The Princess Royal Trust for Carers
Davidson, G (2011) Promoting Independence together: Capturing the benefits of Joint Working in Health and Social Care Services, Powys Local Service Board
Dearden, C. & Becker, S (2004) Young Carers in the UK: the 2004 report
Dudley Metropolitan Borough Council (2012) http://etraining.dudley.gov.uk/nolms/main/launch_nolms.html?unit=ca01&lms=none
Morgan, J. Jordan, R (2012) Helping Carers through the Carers Strategy Measure, Developing a joint outcomes framework
National Institute for Health Research (2011) Supporting unpaid Carers to stay in employment, NIHR School for Social Care Research, London Pengilley, M (2011) Report from the future of Carers Services Symposium http://www.powysCarers.org.uk
Powys Carers Service (2011) Money Matters and Benefits http://www.powysCarers.org.uk
Powys Citizens Advice Bureau (2011) “Advice and Well Being” Annual report 1st April 2010 – 31st March 2011 Powys County Council (2011) 2011 Census First Release published by the ONS, Statistical Research and Information Unit, Powys
Information and Consultation Strategy for Carers Page 59
September 2012
Powys Multi-Agency Reference Group for Carers (2010) Carers Strategy in Powys
Powys Teaching Health Board (2011) One Powys Plan 2011 – 2014
Ross, S (2012) Press Release “over a million Carers miss out on vital support” Macmillan Cancer Support
Social Care institute for Excellence (2005) Adults’ services: SCIE Guide 9: Implementing the Carers (Equal Opportunities) Act 2004
Statistical Research and Information Unit (2011) Powys in figures: Population 2010, Powys County Council
Titterton, M (2006) Support and Services for Carers. A survey of Welsh local authorities 2005-2006
The Princess Royal Trust for Carers (2012) Carers in the workforce, http://www.professionals.Carers.org/health/Carers-in-theworkforce,
Welsh Assembly Government (2011) Annual Quality Framework
Welsh Assembly Government (2010) Carers Strategies (Wales) Measure 2010
Welsh Assembly Government (2009) The United Nations Convention on the Rights of the Child, WAG, Cardiff
Welsh Government (2008) Designed to add value – a third dimension for one Wales
Welsh Assembly Government (2007) Raising the Standard and Fulfilled lives, supportive communities
Welsh Assembly Government (2005) Hospital discharge planning guidance
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Welsh Assembly Government (2003) Caring about Carers: A strategy for Carers in Wales – The third Report, WAG, Cardiff
Welsh Assembly Government (2003) The Strategy for Older People in Wales, WAG, Cardiff
Wikipedia (2012) County of Powys http://www.en.wikipedia.org/wiki/powys
Young Carers www.YoungCarers.net
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25 Appendix 1
Whilst developing this strategy four forums have been held to seek views of Carers, agencies and professionals. These have proven to be a rich source of information, the analysis of which has been used to underpin the development of the strategy.
19 April 2012 Carers Forum Plas Dolerw , Newtown
10 May 2012 Multi-agency and Carers Pavilion, Llandrindod Forum Wells
9 July 2012 Carers Consultation Pavilion, Llandrindod Workshop Wells
11 September 2012 Carers Forum Suddud Hall, Brecon
An Adult Carer questionnaire undertaken by Powys Carers Service on behalf of Powys tHB and local authority was completed in August 2012; the results can be obtained from the:
Quality & Safety Unit
Powys Teaching Health Board
Mansion House
Bronllys
Powys
LD3 OLS
A gap analysis has been undertaken looking at information and services already provided and what needs to be considered for provision in the future. Powys Association of Voluntary Organisations has been pivotal in helping to complete the analysis. This analysis will be used to inform the provision of information and services over the next three years.
A mini consultation was held for a 4-week period from Monday 30 July – Friday 24 August 2012, this was accessible via Powys tHB internet and intranet. Carers were given the opportunity to participate in the Adult Carers Survey, the gap analysis work,
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to view the draft strategy and to share with Powys tHB and local authority their experience of caring. Only one request was received for a copy of the strategy.
Examples of information has been identified as needed on:
Re-ablement and intermediate care
Promoting health and wellbeing
Medicines management including safe administration and impact of altering medication on the cared for and the Carer
Counselling services for Carers
Assistance with eating and drinking
Powys Carers Service
Crisis management – who to contact
Emotional side of caring
Diabetic information
Discharge services available
Signposting to transport
Stress in Carers – Young and adult
Religion and its role in caring
Facilities available, e.g. religious facilities
Mental Capacity Act
Power of Attorney
Domestic abuse
Vulnerable adults
How to access aids, etc
Time out – fun!
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Continence issues
Support networks that are age appropriate
Concerns and fears about reprisals if concerns raised
Training needed on:
Specific illnesses in order to offer ongoing support to cared for
Dementia Support
Areas requiring further work include:
Transport
Information made available early on – not at time of crisis
Staff who are Carers
Carers of war veterans
Out of county services
Transition process for Carers – advice and support when a cared for child becomes cared for adult
Boundaries between what is expected as a parent or spouse
Specialist response by schools to disability situations
Education services need to be a provider of and a route for information for Young Carers
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FOR APPROVAL
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 2.5
MAKING A DIFFERENCE – THE CHARITABLE FUNDS STRATEGY 2012/13
Report of Director of Finance
Paper prepared by Head of Financial Services
Purpose of Paper To present the ‘Making a Difference – The Charitable Funds Strategy 2012/13’ for approval. This document has been developed by the Charitable Funds Committee on behalf of the Corporate Trustee.
Action/Decision required The Board is asked to APPROVE the document ‘Making a Difference – The Charitable Funds Strategy 2012-13’ as the Corporate Trustee for the Powys Local Health Board Charitable Funds
Link to ‘Doing Well, This paper supports Standards 1 and 18 Doing Better: Standards for Health Services in Wales’:
Link to Health Board’s Improving Health & Well-Being Corporate Plan Ensuring the Right Access Striving for Excellence Involving the People of Powys Making Every Pound Count
Acronyms and abbreviations
Making a Difference – Charitable Funds Page 1 of 3 Board Meeting Strategy 2012/13 24 October 2012 Agenda Item 2.5
FOR APPROVAL
MAKING A DIFFERENCE – THE CHARITABLE FUNDS STRATEGY 2012/13
Background
The Board is the Corporate Trustee of the Powys Local Health Board Charitable Fund. It delegates the management of Charitable Funds to a Charitable Funds Committee.
The Charitable Funds Committee is an important mechanism for ensuring the effective and appropriate use of charitable donations made into the teaching Health Board. Late in 2010, the committee agreed that it would review and refresh its approach to the strategic management of charitable donations and develop a new strategy to take this work forward. The Charitable Funds Committee over the past 18 months has been developing the enclosed strategy
The draft strategy and an accompanying policy and guidance for staff document was finalised and approved by committee members at the 6th March 2012 meeting, which resulted in a final draft strategy issued for consultation during May 2012. Consultation responses were considered at the Charitable Funds Committee on 10th July 2012. The final version of the strategy was approved by the Board of Directors on 30th August 2012 (BD/12/119 refers) and Charitable Funds Committee on the 4th September 2012 (CF/12/42 refers). The document is now finalised for approval by the Corporate Trustee.
Making a Difference – Charitable Funds Strategy 2012/13
The strategy has been called ‘Making a Difference’ and aims to articulate how the committee on behalf of the Corporate Trustee might wish to have a more strategic approach to the use of charitable donations. There are five key strategic aims, including the development of local plans, policies that offer flexibility locally and a focus on outcomes and sharing success and benefit.
At Appendix 1, the strategy outlines the alignment with the tHB vision outlined within its Annual Plan document. At Appendix 2 there is an implementation programme detailed for the charitable funds strategy outlining each strategic aim, with detail of action required, expected participants, an estimated timescale for completion and an indication how the Charitable Funds Committee will review progress of the Implementation Plan.
To aid the implementation of this strategy a Charitable Funds Policy has been developed including a guidance document for tHB staff around the receipt and use of charitable donations. This policy is available for Board Members should this be required.
Conclusion
The Charitable Funds Committee over the past 18 months has developed the enclosed strategy to outline its proposed approach to charitable donations received and expended by the Charity. The strategy has been called ‘Making a Difference’ and
Making a Difference – Charitable Funds Page 2 of 3 Board Meeting Strategy 2012/13 24 October 2012 Agenda Item 2.5
FOR APPROVAL aims to articulate how the committee on behalf of the Corporate Trustee might wish to have a more strategic approach to the use of charitable donations. This document is now finalised for approval by the Corporate Trustee.
Recommendation
The Board is requested to APPROVE the document ‘Making a Difference – The Charitable Funds Strategy 2012-13’ as the Corporate Trustee for the Powys Local Health Board Charitable Funds
Report prepared by: Presented By: Sarah Pritchard Rebecca Richards Head of Financial Services Director of Finance
Background Papers None
Financial Consequences None
Other Resource Implications None
Consultees Previously consulted with tHB Staff Members and agreed by the Charitable Funds Committee and Board of Directors
Making a Difference – Charitable Funds Page 3 of 3 Board Meeting Strategy 2012/13 24 October 2012 Agenda Item 2.5
Powys Teaching Health Board Charitable Fund
Making a Difference: The Charitable Funds Strategy
2012-2013
Version 6: August 2012
Charitable Funds Strategy Page 1 of 10
Introduction
Powys Local Health Board Charitable Fund (the Charity) is registered with the Charity Commission (Charity No 1057902); Powys teaching Local Health Board (Powys tLHB) is designated as Corporate Trustee.
The Charity was formally created on the 28th May 2004 by a ‘Deed of Arrangement’ and replaced the Powys Health Care NHS Trust Charitable Fund, which had been in existence since 26th July 1996.
The Charity’s main fund has NHS wide objectives as follows: “The Trustee shall hold the Trust fund upon trust to apply the income, and at their discretion, so far as may be permissible, the capital, for any charitable purpose or purposes relating to the National Health Service, wholly or mainly for the services provided by Powys Local Health Board (hereinafter referred to as “the objects”)”.
This means that the funds can be used for the benefit of patients and staff who receive or help deliver the services provided by Powys Local Health Board in accordance with the Deed of Trust.
All gifts, donations and legacies made to Powys tHB are placed in its charitable funds account which is subject to Charity Commission regulation. The Health Board is the Corporate Trustee but it has instituted a Charitable Funds Committee (consisting of five Board Members who are supported by a senior member of the finance staff) to control the funds on its behalf.
In order to make sure that these gifted resources are used in the way the donor intended, there are many separate account headings that specify how each fund can be used (eg in relation to the work of the North Locality District Nursing Service). There is also a general fund that can be used for charitable health purposes anywhere within Powys.
The strategy that follows, which will be reviewed every two years, sets out the Charitable Funds Committee’s goals. It is supported by a Charitable Funds policy, guidance for staff and annual expenditure plans.
This strategy aims to outline how the Charitable Funds Committee and therefore Trustees will work with partners, donors, staff and other stakeholders to add benefit to the population of Powys receiving health care services. Over many years, patients, carers and others have supported local health services through the donation of financial and other ‘gifts’. These donations are important to support the work that staff and others do for patients, clients, service users and others. It is especially important that we as Trustees of the Charity put the money
Charitable Funds Strategy Page 2 of 10 donated to good use and can celebrate the real difference it makes to peoples lives. This is therefore an especially important strategy for our Charity.
The strategy is supported by more technical documents that help to ensure the effective probity of charitable donations, but the strategy itself intends to give a clear focus and direction in relation to the way in which charitable donations are used and importantly measure and share the impact that such donations bring.
The strategic objective
The charitable funds committee supports the Vision of the Health Board (see appendix 1) and aims to use its resources to complement this work. The funds will not replace the tHB’s core expenditure but will be used to improve the health of Powys people by enhancing what the tHB already does, helping with the introduction of planned improvements and encouraging research into how and what services will be developed in future.
Five Strategic Aims
The charity has highlighted five aims for the forthcoming two years and they are as follows:
• Partnership • Local Planning • Delegation • Impact • Publicity and Public Interest
These are further expanded below.
Strategic Aim 1: Partnership
We will further develop our relationships with our key partners in order to design a common set of priorities for the generation and use of charitable donations.
Who are our key partners?
It is important to outline who we need to consider as a Charity to help us to help others to provide high quality patient- centred health. It is recognised that others may have a key role in the generation, the planning and use of charitable donations.
Charitable Funds Strategy Page 3 of 10
Firstly we recognise that healthcare staff are essential partners in care. Clearly donations are often provided to the Charity as a result and in recognition of excellent care and service. Staff may also be able to indicate where best any donation can be used to bring about the maximum benefit.
Individual patients, clients, service users and carers are key partners and those who often make donations to the Charity. There are times when donors also are clear on how they wish their donation to be used for the benefits of others and the Charity will honour these directions. If any bequests are not able to be fulfilled or are at odds with the strategic goals of the charity, the donations must not be accepted.
Statutory organisations such as NHS bodies or Local Authorities could be partners on certain projects. Other charitable organisations are also key partners. Leagues of Friends and local voluntary organisations, and community groups work with us to make improvements for local people. They also bring ideas on how best charitable funds can be used to maximum benefit.
The Charity wishes to support collaborative health projects with the key partners above, including expenditure with other charitable organisations to facilitate a common aim.
It is recognised the above partners will enhance formulation of the charitable funds agenda, providing key interaction with the Corporate Trustee with whom the ultimate responsibility for the Charity resides.
Strategic Aim 2: Local Planning
Local plans will be developed annually to identify how charitable donations will be used, in line with the Charity’s strategic goals. This will include the following:
South Locality Mid Locality North Locality Women & Childrens Directorate Mental Health Planning Directorate Executive Directorates
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How will we plan and implement improvements?
We are guided as a Charity by comprehensive standards issued by the Charities Commission, and the link to this is provided within the Charitable Funds Policy. Our inherent wish as a Charity is to use any donation made to us as wisely as possible in order that the maximum public benefit can be achieved.
Any donations made will be used wisely and it seems entirely appropriate that they should mirror the aims outlined within the tHB vision, i.e to improve health and wellbeing; to continually improve care and to work in an integrated way. However there is a need to plan locally how such donations can be used in order to ensure a well considered and planned approach. This will need to be balanced however with the flexibility in the use of relatively small amounts of charitable funds particularly in order to ensure that local decisions can be made quickly for the benefit of patients, staff and services users.
Fund managers supported by the Senior Locality teams/Directorate Managers will be required to fully consult and discuss with their teams, areas of service development and provision that can utilise the balance of funds held to ensure the expenditure of monies is fulfilled in a timely manner from when the donation is received. Fund Managers will be required to submit to their Management team at the beginning of the financial year a list of areas of expenditure that are considered as their priorities for the forthcoming year (accompanied by a statement of need and impact) so that the agreed plans can be approved locally and implemented to maximise the benefit from donations received. These plans will be reported to the Charitable Funds committee for information who will actively monitor updates against these plans to scrutinise that the expenditure is in line with the aims outlined by the Trustees and in turn fulfil the responsibility of the Corporate Trustee as defined by the Charities Commission.
Strategic Aim 3: Delegation
Policies will be developed to enable appropriate levels of flexibility to enable local decision making.
Creating a framework to enable delegation
The role of the Charitable Funds Committee, made up of trustees is important in setting the strategic direction for the generation and use of Charitable Funds, and for ensuring that donations are used appropriately and wisely. The Charitable Funds committee therefore will take a key role in ensuring that the plans put in
Charitable Funds Strategy Page 5 of 10 place for using charitable donations are implemented to the maximum benefit. This will include the provision of guidance to all staff responsible for the management or administration of charitable funds for their delegated areas to aid fulfilling this remit.
Strategic Aim 4: Impact
Arrangements for monitoring the use of charitable funds and identifying their impact to patients, staff and service users will be further strengthened.
How do we monitor the impact of utilising funds to the service?
The Charitable Funds Committee will develop methodology of reporting expenditure committed locally to the Charitable Funds Committee which will include a required submission on what impact and benefit has been achieved at local level by utilising the funds as outlined in the agreed annual plans. There will also be a mechanism developed to provide communication of these benefits to the Board as Corporate Trustee and other partners.
Strategic Aim 5: Publicity and Public Interest
Ways of sharing the benefit and the successful use of charitable donations with key stakeholders and the general public will be identified and implemented.
How will we share success?
The Charity has not to date sought to work as some other Charities in having a leading strategy on generating charitable income. The donations are made mainly as a result of personal patient or relative experience of the service provided.
It is also important for us to be able to make and demonstrate the difference made to patients, staff and service users through the use of charitable donations. ‘Making a difference’ is something that we, as a Charity, can do as a result of a charitable donation. It is incumbent therefore that we do much more to share the benefit and the successful use of such donations, as least in part to say ‘thank you’ but to also encourage others to consider donating where they can do so.
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The Charity will explore through discussions with local fund managers a method by which to publicise the successes of the charity and patient/population benefits received at local level by the use of charitable funds on a regular and consistent basis. The Charity acknowledges that nearly all the donations and support received is through the generosity of grateful service users and their families. Another key stream of income for the charity is often initiated by key stakeholders of the service (such as League of Friends or local community organised events), and it is important to ensure that patients and residents of Powys are informed how much of a difference this support makes to the work of the Charity and enhancing the provision of services
Conclusion
This short but important strategy outlines the strategic direction of the Charity and the important difference charitable donations can make to patients, staff, service users and other key stakeholders. It sets out how we will continue to improve the use of charitable donations to the maximum effect, and to share the benefit with a wide range of partners and stakeholders. The Strategy is anticipated to be implemented as part of a 2 year work programme which is outlined in appendix 2 to the strategy. This work programme will be led and monitored by the Charitable Funds Committee on behalf of the Corporate Trustee of the Charity, and reported through to the organisation’s Board.
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Appendix 1
Powys Teaching Health Board Charitable Fund – alignment with the tHB vision
The Charity is established within the Charities Commission guidance (Registered Charity Number 1057902) and is held to account for it management of charitable funds through guidelines prescribed by the Charities Commission and via established audit mechanisms. The Trustees of the Charity are responsible for ensuring the best use of donations is achieved. The main of aim of the charity is to support local health services for the population of Powys in improving the health and wellbeing benefits for patients/clients.
Local services are planned, contracted and in many cases provided by the Local Health Board which has set itself a Strategic vision and Strategic goals outlined within its Annual Plan. The vision is to ensure the health service provides
“truly integrated care centred on the individual”
The vision is supported by five important strategic goals:
1. Improving health and wellbeing 2. Ensuring the right access 3. Striving for excellence 4. Involving the people of Powys 5. Making every pound count
It is these strategic goals that support day to day activities and priorities, and therefore these are critical in shaping the strategy for the generation and use of charitable donations.
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Appendix 2
Implementation Programme for the Charitable Funds Strategy.
Strategic Aim Action Participants Estimated Progress Timescale reviewed by Charitable Funds Committee Partnership: Identify and further Executive Team, April 2013 Quarterly Further Develop engage with key Locality relationships with partners Management Key Partners and Teams, League of common set of Create links with Friends, Third priorities potential donating Sector Groups, bodies and other Local Authority charitable trusts.
Creating links with organisations via joint ventures
Local Planning: Provide mechanism Fund Managers, December Received Local Annual and assistance to Locality/Directorate 2012 Annually, and Plans developed local fund Management monitored managers for teams, Finance quarterly annual planning of Department charitable fund expenditure for consideration and approval by Locality/Directorate managers
Delegation: Provide guidance Charitable Funds December Reviewed Policies will be both through Committee, 2012 Annually developed to documents and Locality/Directorate enable local implementation Management decision making through workshops Teams, Staff Side to provide further Partners, Finance knowledge on Department charitable funds to local fund managers.
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Strategic Aim Action Participants Estimated Progress Timescale reviewed by Charitable Funds Committee Impact: Develop Charitable Funds December Monitored Monitoring the methodology of Committee, 2012 quarterly impact of the use reporting Locality/Directorate of charitable funds expenditure Management committed locally to Teams, Staff Side Charitable Funds Partners, Finance Committee. Department Monitoring the use and consideration evaluations of the effectiveness of charitable fund expenditure incurred and achievement of intended outcomes Publicity and Identify and Charitable Funds April 2013 Reviewed Public Interest: consider potential Committee, Annually, and Sharing the benefit communication Locality/Directorate monitored and the successful channels to Management quarterly use of charitable encompass wide Teams, tHB donations with key ranging audiences. Communications stakeholders and Officer the general public
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FOR DISCUSSION
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 3.1
INTEGRATED PERFORMANCE REPORT
Report of Director of Workforce & OD
Paper prepared by Director of Workforce & OD
Purpose of Paper The purpose of this paper is to:- provide the Board with an update and assurance on the progress being made on the delivery of the high level objectives included in the Annual Plan, and provide an update on the further progress being made to further develop the Health Board’s integrated performance report
Action/Decision required The Board is asked to:- NOTE To progress being made on the delivery of the high level objectives included in the Annual Plan, and NOTE the progress in the development of the performance management framework.
Link to ‘Doing Well, 1. Governance & Accountability Doing Better: Standards for Health Services in Wales’:
Link to Health Board’s Improving Health & Well-Being Corporate Plan Ensuring the Right Access Striving for Excellence Involving the People of Powys Making Every Pound Count
Acronyms and N/A abbreviations
Integrated Performance Report Page 1 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
HEALTH BOARD PERFORMANCE UPDATE
Introduction
This report serves to present the Board with the latest available performance information across the existing Tier 1 and Tier 2 priorities to provide the necessary assurance that the THB is meeting its targets.
The information required to support the delivery of the Integrated Performance Report is collected from a range of providers and external sources, normally monthly or quarterly in arrears. The tHB’s capacity to provide consistent and timely information in this regard has recently been the subject of external review supported by NWIS, but for the purposes of this report, there are reporting timeframes for targets and service areas which may differ.
This report does not include information on the tHB’s performance against its financial targets which is the subject of a separate report from the Director of Finance.
Background
In September the Board was provided with an update of the activity underway to develop the Health Board’s integrated performance management framework to enable the organisation to improve its capacity to track progress against its short, medium and longer term priorities in addition to meeting national targets which have been the focus of current arrangements. The work is part of the wider organisational development activity and seeks to support the delivery of the organisation’s objectives as identified in the Annual Plan 2012/2013. A key element of this work is the development of a Board performance dashboard.
The September report contained the proposed additional and revised performance measures and KPIs which were under development, identifying that this work would require further development and refinement together with alignment of information services to collect and report on activity against the measures. This work is ongoing through a small task and finish group comprising a few executive directors, operational management and the information team.
This performance update has been structured on the basis of the Annual Plan and will routinely incorporate the new measures and will populate the KPIs as the work progresses. Where this is not yet complete, or where there has been no update against the previous data, this is indicated.
Integrated Performance Report Page 2 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
ANNUAL PLAN AMBITION 1: IMPROVING HEALTH AND WELLBEING
Proposed Key aims: 1 Improve opportunity and life chances for children 2 Decrease the risk of premature death
1 Improve opportunity and life chances for children
Key Performance Indicators
• 1.1 Rate of immunisations and vaccinations against target • 1.2 Number of children in looked after system
2 Decrease the risk of premature death
Key Performance Indicators • 2.1 Uptake of flu vaccination amongst at-risk patients (current measure) • 2.2 measures to indicate that the correct levels of statins have been provided • 2.3 It was noted that there are longer-term outcomes such as smoking cessation, managing obesity, reducing diabetes which we may wish to monitor, but these are difficult to measure in the short-term
ANNUAL PLAN AMBITION 2: ENSURING THE RIGHT ACCESS
Proposed Key aims: 1. Maintain waiting time targets 2. Increase the proportion of appropriate care delivered in Powys 3. Reduce of the number of unscheduled admissions 4. Increase the % of people on an appropriate pathway
1 Maintain waiting time targets
Key Performance Indicators • 1.1 RTT by speciality and locality • 1.2 A&E waiting time • 1.3 WAST performance • 1.4 Cancer performance • 1.5 Mental Health • 1.6 Sexual Health
2 Increase the proportion of appropriate care delivered in Powys There has been no update on this data since the last Board
Integrated Performance Report Page 3 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
Key performance indicators Further work is underway to identify and refine the most appropriate measures to report on. The following information on Trauma & Orthopaedic (T&O) daycase activity is provided for illustration at this stage.
3 Reduce the number of unscheduled admissions
Key Performance Indicators: • Emergency/Unplanned admissions
4 Increase the % of people on an appropriate pathway
Key Performance Indicators • 4.1 Decrease in Delayed Transfers of Care (DToC) • 4.2 Bed occupancy levels • 4.3 Average Length of Stay (ALoS) • NAO (2011) indicators (these indicators have yet to be development or to be determined) o emergency admissions to hospital for people aged 65 and over; o emergency bed days for people aged 65 and over; o admissions to residential or nursing care; o admissions to residential or nursing care direct from hospital; and o the numbers of people dying at home.
ANNUAL PLAN AMBITION 3: STRIVING FOR EXCELLENCE
Proposed Key aims: • 1 Continually improve safety, quality and experience: • 2 Workforce: Ensure Staff are appropriately skilled to undertake their roles and develop to full potential.
1 Continually improve Safety, Quality and Experience
Key Performance Indicators (to include number of falls and pressure sores and Hospital Acquired Infections): • 1.1 Primary Care Prescribing Performance • 1.2 Hospital Acquired Infection Rates • 1.3 Safety indicators: To be determined • 1.4 Quality Indicators: To be determine • 1.5 Experience Indicators: To be determined
2 Workforce: ensure staff are appropriately skilled to undertake their roles and develop to full potential
Key Performance Indicators
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FOR DISCUSSION
• Number and % of staff appraisals completed within last 12 months (rolling 12m period) – benchmarked against a baseline for actual and targets over the year. A trajectory to measure against will be set. • Number and % of staff undergoing Mandatory training within required timescales, actual and target – to be developed ANNUAL PLAN AMBITION 4: INVOLVING THE PEOPLE OF POWYS
As noted above in section 1. It has been acknowledged that Powys has not previously reported routinely on this area and further work is underway to determine how we measure and report in relation to:
• engagement, consultation and involvement of patients and the public in the design and delivery of services • engagement, consultation and involvement of our staff and their representatives in the design and delivery of services and employment practice (the NHS Staff Survey will be of value in this respect) • Potential KPIs could include % of change achieved through a co-production model.
ANNUAL PLAN AMBITION 5: MAKING EVERY POUND COUNT
Proposed priority Aim 1: Powys is achieving financial balance • Potential KPIs: surplus or deficit against budget – actual against target, Activity volumes against agreed contracts, year to date and forecast for full year
Potential key performance indicator Monthly Paybill incorporating split between basic and variable pay.
Current Key performance indicator - Monthly Change in FTE (Data source ESR)
Integrated Performance Report Page 5 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
ANNUAL PLAN AMBITION 1: IMPROVING HEALTH AND WELLBEING
Proposed Key aims: 3 Improve opportunity and life chances for children 4 Decrease the risk of premature death
1 Improve opportunity and life chances for children
Key Performance Indicators
• 1.1 Rate of immunisations and vaccinations against target • 1.2 Number of children in looked after system
1.1 Rate of childhood immunisations and vaccinations against target
Information on vaccine uptake in children in Wales is published on a quarterly basis. The latest report was published in August 2012 (COVER 103). There has been no update on this data since the last Board
Comparison with national uptake rates Figure 1 in conjunction with table 1, shows that Powys is above the 95% target for all vaccinations for 1 year olds. Powys’ uptake is similar, but slightly lower than national rates for 2 and 5 year olds, and is some way behind Welsh targets for MMR1 and MMR2 in 16 year olds. Powys rates for 3 in 1 in 16 year olds is higher than the Welsh figure.
PtHB trends in routine childhood immunisations Source: Public Health Wales quarterly COVER reports
Integrated Performance Report Page 6 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
Age Vaccination Powys Wales Age Vaccination Powys Wales 2 MMR1 93.0% 94.5% 1 5 in 1 95.1% 96.0% 5 MMR2 87.4% 89.1% 2 PCV 93.7% 95.4% 16 MMR1 86.5% 91.6% 2 Hib/MenC 92.7% 94.5% 16 MMR2 74.7% 83.3% 5 4 in 1 90.0% 91.2% 16 3 in 1 80.6% 78.4% Uptake of immunisations for resident children between 01/04/12 and 30/06/12 Source: Public Health Wales quarterly COVER reports
Powys would have achieved 95% uptake for 2012 quarter 1 if the following number of additional children had been vaccinated:
Age Vaccination No. to target 2 MMR1 6 5 MMR2 26 16 MMR1 33 16 MMR2 79 2 PCV 4 2 Hib/MenC 7 5 4 in 1 17 16 3 in 1 56 Numbers required to reach 95% take up target for 2012 Quarter 1 Public Health Wales quarterly COVER reports
Action To increase MMR uptake in teenagers, a joint project is being undertaken by Public Health and the Women and Children’s Directorate to develop a MMR catch up campaign for Year 9 pupils. The catch-up programme is planned for Autumn 2012. A Powys Immunisation Planning Group Action Plan has been developed to incorporate improvement actions to improve uptake. This plan is regularly reviewed and updated by the Group.
HPV vaccination
Powys Wales Resident No. Resident No. Age children immunised % children immunised % 13 702 506 72.1 16,425 12,432 75.7 14 690 562 81.4 16,941 14,576 86.0 15 733 581 79.3 17,480 14,605 83.6 16 690 594 86.1 16,975 14,827 87.3 17 733 578 78.9 17,345 13,783 79.5 Uptake of HPV vaccine (3 doses) in girls aged 13 to 17. Source: Public Health Wales quarterly COVER reports
Integrated Performance Report Page 7 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
Table 3 compares HPV vaccine uptake rate between Powys and Wales for the period 01/04/12 and 30/06/12. This shows that HPV uptake in Powys is lower than Welsh national rates.
Action An audit of current HPV uptake by school is planned for the autumn term 2012 to better understand reasons for low uptake.
1.2 Number of children in looked after system
30 Sept 11 31 Dec 11 31 Mar 12 30 Jun 12 Total looked after 158 168 172 161
In/Out of County In 107 117 116 110 Out 50 51 56 51
Team Rate per 10,000 pop 0-17 Powys (27,690) 57.1 60.7 62.1 58.1 Brecon & Ystradgynlais (7,814) 46.1 48.6 53.7 48.6 Radnor (6,274) 52.6 66.9 71.7 68.5 Newtown (5,825) 56.7 54.9 49.8 46.4 Welshpool (7,777) 30.9 29.5 27.0 24.4 Source: Corporate Parenting Report - Powys People Services Directorate
2 Decrease the risk of premature death
Key Performance Indicators • 2.1 Uptake of flu vaccination amongst at-risk patients (current measure) • 2.2 measures to indicate that the correct levels of statins have been provided 2.3 It was noted that there are longer-term outcomes such as smoking cessation, managing obesity, reducing diabetes which we may wish to monitor, but these are difficult to measure in the short-term
Current Key Performance Indicator
4.1 Uptake of flu vaccination amongst at-risk patients in Powys 2011/12
Regular Influenza Vaccination uptake reports for Health Boards are available. In addition, there are monthly vaccination uptake reports available for GP Practices. There has been no update on this data since the last Board
• Patients aged 65 years and over
Date Powys Powys Powys uptake Wales uptake Immunised denominator 28.02.12 18031 26940 66.9% 67.3%
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FOR DISCUSSION
GP Practice Uptake - latest (10/04/12 ) figures for GP Practice uptake for patient aged 65 years and over show that uptake varies from 57.8% (Cemmaes Road) and 56.8% (Rhayader Medical Practice) to 79.5% (Presteigne Medical Practice).
• Patients aged less than 65 years who are at risk
Date Powys Powys Powys uptake Wales uptake Immunised denominator 28.02.12 5729 11626 49.3% 50.1%
GP Practice uptake - latest (10/04/12) figures for GP Practice uptake for patients under 65 who are at risk show that uptake varies from 36.7% (Montgomery Medical Practice) to 59.6% (Presteigne Medical Practice).
Action – A flu subgroup has been set up to develop a systematic approach to improving flu vaccination uptake. It is also within the objectives of each locality to develop a local plan to increase uptake of the flu vaccination. These plans will be monitored as the flu campaign progresses. A related plan relating to the uptake amongst the tHB’s workforce is also under development.
4.2 Measures to indicate that the correct levels of statins have been provided Indicators to be determined
4.3 Longer-term outcomes such as smoking cessation, managing obesity, reducing diabetes which we may wish to monitor Indicators to be determined.
Integrated Performance Report Page 9 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
ANNUAL PLAN AMBITION 2: ENSURING THE RIGHT ACCESS
Proposed Key aims: 5. Maintain waiting time targets 6. Increase the proportion of appropriate care delivered in Powys 7. Reduce of the number of unscheduled admissions 8. Increase the % of people on an appropriate pathway
1 Maintain waiting time targets
Key Performance Indicators • 1.1 RTT by speciality and locality • 1.2 A&E waiting time • 1.3 WAST performance • 1.4 Cancer performance • 1.5 Mental Health • 1.6 Sexual Health
1.1 Referral to Treatment (RTT) • 95% of patients to be treated within 26 weeks, and • 100% patients to be treated within 36 weeks.
The information below provides a summary of the waiting time position for Powys tHB patients using the latest available information which is for August.
> 26 Weeks but < 36 weeks > 36 Weeks June July Aug June July Aug % of % of % of % of % of % of No total No total No total No total No total No total ABM ULHB 67 5.50% 84 6.70% 83 6.40% Aneurin Bevan LHB 119 7.10% 121 7.40% 135 8.40% Betsi Cadwaladr ULHB 18 7.70% 15 7.10% 16 7.70% Detailed information cannot be disclosed due to Cardiff & Vale the possible identification of individual patients as ULHB 50 17.40% 51 16.60% 41 12.70% the numbers are small Cwm Taf LHB 19 11.00% 22 12.90% 25 16.00% Hywel Dda LHB 67 10.60% 36 6.90% 44 1.30% Powys Teaching LHB 50 1.00% 38 0.70% 67 1.40% Wales total 390 4.20% 367 4.00% 411 3.50% 41 0.40% 48 0.50% 33 0.30% English Trusts 135 3.50% 128 3.20% 0 N/A 42 1.10% 46 1.10% 47 1.10% Grand Total 525 4.00% 495 3.70% 0 N/A 83 0.60% 94 0.70% 77 0.60%
At the aggregate level the 26 week 95% target is being met for Powys patients whether treated in Wales or in England.
The latest available information for English providers (August) shows a number of patients have breached the 36 week target. A breakdown by provider and length of wait is below.
Integrated Performance Report Page 10 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
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Between the Specialities of T&O and Ophthalmology there were a number of patients waiting between 36 and 52 weeks at Robert Jones & Agnes Hunt, Wye Valley Trust and Shrewsbury & Telford Hospitals Trust.
Number of weeks waiting 41- 45- 49- Total > 36 Location Speciality 36-40 44 48 52 wks Robert Jones T&O 13 8 5 18 44 There are a small number of patients waiting longer than Wye Valley 36 weeks for these 2 providers but due to the possible identification of individual patients the numbers cannot be disclosed Shrewsbury
Action With regard to breaches at Robert Jones there is an on-going management plan to address breaches which includes additional evening and weekend sessions. The number and extent of the breaches is being reduced and PtHB continues to monitor the situation.
At Shrewsbury & Telford Hospitals (SaTH) the patient(s) waiting over 36 weeks in Ophthalmology have been seen and no further patients have slipped into this category. SaTH had reported that their service delivery difficulties were due to a ‘never event’ which had caused a reduced service and limited capacity. The North Powys Locality General Manager is working in partnership with Hywel Dda Health Board to increase services delivered by Hywel Dda Health Board in Bronglais and in ‘outreach’ in North Powys.
The Wye Valley Trust (WVT) breach(s) have been rectified and attendance dates at WVT agreed.
The latest available information for Welsh providers (August) shows a number of patients have breached the 36 week target. A breakdown by provider is below.
No. wks waiting Location 36 - 105 ABM ULHB 8 Cwm Taf LHB 8 Cardiff & Vale 15
For the Welsh Providers of Hywel Dda, ABMU, Cardiff & Vale and Cwm Taf there were a number of patients waiting for between 36 and 105 weeks. The number of patients at Hywel Dda cannot be disclosed due to the possible identification of individual patients. A breakdown by Speciality is not available to the possible identification of individual patients.
Action The reasons for these breaches, and actions being taken to address them, are under investigation by PtHB.
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1.2 Unscheduled Care - Accident & Emergency performance • 95% of all patients should spend no longer than 4 hours in a major A&E department from arrival until admission, transfer or discharge.
Powys residents attended A&E at 26 sites around Wales. There were 10 sites where the 95% target was not met; they are in the table below. Over all 94.35% of Powys residents spent no longer than 4 hours in A&E. Powys teaching Health Board achieved 100% within our MIUs.
Hospital Site Jul-12 Bronglais General Hospital 86.36% Morriston Hospital 89.47% Neath Port Talbot Hospital 87.50% Nevill Hall Hospital 66.67% Prince Charles Hospital 92.31% Princess Of Wales Hospital 66.67% Royal Gwent Hospital 50.00% University Hospital Of Wales 89.47% West Wales General Hospital 87.50% Ysbyty Gwynedd 66.67%
Latest performance for Powys residents attending major A & E departments in Welsh hospitals where the target of 95% has not been met
The performance levels for the percentage of Powys patients being seen within 4 hours vary considerably and we have little ability to directly address these breaches which are addressed as part of the provider compliance. Some of this variation is due to the fact that the numbers attending are small which can skew the percentages disproportionately.
Action The DSU is working with Health Boards to improve A&E performance and system flow. Powys participates on a daily basis in the executive capacity call. In addition, the Welsh Government has recently invited organisations to bid for funding for initiatives to ease pressures on the USC system. Powys has been awarded £370k.
Information is not available for Powys residents attending major A & E departments in English hospitals. However both Shrewsbury (SaTH) and Hereford (WVT) have consistently met the 95% A&E target.
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1.3 WAST performance for Powys • Target - 60% of Category A calls are attended within 8 minutes.
WAST performance ‐ % of category A calls attended within 8 minutes ‐ target = 60% Year on year comparsion using rolling 12 month period (not Financial Years) 70
65 minutes
8
60 within 55
50 attended
45 Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
Percentage 2010/11 2011/12 Target Linear (Target)
Ambulance Response times for Powys category A calls
The rural nature of Powys, rising demand and ambulance handover issues at major A&E departments remain a challenge. The latter issue means that ambulances are delayed at the respective DGHs leaving resources in Powys stretched. However, over the rolling 12 month period, the target was achieved in ten of the twelve months and consistently since December 2011. The performance of WAST will remain a collective focus of WAST and LTHBs and WG/WAST will formally review handover and compliance processes.
1.4 Cancer (Latest available information – July 2012. Source: StatsWales). N.B. it is anticipated at the time of drafting this report, that additional information specific to Powys patients and provider location will be available over the following two weeks. If available, this will be provided prior to or at the Board.
31 day target. • patients not referred as urgent suspected cancer, but subsequently diagnosed with cancer, start definitive treatment within 31 days of diagnosis regardless of the referral route.
Across Wales compliance with the 98% target has been maintained with Wales achieving 98%. Half of LTHBs are achieving the 98% target individually and the target has been achieved for 27 consecutive months at the all Wales level. Specific performance measures relating to Powys are being developed.
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FOR DISCUSSION
62 day target • patients referred by their GP with urgent suspected cancer, and subsequently diagnosed as such by a cancer specialist, start definitive treatment within 62 days of receipt of referral.
The latest performance across Wales was 87% against a 95% target. In part this deterioration is reflective of the backlog of patients whose treatments were postponed in December/January and the fluctuation in capacity. The DSU are working with those organisations, which have failed to achieve the target, to ensure a focussed improvement in performance. Specific performance measures relating to Powys are being developed.
1.5 Mental Health – access to crisis resolution services Target • 95% of services users who are admitted to a psychiatric hospital between 9am and 9pm to have received a gate-keeping assessment by the Crisis Resolution Home Treatment prior to admission.
Currently Powys is achieving 60% against this target as only service users in Ystradgynlais and Mid and South Powys have access to these services.
Target • 100% of service users who are admitted to a psychiatric hospital, who did not receive a gate-keeping assessment by the CRHTs, to have received a follow up assessment by the CRHTs within 24 hours of admission.
Currently Powys is achieving 60% performance against this target as only service users in the Ystradgynlais and Mid and South Powys have access to these services.
Action A task and finish group has been established in partnership with Betsi Cadwaladr University LHB (BCU) which is exploring the most appropriate model for Out Of Hours (OoH) services for North Powys, including crisis team development. In September the Mental Health team met with representatives from BCU and the Local Authority to make progress with the model in North Powys. The Team are also exploring interim solutions.
1.6 Sexual Health There has been no update on this data since the last Board
Target • all patients, who require access, have access to core sexual health services (HIV and sexually transmitted infection testing and routine contraception advice) provided by appropriate specialists within 2 working days.
There is no specific information available at present in relation to Powys residents attending Genito-Urinary Medicine (GUM) services outside the county. The main reasons for the current performance include the following:-.
Integrated Performance Report Page 14 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
• GUM services are currently provided by a Visiting GUM Consultant who is employed by Hywel Dda LTHB; • The current configuration of GUM service provision with two sessions one at Newtown and one at Builth on the same day i.e. once a week poses a challenge for Powys residents to access local services within the 48 hour target; • Powys is only able to report data for the Powys GUM services. However, it should be noted that Powys residents are able to access GUM services at hospitals situated in neighbouring Health Board areas.
Action The tHB’s Sexual Health Strategy was considered by the Board in August 2011. A range of costed options to improve service provision were considered by in July 2012 and agreed in principle. However, currently the THB is unable to release new funds to support the preferred options. Funding sources continue to be explored.
2 Increase the proportion of appropriate care delivered in Powys There has been no update on this data since the last Board
Key performance indicators Further work is underway to identify and refine the most appropriate measures to report on. The following information on Trauma & Orthopaedic (T&O) daycase activity is provided for illustration at this stage.
T&O Daycase activity (NB: This analysis is of procedures recorded in the National Admitted Patient Care (APC) dataset using full Standard Definitions. Standard definitions do not include activity that is not Consultant led e.g. procedures undertaken by a General Practitioner with Special Interest (GPwSI)
Summary: over the last 5 financial years • T&O activity for Powys residents has increased by 107% - with increases in the North of 152%, the Mid of 87% and the South of 72%. • T&O activity taking place in Powys has increased by 35%, with 0% in the North, 8% in Mid and 72% in South.
The number of T&O procedures has more than doubled from 707 to 1,463, an increase of 107%. Activity undertaken in Powys has varied from 126 to 188; in the last financial year the activity was towards the top of that range at 170. The number of T&O procedures undertaken outside of Powys has increased from 581 to 1,293 (123%) over the period.
T&O activity by location that the activity took place
2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 Total % of Total % of Total % of Total % of Total % of Location activity total activity total activity total activity total activity total PtHB 126 18% 188 18% 159 14% 145 11% 170 12% Non Powys Sites 581 82% 871 82% 992 86% 1125 89% 1293 88% Total 707 100% 1059 100% 1151 100% 1270 100% 1463 100%
Integrated Performance Report Page 15 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
As the amount of activity taking place in Powys is relatively flat, whereas the activity taking place outside of Powys has risen significantly, then the percentage of activity actually taking place in Powys has fallen from 18% to 12% over the 5 year period.
T&O activity, change over 5 years from 2007/08 to 2011/12 Location that % change in procedure took activity from place 2007/08 to 2011/12 Powys Teaching LTHB 35% Non Powys Sites 123% Total 107%
T&O activity by location that the activity took place T&O procedures 2007/08 to 2011/12
160018% 18% 1463 20% 1400 1270 18% 1151 16% 1200 1059 14% 11% 12% 14% 1000 12%
procedures 707 800 10% of 600 8% 6% 400 126 188 159 145 170 4% Number 200 2% 0 0% 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 Financial year
All Procedures Procedures undertaken in Powys % of procedures undertaken in Powys
The overall increase in day case activity will be partly due to the incremental switch from inpatients to day case not purely increases in demand. Increased activity is also reflective of changes to waiting times over the period and the need to address backlogs in some years to achieve RTT.
The data provided does not include activity that has been switched to non consultant led intervention but which is still done in Powys e.g. podiatric surgery
Integrated Performance Report Page 16 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
3 Reduce the number of unscheduled admissions
Key Performance Indicators: • Emergency/Unplanned admissions
Below is information showing the number of emergency admissions of Powys patients for the last 2 years. More detailed information is available with respect to location of admission and speciality of admission. This is the subject of a detailed report that is currently being developed by PtHB Information Team and it is proposed that this is the focus of a future more detailed report/annex.
Emergency admissions of Powys patients to Welsh providers for the last 2 years, together with the relative 12 month averages. Emergency admissions of Powys patients by Welsh providers ‐ rolling 12 month period (not Financial Years) 600 580 560 540 admitted
520 500 480 patients
of 460
440 No. 420 400 Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
Welsh providers 2010‐11 Welsh providers 2011‐12 Wales ave 2010‐11 Wales ave 2011‐12
Integrated Performance Report Page 17 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
Emergency admissions of Powys patients to English providers for the last 2 years, together with the relative 12 month averages. Emergency admissions of Powys patients by English providers ‐ rolling 12 month period (not Financial Years) 600 580 560 540 admitted
520 500 480 patients
of
460
No. 440 420 400 Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
English providers 2010‐11 English providers 2011‐12 Eng ave 2010‐11 Eng ave 2011‐12
Emergency admissions – top 10 Diagnosis Groups – April 2010 to June 2012 Symptoms, signs and abnormal Emergency admissions of Powys registered patients clinical and laboratory findings, not elsewhere classified Injury, poisoning and certain other consequences of external causes Diseases of the respiratory 600 system Diseases of the circulatory 500 system Diseases of the digestive system 400 Diseases of the genitourinary 300 system Diseases of the musculoskeletal system and connective tissue 200 Neoplasms 100 Certain infectious and parasitic diseases 0 10/11 10/11 10/11 10/11 11/12 11/12 11/12 11/12 12/13 Mental, Behavioral and Neurodevelopmental disorders Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
Emergency admissions – main constituents of the Diagnosis Group “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified" – April 2010 to June 2012
Integrated Performance Report Page 18 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
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Dyspnoea Nausea and vomiting Senility 5% 5% 5% Chest pain, unspecified Precordial pain 18% 6%
Headache Pain localized to 7% other parts of lower abdomen 14% Pain localized to upper abdomen Other and 7% unspecified Other chest abdominal pain pain 13% 9% Syncope and collapse 11%
Emergency admissions of Powys registered patients
Action. This is currently being addressed as one of the three core projects under the accelerated clinical change programme.
4 Increase the % of people on an appropriate pathway
Key Performance Indicators • 4.1 Decrease in Delayed Transfers of Care (DToC) • 4.2 Bed occupancy levels • 4.3 Average Length of Stay (ALoS)
• NAO (2011) indicators (these indicators have yet to be development or to be determined) o emergency admissions to hospital for people aged 65 and over; o emergency bed days for people aged 65 and over; o admissions to residential or nursing care; o admissions to residential or nursing care direct from hospital; and o the numbers of people dying at home.
4.1 Delayed Transfers of Care (DToC)
The four graphs below show the number of patients delayed and the total number of days that the patients have been delayed within Powys tHB Hospitals for the period from July 2011 to August 2012.
Integrated Performance Report Page 19 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
Number of DToC patients for non‐Mental Health 35 30 25
patients 20
of 15 10 Number 5 0
Number of non-Mental Health DToC patients
Number of DToC patients for Mental Health 12
10
8 patients
of 6
4
Number 2
0
Number of Mental Health DToC patients
Integrated Performance Report Page 20 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
Number of DToC days for non‐Mental Health 1,800 1,600 1,400 1,200 days
of 1,000
800 600 Number 400 200 0 12 12 12 12 12 12 11 11 11 11 12 12 11 11 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Jul Jul Jan Jun Oct Apr Feb Sep Dec Aug Aug Nov Mar May Number of non-Mental Health DToC days
Number of DToC days for Mental Health 700 600 500 days 400 of
300
Number 200 100 0
Number of Mental Health DToC days
As previously reported to the Board meeting there was an increase in the number of non- Mental Health DToC patients towards the end of 2011. The reasons given at that time were: • The level of demand for Care Home places and in particular the availability of care homes within the contract price range acceptable to the Local Authority; • The rate of discharge of patients from Shrewsbury and Telford NHS Trust (SaTH) has increased as a result of SaTH’s changing practice to discharge patients more quickly; • Issues relating to multi-professional discharge planning for complex care patients and the requirement to complete a Decision Support Tool are causing some delay although this has reduced generally; • The availability of Home Care providers in certain parts of the County as a result of lack of market availability and some safeguarding restrictions.
At that time it was noted that the Director of Social Services was aware of the increases in the DToC rate and a new interim Head of Adult Services would be working closely with the Integrated Performance Report Page 21 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
Health Board to agree actions for reducing or resolving the delays. Furthermore, close monitoring and agreed escalation of discharge arrangements from Shrewsbury in particular was taking place to ensure good outcomes were achieved. As evidenced in the charts the position has improved.
Action The reduction of DToC remains a key priority for both the teaching Health Board and Powys County Council. The tHB monitors the performance of this target through the Unscheduled Care Partnership Board led by the tHBs Medical Director. Action plans have been developed to achieve the targets and these include the following main actions:
• A weekly DToC escalation and review process is in place between the tHB and Local Authority colleagues to review the most complex cases on an individual basis; • Increased working with the Third Sector for Tier 1 Services; • Improved goal setting through MDT’s; • The appointment of Care Transfer Coordinators to support discharge from DGHs into more appropriate community settings in Powys; • Extension of the District Nursing and reablement services; and • Further discussions on pathway changes/ alternatives to admission for frail elderly/ those with chronic conditions.
Powys Hospitals Efficiency & Capacity
4.2 Bed occupancy levels
The indicative target of optimum efficiency is a minimum of 85% bed occupancy level. The tables below provide information relating to the bed occupancy levels at Powys Hospitals for July 2012.
Without August 2012 With DToC DToC Brecon 89% 76% Bronllys 89% 89% Builth 70% 59% Knighton 88% 88% Llandrindod 95% 95% Llanidloes 91% 73% Machynlleth 93% 78% Newtown 95% 69% Welshpool 97% 62% Ystradgynlais 91% 80% Bed Occupancy levels at Powys Hospitals with and without DToC patients
The information in the tables indicate that the level of DToC patients has a significant impact on the operational bed management within Powys Community Hospitals. As above, the reduction of DToC remains a key priority for the teaching Health Board as the release of a proportion of these beds could present a significant resource and opportunity for the tHB to repatriate patients from DGHs.
Integrated Performance Report Page 22 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
4.3 Average Length of Stay (ALOS)
The All Wales target for ALOS for Combined Medicine is 9.3 days. However, this target does not capture the different and varied patient groups within Powys Hospitals and the tHB is working with WG to develop a different and more appropriate set of metrics to capture the correct data for Powys residents against the specific ALOS target.
Average Length of Stay in Powys Hospitals 12 months to August 2012. All Powys. (Monthly average = 26) 40 35 30 25 days 20 of
15 No. 10 5 0 Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
Average Length of Stay in Powys Hospitals by individual Hospital. 12 months to August 2012. (Monthly average for all Hospitals = 26) 40 35 30 25 days 20 of 15
No. 10 5 0
Note: There is a piece of work underway to investigate the links between Average Length of Stay and Bed Occupancy which should be available for the next Board meeting.
Integrated Performance Report Page 23 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
ANNUAL PLAN AMBITION 3: STRIVING FOR EXCELLENCE
Proposed Key aims: • 1 Continually improve safety, quality and experience: • 2 Workforce: Ensure Staff are appropriately skilled to undertake their roles and develop to full potential.
1 Continually improve Safety, Quality and Experience
Key Performance Indicators (to include number of falls and pressure sores and Hospital Acquired Infections): • 1.1 Primary Care Prescribing Performance • 1.2 Hospital Acquired Infection Rates • 1.3 Safety indicators: To be determined • 1.4 Quality Indicators: To be determine • 1.5 Experience Indicators: To be determined
1.1 Primary Care Prescribing within Powys tHB: • Is comparatively cost effective and continues to improve; • continues to be the lowest LTHB cost per Prescribing Unit (PUs = all patients under 65=1 PU, over 65=3PU) of the 7 LTHBs.
Overall, the qualitative aspects of Primary Care prescribing within Powys compare favourably to the rest of Wales, although there is variation between practices. The tHB is continuing to work with GP leads to identify areas within prescribing and other aspects of medicines use that may be effective in reducing overall costs to the health economy, while supporting, or improving, the safety and quality of care provided.
1.2 Hospital Acquired infection rates
The target for reduction in the number of Clostridium Difficile cases is on course. The reduction in cases has resulted from a number of key strategies being implemented including hand hygiene audits, a focus on environmental cleanliness through Credits for Cleaning monitoring, and the increased focus on antimicrobial prescribing. There is however further work to do in reaching the ambitious goal of zero incidence of Clostridium Difficile. One case was reported in August 2012 (PH Wales Report)
2 Workforce: ensure staff are appropriately skilled to undertake their roles and develop to full potential
Key Performance Indicators • Number and % of staff appraisals completed within last 12 months (rolling 12m period) – benchmarked against a baseline for actual and targets over the year. A trajectory to measure against will be set. • Number and % of staff undergoing Mandatory training within required timescales, actual and target – to be developed
Integrated Performance Report Page 24 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
Compliance with IPR – based on current reporting and not proposed measures.
The tHB has set objectives within its Corporate Plan to ensure that all employees receive individual performance reviews on an annual basis. In support of this, Executive Directors have agreed an action plan which is being championed by the Director of Workforce & OD and monitored by Executive Directors receiving regular reports on progress. The chart below provides the monthly trend in the percentage of staff in receipt of a review on a rolling 12 months basis.
Powys tHB IPRs. Rolling % Aug 2011 to July 2012 (Data source eKSF)
The chart aboveshows that a significant improvement was made up to December 2011; however further improvement has not been made and performance remains considerably short of the tHB target of 100% of staff.
Action. The following actions have been taken:
• A paper based eKSF Lite review process has been implemented for managers to use with their staff. This is simplified process that should help to improve performance in this area. • Regular progress reports are presented to the Executive Team via this report, monthly Locality Performance reports and the Quarterly Workforce Performance Information report. • A cascade providing the opportunity for team based objectives to be developed as part of the process has been implemented in August which it is hoped will result in increased uptake. • There are also development at national level as part of the implementation of the Working Differently: Working Together implementation.
Integrated Performance Report Page 25 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
ANNUAL PLAN AMBITION 4: INVOLVING THE PEOPLE OF POWYS
As noted above in section 1. It has been acknowledged that Powys has not previously reported routinely on this area and further work is underway to determine how we measure and report in relation to:
• engagement, consultation and involvement of patients and the public in the design and delivery of services • engagement, consultation and involvement of our staff and their representatives in the design and delivery of services and employment practice (the NHS Staff Survey will be of value in this respect) • Potential KPIs could include % of change achieved through a co-production model.
Integrated Performance Report Page 26 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
ANNUAL PLAN AMBITION 5: MAKING EVERY POUND COUNT
Proposed priority Aim 1: Powys is achieving financial balance • Potential KPIs: surplus or deficit against budget – actual against target, Activity volumes against agreed contracts, year to date and forecast for full year
Further work is required to identify and define the key performance indicators for this ambition. In the meantime, the financial performance of the organisation and the actions being taken to address areas where progress is off track are the subject of the report of the Director of Finance.
Potential key performance indicator Monthly Paybill incorporating split between basic and variable pay.
Current Key performance indicator - Monthly Change in FTE (Data source ESR)
Powys tHB Staff Full Time Equivalents August 2011 to July 2012
Between August 2011 and July 2012 there has been a net decrease of 171.55 FTE. This is due primarily to the transfer of 209.93 FTE BSC staff to the Shared Services Partnership offset by increases due to the appointment of staff to the All Wales Continuing Care and NISCHR functions, both are externally funded. The change also reflects the movement of seconded employees into substantive posts.
Vacancies above pay Band 7 are reviewed, scrutinised and challenged by the Executive Team on a weekly basis to ensure that, where appropriate, both service and role redesign have taken place before a post is advertised.
Integrated Performance Report Page 27 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
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Conclusion
The tHB is meeting the majority of its externally determined targets. Where performance is not on track, corrective action plans are in place to bring these in line.
As identified, further action is underway to refine the performance management and associated framework to enable the Health Board to assess its progress against its core objectives as well as meeting the targets set by the Welsh Government. This includes considering the recommendations of the information review.
Recommendation
The Board is asked to:- NOTE To progress being made on the delivery of the high level objectives included in the Annual Plan, and NOTE the progress in the development of the performance management framework.
Report prepared by: Presented by: Jo Davies and Paul Cronin Andrew Cottom Director of Workforce and OD and Chief Executive Senior Performance Analyst
------
Background Papers Annual Plan 2012/12 Together for Health (2011) New Directions for Powys (2011) Quality Delivery Plan (2012) Financial Consequences Not addressed Other resource Implications Not addressed Consultees Not addressed
Integrated Performance Report Page 28 of 28 Board Meeting 24 October 2012 Agenda Item 3.1
FOR DISCUSSION
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 3.2
PROFESSIONAL NURSING AND MIDWIFERY REPORT: PROGRESS IN IMPLEMENTING THE NURSING AND MIDWIFERY STRATEGY (2011/14)
Report of Director of Nursing
Paper prepared by Director of Nursing
Purpose of Paper To provide the Board with an update on progress in delivering the strategy
Action/Decision required The Board is asked to NOTE the Professional Nursing and Midwifery Report.
Link to ‘Doing Well, This paper support standards: Doing Better: Standards 1. Governance and accountability framework for Health Services in 2. Equality, diversity and human rights Wales’: 3. Health Promotion, Protection and Improvement 5. Citizen Engagement and Feedback 6. Participating in Quality Improvement Activities 7. Safe and Clinically Effective Care 8. Care Planning and Provision 10. Dignity and respect 12. Environment 13. Infection Prevention and Control (IPC) and Decontamination 14. Nutrition 18. Communicating Effectively 19. Information Management and Communications Technology 21. Research, Development and Innovation 23. Dealing with concerns and managing incidents 24. Workforce Planning 26. Workforce Training and Organisational Development
Professional Nursing and Midwifery Page 1 of 4 Board Meeting Report: Progress in implementing 24 October 2012 the Nursing and Midwifery Strategy Agenda Item 3.2 (2011/14)
FOR DISCUSSION
Link to Health Board’s Improving Health and Wellbeing Annual Plan Ensuring Right Access Striving For Excellence Involving the People of Powys Making Every Pound Count Acronyms and abbreviations
Professional Nursing and Midwifery Page 2 of 4 Board Meeting Report: Progress in implementing 24 October 2012 the Nursing and Midwifery Strategy Agenda Item 3.2 (2011/14)
FOR DISCUSSION
PROFESSIONAL NURSING AND MIDWIFERY REPORT: PROGRESS IN IMPLEMENTING THE NURSING AND MIDWIFERY STRATEGY (2011/14)
Background
One of the key aims within the Annual Plan is the implementation of the Nursing and Midwifery Strategy. The Strategy was approved in September 2011 and runs for a period of 3 years. A commitment was made to produce an annual report on progress alongside a refresh of the main aims and commitments in order that the strategy remains dynamic. The attached report is aimed at a broad audience and in line with being open and transparent will be made available widely to key stakeholders. In order to manage its size, a summary of the key developments is given, however further detail is available upon request.
Progress
The report indicates progress made against 4 enabling aims and 5 strategic aims. There is read across to the organisations strategies and Annual Plan, with an annual refresh enabling the strategy to continue to be a major part of delivering organisational objectives.
Progress has been made in all areas of the strategy; however more has been achieved in the following key areas. These include:
- Evidence based and citizen centered care - Nursing and Midwifery workforce development - Caring with dignity, respect, compassion and professionalism - Improving the safety and quality of care by reducing waste, harm and variation
In line with the organisations aspiration, leading innovation and building capacity for research and development in rural healthcare are areas that require additional focus. This will also support a greater ability to share excellent practice both within and outside of the organisation. These are priority areas for the coming year and already link into work regarding the ‘teaching’ status of the organisation for example.
Conclusion
Good progress has been made in the first year of the strategy. A review and refresh has provided an opportunity for reflection, with renewed energies for the coming year. Ensuring the positive Powys story is heard and understood is a key aim in the coming year, driven by creative and innovative practice development.
Recommendation
The Board is asked to NOTE the Professional Nursing and Midwifery Annual Report.
Professional Nursing and Midwifery Page 3 of 4 Board Meeting Report: Progress in implementing 24 October 2012 the Nursing and Midwifery Strategy Agenda Item 3.2 (2011/14)
FOR DISCUSSION
Report prepared by: Presented By: Carol Shillabeer Carol Shillabeer Director of Nursing Director of Nursing
Background Papers Professional Nursing and Midwifery Report
Financial Consequences None
Other Resource Implications None
Consultees None
Professional Nursing and Midwifery Page 4 of 4 Board Meeting Report: Progress in implementing 24 October 2012 the Nursing and Midwifery Strategy Agenda Item 3.2 (2011/14)
Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
Nursing and Midwifery Annual Professional Report 2011-2012
Introduction
This report provides an overview of the development of nursing and midwifery within Powys teaching Health Board and within its sphere of influence. The intended audience is broad – to include nursing and midwifery professionals themselves, other professionals, the Board, the Chief Nursing Officer for Wales, patients and the wider public. In a context where the need for public accountability and transparency is increasing, the nursing and midwifery professions should ‘stand tall’ in describing where excellence in professional practice is achieved and the areas where improvements are required. The report aligns to the Powys teaching Health Boards Nursing and Midwifery Strategy 2011-2014 reflecting progress made against the key strategic aims.
Strategic Overview
The Nursing and Midwifery Strategy for Powys teaching Health Board was approved in September 2011. The key aims of the strategy are summarised as:
Underpinning Enablers: Highly effective leadership and management Evidence based and citizen centered care Nursing and Midwifery workforce development Articulating and valuing the contribution of Nursing and Midwifery
Strategic Aims: Improving the health of the population working in partnership Caring with dignity, respect, compassion and professionalism Improving the safety and quality of care by reducing waste, harm and variation Caring closer to home Leading innovation and development in rural healthcare
The report covers only some of the key practice developments and achievements and further detail is available. It is important to ensure that the strategic aims and priorities are adapted as new developments within the profession, the organisation and the country occur, ensuring a dynamic rather than static approach. Undertaking a review of progress brings an ideal opportunity to affirm or modify strategic aims.
There are approx 450 whole time equivalent registered nurses and midwives working in Powys teaching Health Board. The diversity of roles is significant – from health visiting, school nursing, child and adolescent mental health, district nursing, hospital nursing, theatres, minor injury units, specialist nursing, midwifery and many others. The professions offer a huge diversity of roles, with an often unique position of spending the most time with patients. Supporting the work of the registered professionals are Healthcare Support Workers, a significant part of the nursing and midwifery family, who work alongside registered practitioners as a core part of the care team. Increasingly the role and value of Healthcare Support workers is being recognised and more varied
September 2012 Page 1 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12 career opportunities are being made available. This report therefore, although focusing on the registered professions of nursing and midwifery, includes the vital contribution made by Healthcare Support Workers.
Enabling Aim 1
Highly effective leadership and management Commitments:
- Ensure all nurses and midwives in a leadership and management role are well prepared to undertake that role - Ensure clear roles; responsibilities; autonomy; authority and accountability exist for our nursing and midwifery leaders - Ensure all nursing and midwifery leaders have clear objectives, personal development plans and appraisal - Develop and implement a Nursing and Midwifery Assurance Framework
The Senior Leadership Team for Nursing and Midwifery is well established with some new recruits joining the team earlier in the year. The team reflects the areas of professional practice within the organisation and is of sufficient seniority and experience to represent the teaching Health Board well nationally. The team includes:
Nurse Director – Carol Shillabeer - appointed substantively in Dec 2011 Assistant Nurse Director (Patient Safety and Experience) – Tracy Yole (from Jan 2012) Assistant Nurse Director (Workforce) – Paul Labourne Lead Locality Nurse (North) – Jason Crowl Lead Locality Nurse (Mid) – Sue Jones Lead Locality Nurse (South) – Paul Labourne Head of Midwifery – Cate Langley Head of Public Health Nursing (including Health Visiting, School Nursing and Community Paediatric Nursing) – Ruth Marks-Twelvetrees Head of Learning Disabilities – Hayley Tarrant Head of Mental Health – Shane Mills (until Sept 2012) now Harold Proctor
The team collectively owns the Nursing and Midwifery strategy, with specific responsibility and accountability for delivering the aims and commitments within their areas of responsibility. At the heart of the delivery of the strategy is effective leadership and management. Important developments and progress has been made in the following areas:
• The Nurse Director has been successful in gaining a Florence Nightingale Foundation Leadership Scholarship following a UK wide selection process. Fifteen nurse leaders from across the UK (1 from Wales) each receive detailed leadership assessment; a personalised, bespoke leadership development programme and mentorship from a high profile leader. The programme includes overseas travel as well as networking within the UK. The learning gained will support the further development of the professions in Powys as well as wider organisational benefits.
September 2012 Page 2 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
• The organisation has had an active role in a national leadership and management development review under the Free to Lead, Free to Care programme. This work is shaping the future of nursing leadership and management development across Wales. • The Clinical Leadership Programme delivered its last cohort of the current format during the year. Approx 10 participants presented the outcomes of their leadership development at a celebration event in November 2011. The projects included more effective medicines management at ward level, the development of a falls service, Child and Adolescent Mental Health guidelines, Client centred care in Learning Disabilities services, amongst others. Colleagues from Welsh Government and the Royal College of Nursing joined the event. • Internally, a leadership and management review is currently being undertaken – a partnership approach between nursing and workforce development. This is enabling a fresh approach to leadership and management development for those in a senior leadership role at Bands 7 and above. The review includes scrutiny of job descriptions in relation to leadership and management role, responsibility and accountability, leading to the development of a training, education and coaching approach. • It is essential the professional leads work as ambassadors for the organisation on a national stage. The Leads within the organisation therefore ensure that Powys teaching Health Board is influencing national policy in areas such as: o Nursing Workforce o Fundamentals of Care o Head of Midwifery (through the Advisory Group for Wales) o Public Health Nursing o Learning Disabilities o District Nursing o Informatics Increasingly specialist nurses and others are taking an active role in shaping national developments, including tissue viability, infection prevention and control, immunisation and many more. • During the year Ward Sister leadership and management development days, held monthly have been reviewed and re-invigorated. Significant, important work is being generated from this group through a leadership development approach. A similar Senior Nurse leadership and management development day system has been established during the year and although in its early days will spread to cover all areas of nursing and midwifery during the coming year. • An essential and tangible outcome measure relating to leadership and management is the proportion of nursing and midwifery professionals who have a Personal Development Review (PDR). Overall, 60% of all nurses and midwives have had a PDR in the last 12 months. The Senior Nursing and Midwifery team have recently reaffirmed their commitment to increase this further to 80% by the end of the calendar year and to reach over 90% by the end of the financial year. • An Assurance Framework for Nursing and Midwifery is in its early stages of development. The learning from the Francis Report into Mid Staffordshire will help to inform the further development and implementation of this over the coming months.
September 2012 Page 3 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
Enabling Aim 2
Evidence based and citizen centered care
Commitments:
- Deliver care that is based on what evidence tells us works well - Work in partnership with the patient/service user/client/citizen/carer to ensure their needs are identified and their care is planned together based on the individuals needs - Actively seek out and listen to the views of our patients/service users/clients/citizens/carers and make improvements as a result
There have been a number of developments during the year that enable us to evidence delivery against these commitments. In summary these include: • A comprehensive review of nursing policies has been established and is progressing well. The Project has focused on achieving clarity regarding what constitutes a professional nursing policy, the directory of policies that already exist and the systematic review of each one to ensure reflect latest evidence base. Senior Nurses from across the organisation have taken an active role in this work. By the end of the financial year all nursing policies will have been reviewed. • Nursing and Midwifery professionals have taken an active leadership role across a number of 1000 Lives Plus work streams. Twelve out of the 21 programme areas currently ‘live’ with 1000 Lives Plus Programme team are now led by nursing and midwifery. This demonstrates the commitment to using evidence to improve care by the professions. Through the coming year, these programme areas are likely to grow and the emphasis will be on ‘spread’ through all clinical areas. • A project has been established to improve the standard of nursing care planning for patients. This work has been led by ward sisters, supported by the Assistant Director of Nursing, with a pilot of new patient-owned goal planning care plans currently taking place in Machynlleth prior to amendment and roll out. • Through the year, work took place to review and revise the Fundamentals of Care patient questionnaire. This is now to be adopted across Wales. Furthermore a ‘you said, we did’ approach is underway to reflect the changes put in place as a result of the feedback received from patients and their carers. • In Midwifery, Powys midwives continue to play a key role on the Welsh Birth Centre guidelines advisory group ensuring that all guidelines are reviewed in line with new and emerging evidence. The Maternity Service Liaison Committee continues to develop, and during this year Healthcare Inspectorate Wales commended the organisation on its innovative approach to engaging mothers in a highly rural setting. • In engaging those who use our midwifery service a COOS Card system has been introduced. COOS – Comments on our Service – enables mothers and families to provide feedback and suggestions (anonymously if they wish). Furthermore a Service User Questionnaire being sent to all users of the service with a specific focus on their reasons for choosing a certain pathway of care. So far 80 returns
September 2012 Page 4 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
have been made. A focus group approach is being undertaken during September on the environment of care, with a specific aim of understanding if improved environments could support more women staying in Powys for the birth of their child. • Within Children and Adolescent Mental Health services, children and young people have given their feedback on the service they receive. This survey work was led by the Advocacy service employed to support children in Powys. Important improvement areas were identified including the environment of care specifically, with children saying that they wanted improved privacy and dignity; and for CAMHS services to be collocated with other children’s services. • Within Health Visiting, School Nursing and Paediatrics nursing evidence based core programmes are completed, with the Health visiting core programme being launched recently. The service is working with colleagues in Welsh Government on RBA (Results Based Accountability) framework that will in time identify the difference being made to children and families.
Strategic Aim 3
Nursing and Midwifery workforce development Commitments:
- Invest in nursing and midwifery, nurses and midwives and their education, training and development based on appraisal and objectives to deliver the agreed core priorities of the profession and organization - Develop and implement nursing and midwifery workforce plans to ensure we have the right number of nurses and midwives with the required knowledge, skills and experience to deliver safe, high quality, modern services - Focus on developing career pathways for nurses and midwives and ensuring succession planning is effective - Invest in the development of Healthcare Support Workers within the nursing and midwifery workforce to work safely and effectively as valued contributors to effective patient care
Recognising that nursing and midwifery are the largest proportion of staff within Powys teaching Health Board, the impact of investing in this workforce is significant. It is also incumbent on the professions to adapt to the needs of patients/clients/service users. The key areas of development against these commitments include: • Participation in All Wales Nurse Staffing Group, enabling benchmarking between organisations across Wales and consideration of nursing workforce issues elsewhere. Work has taken place during the year on safe staffing levels, evidenced to be a key factor in the quality of care afforded to patients. A new system for calculating safe staffing levels called ‘Safer Nursing Care’ is being trialled across Wales, with Powys taking a lead for community hospital settings. In addition this tool is being compared against two other models, the Royal College of Nursing Guidance on Staffing Older People Wards and the Powys Professional Judgement system. Early results have been gathered, with the second phase of Safer Nursing Care Tool being further tested in October. So far the results indicate that generally nurse staffing levels are close to those
September 2012 Page 5 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
recommended. Within Midwifery the Birth Rate Plus review was undertaken in August 2012. Results indicate that current staffing numbers and grade mix remain appropriate. Within Health Visiting a Caseload Tool which including weighting for complexity is likely to be developed following a recommendation in the national Health Visiting Review. • A Nursing workforce plan as part of an integrated plan was developed earlier in the year in time for submission to Welsh Government. Its important role in commissioning the ‘right’ numbers of new recruits into professional training requires a considered approach to service developments. The Programme for Government for example indicated an expansion in Flying Start which required increased numbers of Heath Visitors. The Plan also took into account local developments prompting the changing shape of the workforce, including increasing advanced nurse practitioners and nurse prescribing roles, and the skill mix with the unregistered workforce. • New roles have been developed to reflect the changing priorities for the teaching Health Board. The care of people with dementia is increasingly a feature of all adult service areas and front line nursing staff have indicated their desire to increase their knowledge and skill in caring for people with dementia. A post of Dementia Liaison Nurse has been established and is well regarded in South Powys. This role has supported general nurses and other in provider higher quality and safer care. A similar role is currently being recruited to in North Powys. The liaison role has been supplemented with dementia care training. This will extend over the coming year. • Greater access has been secured to modular post-registration education focused on those staff working in a community-type setting. This important opportunity means that once nurses have completed the Foundation in Community Practice further modules can be completed to achieve a degree. Theses modules will become more important as full-time Specialist Practice Qualifications (SPQ) diminish. The organisation has supported 22 nurses to undertake their SPQ (District Nursing = 11; School Nursing = 3; Health Visiting = 6; Childrens Community Nursing = 2) during 2010/11 and 2011/12. • To reflect the ‘teaching’ status of the organisation, a greater emphasis this year has been on developing in-house curriculum for post-registration education. The first course developed, with support from the University of Glamorgan, is in Palliative Care which will launch shortly. Further courses will be developed this coming year, largely being delivered by Specialist Nurses. • Healthcare Support Workers have been supported to undertake a Foundation programme with the University of Glamorgan. This scheme was developed in order to support HCSWs to develop their educational ability in preparation for potential registered nurse/other programmes. The role of Maternity Support Workers is currently being reviewed as part of Transforming Maternity care to ensure the best utilisation of these roles is taking place.
September 2012 Page 6 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
Strategic Aim 4
Articulating and valuing the contribution of Nursing and Midwifery Commitments:
- Develop mechanisms to identify and celebrate excellence in practice and to share that with colleagues within the teaching Health Board, within Wales and beyond - Measure, and publish, the outcomes of nursing and midwifery care - Judge ourselves against core standards such as the Nursing and Midwifery Council Code of Professional Conduct
This area was assessed when the strategy was developed as one where significant development required. In the last year however the following progress has been made: • There have been a number of areas where national recognition has been achieved. The NHS Awards 2012 winner for Integrated Care involved the team focused on Early Years. This included a Health Visitor as an active member. Furthermore a runner-up in the same awards involved the implementation of the NEWS (National Early Warning Scoring system). A Health Visitor received recognition from the All Wales Welsh language awards for Innovative Practice, for the work in developing a welsh language service for mothers in a rural setting – reducing social isolation whilst promoting the use of welsh language with mothers and their babies. The Transforming Theatre Project was recognised in the national event for Transforming Care, presented by David Sissling, Director General. • This year saw the launch of the Nursing and Midwifery Information Zone, with Powys tHB being in the first wave of Welsh organisations to go live. The Information Zone provides staff with professional information, enabling staff to keep connected. A ‘Question time’ style discussion forum was held earlier in the year. This proved that video conferencing can be used across multiple sites to bring professionals together and a good discussion was held on topical nursing issues. The Nursing and Midwifery Conference is planned for mid December. This will focus on the quality and safety improvements made to patient care across the organisation, how we learn from others excellence, and how we energise and care for ourselves. • The Fundamentals of Care Tool continues to be a major source of audit of standards in Wales. The Standard achieved this year exceeds that of last year in general. Each participating area has an improvement plan in place. In other areas such as Health Visiting and School Nursing RBA (Results Based Accountability) is being developed to help demonstrate outcomes. During the year the Nursing Dashboard/Nursing Metrics was launched. The 4 initial metrics have been agreed and are being implemented. This provides benchmarking information, however more importantly the information provides a basis for ward and shortly community teams to continually improve. • In relation to meeting Nursing and Midwifery Council Professional Code of Conduct, there have been less than 5 professional hearings (that involve a gross misconduct allegation). There has been no pattern to the potential breaches in nursing and midwifery standards. Following a seminar discussing the NMC
September 2012 Page 7 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
Escalating Concerns process, each ward/team leader and Lead Nurse/Midwife has been issued with a full portfolio of professional standards guidance.
Strategic Aim 5
Improving the health of the population working in partnership
Commitments:
- maximize the impact that we, as nurses and midwives can have in promoting the health and wellbeing and the prevention of ill health of ourselves, our communities and our population, through focused information, support, education and training. - support children and their families to have the best start in life and provide further help when needed through developing both universal and targeted services such as Flying Start, School Nursing, Child and Adolescent Mental Health - work effectively in teams with other nurses and midwives, other health and social care professionals, the voluntary sector, patient and carers to improve individuals health, wellbeing and independence and reduce inequalities.
The overarching aim is to ensure that nurses and midwives play their full part in promoting health and wellbeing. Although there is some good work to share, there is recognition that there is much to do. In summary the progress includes: • Midwives taking the lead role in coaching women on lifestyle issues. Knowing that obesity, smoking and excessive alcohol consumption can impact on the health of the woman and the child, and in line with the Welsh Maternity Strategy, Powys midwives have been undertaking motivational interviewing training as a way of supporting women to take different lifestyle choices. Leading the way in promoting health and wellbeing – focus on immunisation for flu – largely delivered through nursing. More focus on role modelling by having the flu jab ourselves. • ‘Farmers Market Nursing’ is a development being undertaken by specialist nurses. Although in its early stages there appear to be positive outcomes in intervening early with people who attend the market. Some people have been found to have uncontrolled blood pressure or early signs of diabetes and have benefited from nursing advice and support. It is intended to publish this work in the future. • The expansion of School Nursing and more latterly Health Visiting as part of the Governments programme of focusing on early years and childhood developments has enabled a greater emphasis on health of children. The organisation continues to successfully implement the School Nursing Framework.
September 2012 Page 8 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
Strategic Aim 6
Caring with dignity, respect, compassion and professionalism Commitments:
- Improve the care we provide to Older People within our hospitals by implementing the Action plan developed in response to the Older People’s Commissioners report – Dignified Care. - Actively participate in developing the understanding and practice of professionalism in nursing and midwifery - Treat all who use our services with dignity and respect and ask our patients/service users/clients/citizens/carers to judge our ability to care for them with dignity, respect, compassion and professionalism. We will act on what they tell us - Seek to understand and learn from ourselves and others where nursing and midwifery care has failed the patient/service user/client/citizen/carer.
There has been significant progress made in relation to this aim over the last year or so. The summary includes: • The key aspects of Older Peoples Dignified Care action plan have been implemented. A ‘real time’ reporting system has been developed and is due to be introduced for ward areas shortly. This will enable a greater understating of the experience of patients and carers. There is further progress to be made in relation to the whole action plan in the coming months. Healthcare Inspectorate Wales has undertaken 1 DECI (Dignity and Essential Care Inspection) review this year giving very positive feedback on the issue of dignity and respect. • The teaching Health Board has had active participation/leadership in an All Wales Professionalism project. The project, which is due to report shortly, is likely to translate into national nursing policy. Locally, initiatives such as increasing the focus on the caring aspects of professional roles at recruitment stages and the potential involvement of lay people in the appointment of nurses is being considered. Within Midwifery an ‘Acceptable Behaviour’ leaflet and discussion has taken place with midwives reinforcing the standards of professionalism expected. Other areas have expressed an interest in this approach. • A senior midwives has been undertaking a PhD with the study area being ‘Issues of Trust between Midwife and Women’. The study will potentially deliver important transferrable messages to nursing on professional relationships formed on trust. • With the introduction of the Putting Things Right/redress regulations, concerns have related to pressure ulcers and falls. These have resulted in improvements to the care provided to patients through changing assessment tools, new equipment, and increased teaching and training for example. The results have been stark with ward collecting outcomes data that reflect hundreds of days in some cases without pressure ulcer development.
September 2012 Page 9 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
Strategic Aim 7
Improving the safety and quality of care by reducing waste, harm and variation
Commitments:
- actively lead the development of quality improvement knowledge, skill and expertise amongst nurses and midwives, encouraging professionals to join the Faculty for Quality Improvement - adopt a zero tolerance approach to preventable harm and unnecessary variation, particularly in relation to preventing infection; preventing pressure ulcers; preventing malnutrition and preventing falls - implement Transforming Care in all areas including community areas, ensuring that the benefits are articulated and recognised
• Whilst Faculty for Quality Improvement is under review (across Wales) nurses and midwives have been building knowledge and skill in quality improvement in significant numbers. Transforming Care now has over 20 facilitators across the organisation, all of whom are working to use the improvement methodology aligned to 1000 Lives Plus. • The Transforming Care Programme is delivering clear improvements for patients. The programme includes elements such as the skin bundle which is reducing the numbers of patients with an avoidable pressure ulcer; the well organised ward ensuring that nursing staff can work in organisation environment and spend more time with patients; safety crosses indicating where an adverse event may have happened (such as a fall), and intentional rounding. In some areas as a result of intentional rounding night time falls have reduced by over 50%. • Transforming Care is the most widespread in Powys. Transforming theatres, Maternity, community and Health Visiting are all programme areas at differing stages of development. This means that the enabling frontline staff to have improvement skills and knowledge builds capacity and capability. • Good work continues to take place in meeting nutrition standards. End to end auditing on each site has enabled further focus on areas for improvement. Latterly, greater attention is being given to oral/mouth care. The 1000 Lives Plus programme area is being introduced with Powys teaching Health Board presenting to the rest of Wales to demonstrate the effective implementation. • Innovative work is taking place on spreading the positive work of 1000 Lives into the Care Home setting. Three care homes are in the first wave of implementing the NEWS (National Early Warning Scoring system) ensuring that action is taken early with patients who are deteriorating. This is a positive sign that care homes will engage across the spectrum of 1000 Lives.
September 2012 Page 10 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
Strategic Aim 8
Caring closer to home
Commitments:
- prepare nurses and midwives to work differently, enabling more care to be provided closer to home through role redesign and the gaining of new knowledge and skill (such as nurse prescribing for example) - maximize the opportunities that informatics and information communication technology, (including telemedicine, telecare and telehealth) bring to enable nurses and midwives to care more effectively and efficiently - identify and support Carers as equal partners in care, seeking to improve their experience of caring
Positive developments are taking place to enable the professions to support patient care closer to home, however there is much more to do. Some of the key improvements include: • Project underway to ensure service delivery information is collected in relation to district nursing. This will enable teams to examine their caseload activity in order to improve both productivity and outcome. Furthermore the Maternity service is currently in the preliminary stage of implementing a new maternity information system. • The new health and social care service at Builth is developing, and nurses have been taking the opportunity to gain knowledge, skill and experience in community nursing to prepare themselves for new roles. • The role of district nursing team leaders has in some areas been redesigned to incorporate a greater Case Manager function. This will support developments such as the implementation of the Virtual ward concept. • A business case is in development to enable more women to access more of the maternity pathway within Powys. The implementation of the IFSS (Integrated Family Support Service) this year has enabled health visitors and other professionals to focus on the needs of highly vulnerable families at risk of breakdown. This service is anticipated to reduce the number of looked after children including placements out of county. • The National Community Informatics Programme is being chaired by the Nurse Director. The programme aims to enable community staff to be able to utilise informatics to assist with their clinical work. Clinical reference groups including nurses and therapists from Powys have contributed to the specification for the new system that will be procured.
September 2012 Page 11 of 12 Powys teaching Health Board Nursing and Midwifery Annual Professional Report 2011/12
Strategic Aim 9
Leading innovation and development in rural healthcare Commitments:
- invest in increasing the research and development capacity and capability of nursing and midwifery, specifically in relation to rural healthcare - seek to link with other rural healthcare organizations and educational institutes to share knowledge and expertise
There remains much to do in relating to growing research and development capacity, however there has been good progress made in a number of areas, including: • The development of a Palliative care Programme for those with a terminal illness. This project, a partnership between palliative care nursing and psychology, was funded through a grant. • The Maternity service is now providing placements for student midwives training in mainland Europe. • The District Nursing service in Brecon has applied for a Burdett Trust grant. Although the outcomes has not yet been received, this demonstrates a greater willingness to apply for such grants. • Last, but not least, a District Nurse Jessie Bergstrom has been appointed as a Queen Nurse. This special award recognises the community to patient-centred care in the community and provides enhanced opportunities to network across the UK and beyond. Jessie is though to be one of only approx 13 such Queens Nurses in Wales.
Conclusion
Good progress has been made over the last year in taking forward the Nursing and Midwifery Strategy. This professional report has highlighted some of the developments that have and continue to take place regarding caring with professionalism, dignity and respect; involving patients and others in shaping nursing services and indeed in their own care; and the significant progress being made on increasing and safety and quality of care through the Transforming Care Programme.
There is however much more to do in driving forward to realization the commitments made within the 3 year strategy. Priorities include maximizing every encounter with the public to help promote health and wellbeing; developing further the outcomes of nursing and midwifery care for the public to see; and demonstrating the contribution of Powys nursing and midwifery both within and outside of the Powys borders.
Further detail is available upon request.
Sept 2012
September 2012 Page 12 of 12 FOR DISCUSSION
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 4.1
POWYS DIRECTOR OF PUBLIC HEALTH ANNUAL REPORT 2011-12
Report of Interim Director of Public Health
Paper prepared by Consultant in Public Health
Purpose of Paper To provide the Board with the Director of Public Health Annual Report 2011-12.
Action/Decision required The Board is asked to NOTE this paper for information.
Link to ‘Doing Well, Standards 3, 8, 12, 14, Doing Better: Standards for Health Services in Wales’:
Link to Health Board’s Improving Health & Wellbeing Annual Plan
Acronyms and N/A abbreviations
Director of Public Health Annual Report Page 1 of 4 Board Meeting 24 October 2012 Agenda Item 4.1
FOR DISCUSSION
DIRECTOR OF PUBLIC HEALTH ANNUAL REPORT 2011-12
Introduction
In this year’s Director of Public Health Annual Report on Powys, an idea from the popular film “Sliding Doors” has been used to show how lives can head off in very different directions due to small decisions and chance situations. The report tells two parallel stories about the imaginary lives of Ffion had she been born under different circumstances. The aim of this report is to highlight some of the factors that influence our health and the interventions that can help give everyone an improved chance of a healthy and longer life.
Key Messages
There are three key messages from this report:
Life course and the determinants of health A person’s health is affected by a complex interaction with the environment in which they live. Health, illness and disease in later life are the result of a combination of experiences and exposures throughout the life course. This report follows the life course through pre-conception, pre-school, primary and secondary school, working age adults, older people and the frail elderly. It shows how at each stage in life, various external factors can impact on health both positively and negatively.
Partnership working It is important to recognise that in order to stop the cycle of deprivation and ill health, partners need to work together. Health and local government services, including social services, have important roles and functions in ensuring services like vaccination and screening, housing, education, ambulance services are as effective and efficient as possible. The various voluntary agencies and community support are also important in extending the range of support available.
Interventions across the life course People are more susceptible to long-term conditions as they age, but poor health is not inevitable. It is important to recognise that health and other partners can help individuals and families improve their own health no matter what their age. Powys has an ageing population and this should be seen as an opportunity. Healthy ageing is about creating the conditions to support the older people in Powys to lead healthy, active lifestyles and continue to play an active role in society.
Director of Public Health Annual Report Page 2 of 4 Board Meeting 24 October 2012 Agenda Item 4.1
FOR DISCUSSION
Report Recommendations
The recommendations of the report contribute to reducing inequalities in health across the life course in Powys. The table below highlights how each of the recommendations link in with Powys teaching Health Board’s Annual Plan:
Recommendation Link to Annual Plan Pregnancy Action 15 Develop a tobacco control action plan, Develop and initiate implementation of ensuring that all pregnant women have the Powys Tobacco Action Plan. access to appropriate and effective smoking cessation services.
Early years Action 7 Develop a Healthy Pre-school Develop the healthy pre-schools scheme Programme to promote all aspects of and maintain the healthy schools scheme health and give young children the best across Powys. start in life.
School aged children Aim Support the pilot Community Alcohol Reduce the impact on of alcohol on Project, to promote a partnership individuals, families and communities. approach to protecting children from alcohol related harm.
Adults Action 16 Develop a healthy weight strategy with Develop and implement a local obesity partner organisations. strategy.
Older people Action 30 Ensure that healthy ageing is Develop and implement Frail and Older everybody’s business by working with People Strategy and Action Plan. partners to include healthy lifestyles in strategies and services being developed for older people.
Elderly Action 35 Work with partners in the health sector, Increase flu immunisation uptake. statutory sector and Voluntary and Community Organisations to increase flu vaccination uptake.
Recommendations The Board is asked to NOTE the Director of Public Health Annual Report for information.
Director of Public Health Annual Report Page 3 of 4 Board Meeting 24 October 2012 Agenda Item 4.1
FOR DISCUSSION
Report prepared by: Presented By: Consultant in Public Health Dr Sumina Azam Interim Director of Public Health
Background Papers Powys Director of Public Health Annual Report
Financial Consequences n/a
Other Resource Implications n/a
Consultees As per the Director of Public Health Annual Report 2011-12.
Director of Public Health Annual Report Page 4 of 4 Board Meeting 24 October 2012 Agenda Item 4.1
Director of Public Health Annual Report 2011-12
Powys Teaching Health Board 1 Contents Acknowledgements 3 Foreword 4 Vision and mission statement 6 Recommendations 7 Chapter 1 Ffion’s story - Take One 9 Ffion’s story - Take Two 11 Chapter 2 What affects our health? 13 Chapter 3 Specific health issues in Powys 14 Chapter 4 What affects the health of Ffion as she journeys through life? 18 Part A: Supporting a healthy pregnancy 19 Part B: Preschool years - giving young children the best start 22 Part C: Primary school children - the foundation years 26 Part D: Secondary school children - freedom to grow, learn and enjoy a healthy life 29 Part E: Working age adults - live healthy, happy prosperous lives 33 Part F: Healthy and active ageing - the age of opportunity 36 Part G: The golden age - remaining happily independent 40 Chapter 5 Ffion’s story retold: Can you change my life? 45 References 47
2 Acknowledgements
I would like to thank:
Leonie Roberts, Consultant in Public Health for leading and co-ordinating the production of this report Leon May, Senior Public Health Intelligence Analyst, Public Health Observatory Maria Morgan, Welsh Oral Health Information Unit Dr Sharon Hillier, Deputy Director, Screening Division, Public Health Wales Stephen Hiles, for his time in designing and formatting the report
Contributors from the Powys Public Health Team: Sumina Azam Marie Granell Sophia Bird Kate Heneghan Wendy Bowler Kate Higginson Claire Dunning Jayne Ingram-Jones Mary Evans
© 2012 Public Health Wales NHS Trust. Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated. Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust.
Cover image reproduced with the kind permission of Paul Rodgers as well as the images on pages 6, 10, 12. The image on page 46 was reproduced with the kind persission of Kate Heneghan.
3 Foreword In this year’s public health annual report on Powys I have used an idea from a popular film to show how lives can head off in very different directions due to small decisions and chance situations. This is as true of our health as for any other aspect of life, and in the case of health can depend on decisions made by our mothers even before we are born. In the report you can read the imaginary lives of Ffion, depending whether she is born in Gogoneddus Wells (Glorious Wells) to one set of parents, or Bryn Gobaith (Hope Hill) to another set. It is important to stress three things about these stories:
Firstly, Ffion, who is born in Bryn Gobaith has a mother who loves her, but faces many pressures and problems that the mother in Gogoneddus Wells doesn’t. Her health and the choices she makes are affected by a complex interaction of the environment in which she grew up in, the culture and the norms and practices of her friends and families.
Secondly, if we want to stop the cycle of deprivation and ill health it is vital that we all recognise that better health and well-being depends on partnership. There isn’t a simple pill or operation that will fix every health problem. Health services and local government services, including social services, have important roles and functions in ensuring services like vaccination and screening, housing, education, ambulance services are as effective and efficient as possible. The various voluntary agencies and community support are also important in extending the range of support available.
Thirdly, it is also important to stress that it is never too late to change. At almost any age and with almost all conditions, individuals can make choices or develop habits that will make things better or worse for their health. If you have already developed a chronic health problem, stopping smoking, reducing alcohol consumption, eating at least 5 fist sized portions of fruit and vegetables a day and walking more would help almost everyone with minimal risks attached. If you have not taken up screening opportunities such as breast screening, it can be very important to your health to do so. As can ensuring all your “jabs” are up to date - including ‘flu for the over 65s and chronically ill and teenage boosters for young people going abroad or to university. If you realise that you are facing problems that are overwhelming you due to debt, unbearable housing, or health problems, then again it is never too late to seek help. Better health and well-being for all is a partnership, and the services are there to help.
This is my last Annual Report as Director of Public Health for Powys and it has been a very rewarding and interesting experience for me, trying to understand and respond to the many public health challenges in the county. Powys is a beautiful place with so many outstanding natural amenities and a resilient and independent population. Although its health is generally good compared to some other areas, it still concerns me that avoidable premature mortality and morbidity rates can be so high in pockets of Powys. Powys County Council, Powys teaching Health Board, other partner organisations, voluntary agencies and my colleagues will continue to strive to improve the services available.
I hope this report, with its emphasis on “sliding doors”, will help reinforce the appreciation that we all have a part to play.
Dr Christopher C. Potter, FFPH, FCIPD, FHM
4 Rhagair Yn yr adroddiad blynyddol ar iechyd cyhoeddus ym Mhowys eleni rwyf wedi defnyddio syniad o ffilm boblogaidd i ddangos sut y gall bywydau ddilyn trywydd gwahanol iawn yn sgil penderfyniadau bach a sefyllfaoedd sy’n digwydd ar hap. Mae hyn yr un mor wir am ein hiechyd ag am unrhyw agwedd arall ar ein bywydau, ac yn achos iechyd gall ddibynnu ar benderfyniadau a wnaethpwyd gan ein mamau cyn i ni gael ei geni. Yn yr adroddiad gallwch ddarllen am fywydau dychmygol Ffion, yn dibynnu p’un a gaiff ei geni yng Ngogoneddus Wells i un set o rieni, neu ym Mryn Gobaith i rieni eraill. Mae’n bwysig pwysleisio tri pheth am y storïau hyn.
Mae gan Ffion sy’n cael ei geni ym Mryn Gobaith fam sy’n ei charu, ond sy’n wynebu llawer o bwysau a phroblemau nad yw’r fam yng Ngogoneddus Wells yn eu hwynebu. Caiff ei hiechyd a’r dewisiadau a wnaiff eu heffeithio gan gymysgedd gymhleth o ffactorau sy’n cynnwys yr amgylchedd ble y cafodd ei magu, diwylliant, a normau ac arferion ei ffrindiau a’i chyfeillion.
Yn ail, os ydym am atal y cylch o amddifadedd a salwch mae’n hollbwysig ein bod yn cydnabod bod sicrhau gwell iechyd a lles yn dibynnu ar bartneriaeth. Nid oes pilsen neu lawdriniaeth a fydd yn gwella pob problem iechyd. Mae gan wasanaethau iechyd a gwasanaethau llywodraeth leol, gan gynnwys gwasanaethau cymdeithasol, rolau a swyddogaethau pwysig i sicrhau bod gwasanaethau fel brechu a sgrinio, tai, addysg a gwasanaethau ambiwlans mor effeithiol ac effeithlon â phosibl. Mae’r amrywiol asiantaethau gwirfoddol a’r cymorth cymunedol hefyd yn bwysig o ran ehangu’r ystod o gymorth sydd ar gael.
Yn drydydd, mae hefyd yn bwysig pwysleisio nad yw byth yn rhy hwyr i newid. Beth bynnag eu hoed a beth bynnag y cyflwr, gall unigolion wneud dewisiadau neu ddatblygu arferion a fydd yn gwella eu hiechyd neu’n gwaethygu eu hiechyd. Os ydych eisoes yn dioddef o broblem iechyd gronig, byddai rhoi’r gorau i ysmygu, yfed llai o alcohol, bwyta o leiaf 5 dogn maint dwrn o ffrwythau a llysiau y dydd a cherdded mwy yn helpu bron unrhyw un, heb fawr ddim risg. Os nad ydych wedi manteision ar gyfleoedd sgrinio fel sgrinio’r fron, gall gwneud hynny fod yn bwysig iawn i’ch iechyd. Felly hefyd sicrhau eich bod wedi cael pob un o’ch pigiadau - gan gynnwys pigiad y ffliw ar gyfer pobl dros 65 oed a’r rhai a chanddynt salwch cronig a phigiadau atgyfnerthu i bobl ifanc sy’n mynd dramor neu i’r brifysgol. Os ydych yn sylweddoli eich bod yn wynebu problemau sy’n eich llethu oherwydd dyled, ty mewn cyflwr gwael, neu broblemau iechyd, nid yw byth yn rhy hwyr i chwilio am help. Mae sicrhau gwell iechyd a lles i bawb yn bartneriaeth, ac mae’r gwasanaethau hyn yma i helpu.
Hwn yw fy Adroddiad Blynyddol olaf fel Cyfarwyddwr Iechyd Cyhoeddus Powys ac mae wedi bod yn brofiad diddorol a llawn boddhad i mi yn ceisio deall ac ymateb i’r llu o heriau iechyd cyhoeddus yn y sir. Mae Powys yn lle prydferth ac mae yma lu o amwynderau naturiol nodedig a phoblogaeth gadarn ac annibynnol. Er bod iechyd y boblogaeth yma’n gyffredinol dda o gymharu ag ardaloedd eraill, mae’r ffaith bod cyfraddau marwolaeth cyn pryd ac afiachusrwydd y gellir eu hosgoi mor uchel mewn rhai rhannau o Bowys yn parhau i beri pryder i mi. Bydd Cyngor Sir Powys, Bwrdd Iechyd Addysgu Powys, sefydliadau partner eraill, asiantaethau gwirfoddol a’m cydweithwyr yn parhau i geisio gwella’r gwasanaethau sydd ar gael.
Gobeithio bod yr adroddiad hwn, gyda’i bwyslais ar “ddrysau llithro”, yn helpu i atgyfnerthu’r syniad bod gan bawb ohonom ran i’w chwarae.
Dr Christopher C. Potter, FFPH, FCIPD, FHM
5 © Paul Rodgers
Vision The Powys Public Health team are here to protect and promote the health and well-being of the people of Powys
Mission Statement We will provide advice using the best knowledge and evidence available to us ..... We will work in partnership...... We will facilitate change..... We will advocate.....
...... To protect and improve the health of the people in Powys
Purpose of the 2012 Report The Director of Public Health Annual Report is an independent professional statement on the health of the people, of Powys. The aim of the report is to provide an assessment of the current and future health of the population.
6 Recommendations
Our aim is to reduce inequalities in health across the life course in Powys.
Pregnancy Develop a tobacco control action plan, ensuring that all pregnant women have access to appropriate and effective smoking cessation services.
Early years Develop a scheme in Powys to promote all aspects of health and give young children the best start in life.
School aged children Support the pilot Community Alcohol Project, to promote a partnership approach to protecting children from alcohol related harm.
Adults Develop a healthy weight strategy with partner organisations.
Older people Ensure that healthy ageing is everybody’s business by working with partners to include healthy lifestyles in strategies and services being developed for older people.
Elderly Work with partners in the health sector, statutory sector and Voluntary and Community Organisations to increase uptake of flu vaccination.
7 Sliding doors
Sliding doors is a 1998 romantic comedy film. The film follows the story of Helen Quilley over two parallel universes, based on whether or not she catches a train.
This is a story about Ffion and how, by being born in different places, in different environments, she has an unequal chance of health and happiness.
8 CHAPTER 1: Ffion’s Story – Take One
My name is Ffion, and this is my story. It is 15th April 2011 and I don’t exist yet. My parents are David and Catherine. My father runs his own business and my mother is a teacher in the local primary school. They live in Gogoneddus Wells, a beautiful town with a close community.
My parents are waiting nervously for the results of a pregnancy test. As two blue lines appear, Catherine squeals in delight and David gives his wife a hug.
My mother immediately researches pregnancy on the Internet. She makes sure she is eating healthily, continues to take her folic acid and cuts out alcohol and caffeine. She attends her appointments with the midwife and is happy to have all the tests to check I am healthy.
On 8th October 2011, I arrive in this world. As my mother Catherine holds me for the very first time, she says to David, “This is the most incredible moment of my life, and we are going to make sure that she has the best chance in life.”
My mother knows that breast feeding is best for me and will help her lose her baby weight. My mother is shocked to find that breastfeeding isn’t as easy as she imagined. However, she seeks help from her health visitor, friends and family and continues to breast feed until I am six months old.
My mother takes me for my immunisations as she knows how important it is to keep me safe.
My mother goes back to work at the local school when I am a year old. I go to nursery where I play with friends and learn all my letters. I have to clean my teeth every morning in the nursery, and we try lots of fruit and vegetables.
When I am nearly five, I start in big school. I am confident as I already know my letters and numbers and my mother and father help me at home. I love going to gymnastics, swimming and music lessons after school.
When I am 10 my friend moves school. I am very upset at losing a friend and slip behind with my work. Luckily, my mother and father notice and get me some extra tuition. When I start in secondary school, I am back at the top of the class.
I do well in school and go on to University in London to study graphics.
9 I am reading a paper on my tablet and drinking coffee in my local cafe when I meet William who will become my husband.
We stay in London for a few years. There aren’t many professional jobs in Gogoneddus Wells. I get a job working in an advertising agency and William works in IT.
The year is 2041; we are 30 now, and I begin to become tired of the fast pace of life in the big city. We pack our bags and move back to Gogoneddus Wells. We are surprised by how high the local house prices are. They certainly don’t relate to local wages. We get married on a glorious sunny day in a marquee in the village.
By now we have two beautiful children, Caitlyn and Rhydian. We have a very nice quality of life.
I am 36 years old now, I notice that I am starting to put on some weight and am not as fit as I used to be. One of my friends suggests that we take part in the Race for Life. We train together for a few months; I don’t think I would have done it without her.
Time is going by so fast. My children have grown up and left home. There are no suitable jobs for them here, so they move to the city. I get my first invitation for my breast screening. I can’t believe I am 50.
Some weeks later I get a letter. The letter states that I need to go back for further tests. I go through months of cancer treatment, but my friends and family are marvellous. The Doctors say I am lucky as the cancer was picked up early by the screening test.
Over 5 years have passed since I was given the all clear. Now I am 65 and retired, but keep busy with my work on the local Church Committee. We look after ourselves; we eat lots of fruit and vegetables, keep active and have the annual flu vaccination, which is lucky, as there is a lot of flu about in 2077.
It is 2101 and William has sadly passed away - life isn’t the same without him. I’ve had a long healthy and happy life. I couldn’t ask for anything more and I hope my children and grandchildren will experience the same.
© Paul Rodgers 10 CHAPTER 1: Ffion’s Story – Take Two
My name is Ffion and this is my story. It is the 15th April 2011, and I don’t exist yet. My mam has just brought home a pregnancy test and is anxiously waiting for the blue lines to appear. She already has three boys and doesn’t want another child. My dad Cai works in the local garage and my mam works in the supermarket. They are struggling to make ends meet as the cost of living keeps rising.
My mam cannot cope with the stress of three young children. She continues to smoke when she is pregnant, but she is so stressed out that harming me is the last thing she is thinking of.
On the 8th October 2012, I am born in Bryn Gobaith. I am incredibly small - the doctors said it was because my mother smoked. My mam starts to breast feed me, but as soon as she goes home, she finds it really difficult. She has my brothers to look after and the bottle is much easier. My mam gives up her job in the local supermarket as the childcare fees means it is not worth working.
I did have some of my immunisations, but my mam was concerned about the safety of the measles, mumps and rubella immunisations. I am 3 years old when I go to the local playgroup for a couple of hours per day. I really enjoy it since I can play with the toys and look at books. We don’t have books at home. When my mam picks me up, we sometimes go to the local fish and chip shop for dinner.
I am 4 years old and I have to go to the dentist. It isn’t a very nice experience as I have to have a filling. The dentist says it is because I eat too many sweets and fizzy drinks.
I am nearly 5, I start reception class in school. I like school; I am able to play with friends, and I am learning how to read. I really like the school dinners as we don’t have pasta at home.
I am 14 years old now and in secondary school. I am doing quite well in school but some of my friends don’t think school is cool and there is a lot of pressure not to try too hard.
I am 15 years old and my best friend Laura is killed riding on the back of motorbike. I don’t know how to deal with it. I make new friends, who introduce me to alcohol. My schoolwork starts to suffer, but no one expects much of me and no one notices.
11 I am 16; I leave school and get a job in the local cafe. I eat quite a lot in my breaks, it’s a perk of the job. There aren’t many jobs in Bryn Gobaith and I didn’t do well in school.
I am 21; I meet Andy in the local pub and I soon become pregnant with our first child. I keep on eating, I tell people I am eating for two. I know I am overweight, I wish someone would ask me about it.
I want to have the baby at home, but they tell me I can’t as I am in the high risk category. This means I have to go to hospital in Any Town, which is a long way. I end up having to have a caesarean section which means I can’t drive for 6 weeks. If you can’t drive in Bryn Gobaith, you can’t go anywhere.
I am stuck in the house on my own with the baby, I’m bored and so just continue to eat. Looking back I was really depressed.
I am 45 and I have been diagnosed with diabetes. This is a real shock. I know I should do something, but I can’t cope with going on another diet. I have enough difficulties looking after the children and managing the budget.
I am 55 and I am in a lot of pain, I am waiting for a knee replacement. The Doctor told me to lose weight, but I am in so much pain I can’t do any exercise. I have thought about giving up smoking too, but I don’t see the point now.
I am 60 when Andy is diagnosed with Alzheimers. It is very tiring and exhausting caring for him. I need a break sometimes, but it’s difficult to get out of the house. Who would care for him?
I am 65 years old. I didn’t recognise the signs until it was too late. I had a big stroke. I wish I had done the things that I had planned to do such as giving up smoking and taking more exercise. I was just managing day to day.
12 © Paul Rodgers CHAPTER 2: What Affects our Health?
Chapter 1 tells two parallel stories about the life of Ffion and what would have happened to her had she been born under different circumstances. The sliding doors story illustrates how the accumulation of life events and circumstances can lead to differences in health outcomes. Although fictional, the story is inspired by real life events, evidence from data and research. The aim of this report is to highlight some of the factors that influence our health and the interventions that can help give everyone an improved chance of a healthy and longer life.
“Health: State of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” World Health Organisation
What affects our health? Fig. 1 The determinants of health ural an A person’s health is affected by a complex interaction with the environment in , cult d en ic vir which they live. Figure 1 illustrates factors that influence a person’s health. It can om on on m be seen that an individual’s biology plays a small part of the overall health matrix. c Living and working en -e conditions t o a i l c Work Unemployment c Health, illness and disease in later life are the result of a combination of o environment o s n experiences and exposures throughout the life course. This report follows the l ommuni d a c ty i r d n life course through pre-conception, pre-school, primary and secondary school, n e Water and t e Education a t i l w sanitation o working age adults, older people and the frail elderly. It shows how at each n n ia l lifestyle o e a r c u fa k s stage in life, various external factors can impact on health both positively and o d G i c s Health t S iv o care negatively. Agricultural d r services and food s n production I
Housing Age, sex and constitutional factors
Source: Dahlgren and Whitehead, 1991
13 CHAPTER 3: Specific Health Issues in Powys
Powys appears to be one of the healthiest places to live in Wales. However, issues affecting the health of the population are not always recognised. Challenges to Public Health in Powys include having an aging population, high rurality, hidden deprivation and difficulties in accessing services.
Rural/urban definition, Powys Teaching Health Board, 2005 Census output area Fig 2:Urban (60) Town and fringe (115) Village (132) Hamlet and isolated dwellings (129)
Local authority boundary Rurality
Powys Teaching Health Board covers a quarter of the landmass of Wales, but has less than 5% of the population, making it Wales’ most sparsely populated area. Figure 2 shows the urban / rural classification for areas in Powys.
Proportion of population by age and sex, Powys & Fig 3: Wales: 2010
Produced by the Public Health Wales Obseravtory using data from 2010 mid year population estimates, Office for National Statistics
Powys LA females Powys LA males Wales females Wales males
85+ 80-84 75-79 70-74
Produced by Public Health Wales Observatory, using data from ONS (Rural/Urban definition 2005) 65-69 ©Crown Copyright and database right 2012. Ordance Survet 100044810 60-64 55-59 50-54 45-49 Ageing Population 40-44 35-39 30-34 Powys has an estimated resident population of 132,000. Figure 3 illustrates that there is a greater 25-29 20-24 percentage of people aged over 50, and a substantially smaller proportion of working age adults 15-19 10-14 in Powys compared with Wales. 05-09 00-04
14 12 10 8 6 4 2 0 2 4 6 8 10 12 14 Proportion (%) of population
14 Proportion of projected population by age and sex, Powys & Wales, 2033 FigProduced 4: by the Public Health Wales Obseravtory, using population projections from Stats Wales (WG)
How will the age structure of our population change? Powys LA females Powys LA males Wales females Wales males Figure 4 shows the projected population pyramid for Powys’ resident population for 2033. 85+ 80-84 There are substantially fewer 20-24 year olds compared to the Welsh average, and there are 75-79 substantially more people aged over 65 than the Welsh average. 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 05-09 00-04
14 12 10 8 6 4 2 0 2 4 6 8 10 12 14
Projected proportion (%) of population
2008-based population projections for Powys Teaching Health Board, persons: 2008 to 2033 Fig 5: Produced by the Public Health Wales Observatory, using data from the Welsh Assembly Government
0-15 16-24 25-44 45-64 65+ 100
80 Figure 5 shows the population projections for Powys until the year 2033. 60 The over 65 age group is set to increase dramatically, with an 80% increase
40 between 2008 and 2033. If current trends continue, the proportion of people aged under 65 will decrease by the year 2033.
20 Percentage change from 2008 0
-20 2011 2021 2031 2008 2009 2010 2012 2013 2014 2015 2016 2017 2018 2019 2020 2022 2023 2024 2025 2026 2027 2028 2029 2030 2032 2033
15 Key Points • There is a growing population imbalance between older and younger population groups • The proportion of over 65s will rise substantially by 2033
Health Implications • There will be an increase in age related morbidity levels in Powys • There will be an increased need for health services and health budgets will become increasingly stretched
FigDrive-time 6: analysis to District General Hospitals in Wales and cross border
MSOA boundary
Local authority boundary Access to services
Rural communities are more reliant on their cars, as public transport can be infrequent, or non-existent. However, running a car is expensive, particularly with rising fuel costs and longer journeys. Poor access to health services is more likely to affect certain groups: older people, families with children, disabled groups and those individuals without a car. Figure 6 illustrates that it takes longer than 40 minutes to reach a District General Hospital for most areas in Powys, based on the 2007 road networks.
©Crown Copyright 2008. All rights reserved. Welsh Asembly Government. Licesnse Number 100017916 ©Hawlfraint y Goron 2008. Cedwir pob hawl. Llywodraeth Cynulliad Cymru. Rhif trydded 100017916
16 Deprivation Fig 7: How is deprivation measured? Disadvantage begins before birth and accumulates through life. An individual growing up in a more The Welsh Index of Multiple Deprivation affluent household is likely to have a better education, (WIMD) is the official measure of higher paid employment, better health, and a longer deprivation in small areas in Wales. life expectancy than an individual growing up in a The WIMD is constructed from eight household where money is scarce. This is illustrated in different types of deprivation. These are: the story of Ffion. income, housing, employment, access to services, education, health, community safety, Figure 7 illustrates that within Powys, the most deprived and physical environment. areas are Welshpool, Newtown and Ystradgynlais.
Although the Welsh Index of Multiple Deprivation (WIMD) is a useful measure of deprivation in urban areas, it does not reflect the true picture in rural areas. Rural areas tend to have a more mixed population, with those living in poverty being dispersed throughout geographical areas. Although 18% of those living below the poverty line live in rural areas, the majority do not live in areas classified as deprived1.
2001-05 2005-09 Life expectancy with 95% Inequality gap Fig 8: Life expectancy inequality gap confidence interval (SII in years)
Males Life expectancy 6.0 Life expectancy 77.5 79.1 5.5
Figure 8 shows the difference (inequality gap) in life expectancy, healthy life Healthy life expectancy 66.7 6.4 expectancy and disability free life expectancy between the most and least 67.7 5.9 Disability-free life 61.6 7.1 deprived population in Powys. Between 2001-05 and 2005-09, the inequality expectancy 62.5 6.3 gap between the most and least deprived population decreased for all Females measures for both males and females. The largest inequality gap is seen in the Life expectancy 81.2 5.7 healthy life expectancy for females. This is reflected in the second story of Ffion 82.7 4.9 Healthy life 66.7 13.7 who experiences diabetes, joint problems and stroke unlike Ffion in the first expectancy 67.5 13.6 story who lives a long healthy life. Disability-free life 62.8 9.6 expectancy 63.3 9.3
17 CHAPTER 4: What affects the health of Ffion as she journeys through life?
This next section of the report highlights where the NHS, Local Authorities, Voluntary and Community Organisations can intervene along the life course to improve health outcomes. This report focuses on the factors that particularly influence the health of Ffion.
Road traffic accidents Illegal substances Unemployment Alcohol misuse Infections Smoking Bottle feeding Poverty Communicable diseases Stress at work Chronic disease Dementia Stress Stairs Dental decay Alcohol Obesity Inactive lifestyle Falls
Exercise Self-care Healthy diet Weaning Education Healthy lifestyle Nutrition Self-esteem Safe housing Screening Immunisations Positive parenting Resilience Social relationships Safe environment Screening
18 Part A: A Healthy Pregnancy
Mental Health Supporting a healthy pregnancy Alcohol and substance The health and well-being of women before, during and after misuse pregnancy is a critical factor in giving children a healthy start in life and laying the groundwork for good health and well-being in later life. For example, there is strong link between poor nutrition, alcohol consumption, smoking, and poor mental health during pregnancy and low birth weight in babies2. Smoking What are we hoping to achieve in Powys? We want to reduce the number of low birth weight babies and pre- Obesity term births and increase the number of healthy babies.
Folic acid
A baby born weighing less than 2500g is termed low birth weight. Low birth weight is a leading cause of infant mortality in the UK. Babies born weighing less than 2500g are more likely to suffer poor health and suffer chronic diseases such as diabetes in adulthood
19 The Story of Ffion
In the first story Ffion’s mother made sure that she had a healthy pregnancy and was able to give Ffion the best start. In the second story, Ffion’s mother loved her child but was living in very stressful situations and found it difficult to give up smoking.
Smoking in pregnancy Women who smoke during pregnancy put themselves and their unborn baby at risk. Serious health consequences for the baby include low birth weight, miscarriage, premature births, death of a baby before seven days (perinatal mortality) and a number of birth defects e.g. cleft lip and palate.
A third of mothers (33%) smoke either before or during pregnancy. Across the UK, one in eight mothers (12%) continue to smoke throughout pregnancy, and are still smoking after the baby was born. Mothers in Wales are more likely to smoke throughout their pregnancy (16%) compared with England (12%), Scotland (13%) and Northern Ireland (15%) 3.
Stop Smoking Wales offers a fast track service for pregnant women and pre-operative patients as research highlights the huge benefits to quitting for these two groups.
All NHS staff who work with these groups have been invited to attend Brief Intervention Training to encourage quit attempts in patients.
CASE STUDY Stop Smoking Wales is a free NHS service aimed at supporting those who wish to stop smoking. Accessing this service means quitters are four times more likely to succeed in their quit attempt.
Between April 2011 and March 2012, 677 contacts to the service were made by Powys residents. Of these 50% reported they had quit at 4 weeks and 26% reported they had quit at 52 weeks.
A rural health fund grant has led to a successful Community Pharmacy smoking cessation scheme operating in 7 locations across Powys.
20 Story 1 Story 2 My mother immediately goes into action, she I wasn’t very happy, I kept on eating. I used researches pregnancy, she makes sure she is to tell people I was eating for two. I knew I eating healthily. was overweight.
Maternal obesity Obesity in pregnancy has been linked to an increased risk of complications and adverse outcomes including miscarriage, high blood pressure, diabetes, and dysfunctional labour. There is also a higher caesarean section rate and lower breastfeeding rate when compared to women with a healthy BMI4. Evidence suggests that managing weight gain in pregnancy could significantly reduce labour interventions.
Statistics suggest that 50% of women who are of childbearing age are overweight and 18% are obese at the start of their pregnancies in the UK5. An audit completed in 2011 in Powys, found that, 21% of women were overweight, 11% obese and 4% were morbidly obese. 13% of the forms audited had no BMI recorded6.
Opportunities to help ensure every child in Powys is born healthy
• Ante natal screening Advice on healthy eating and folic acid Key actions • • Access to appropriate physical activity during • Advice on alcohol and substance misuse pregnancy with referral to services
Reduced numbers of.. • Babies with disease and illness Key • Women smoking and drinking alcohol during pregnancy outcomes • Medical interventions during labour • Pregnant women with high blood pressure and pre-eclampsia • Low birth weight babies
21 Part B: Preschool years - giving young children the best start
The pre-school years
Mental Health Accidents Experiences in the first months of a child’s life lay the foundation for the rest of their and injuries life. Children’s physical, social and cognitive development strongly influences their school readiness, educational attainment and health.
What are we hoping to achieve in Powys? We want to ensure every child in Powys is given the foundations for a healthy life. Communicable Diseases The Story of Ffion
In the first story, Ffion’s mum struggled with breastfeeding but had a supportive Nutrition environment, so managed to continue to breastfeed. Catherine had spent a lot of time including with Ffion making sure she could read by the time she went to school. In contrast, in Dental Health breastfeeding the second story Ffion’s mum struggled to breastfeed, so without help and support she switched Ffion onto bottled milk.
Breastfeeding
Evidence shows that breastfeeding has short and long term health benefits for both mother and baby. Breastfeeding protects the infant against gastroenteritis and respiratory infections. It also reduces the mother’s risk of developing some cancers such as pre- TableNumber 3: Percentage of babies of babies breastfeeding breastfeeding at birth andBirth 28 days in Powys28day menopausal breast cancer and increases the likelihood that she will lose the weight gained BMI not recorded 71% 48% during pregnancy6. BMI <18 63% 25% BMI 18 -25 78% 53% Data from the National Community Child Health Database shows that breastfeeding BMI 25.5 – 30 70% 43% rates in Powys were 78%, the highest in Wales7. An audit of 1194 women conducted in BMI 30.5-35 75% 41% Powys found the proportion of women still breastfeeding at 28 days fell to approximately BMI 35.5 -40 70% 50% 50%. The audit showed highest breastfeeding rates in mothers with BMI of 18-25 (table 3). BMI > 40 65% 19%
22 Impact of Smoking
Living in a household where one or two people smoke, more than doubles the risk of sudden infant death syndrome. Exposure to second hand smoke in childhood increases the risk of a range of illnesses including lower respiratory tract infection, asthma and persistent ear infections8.
Mental Health: Emotional health and well-being
Mental health is the ability of individuals to realise their own abilities, cope with the normal stresses of life, work productively and contribute to their community. In the early years, a child forms emotional attachments that lay the foundations for good mental health. It has been estimated that between 10-15% women suffer from post-natal depression. Symptoms include low energy levels, feeling unable to cope, and difficulties in bonding with the baby. Research shows that serious or long-term post-natal depression can impact on a child’s cognitive and language development. Depressed and anxious parents are less likely to respond to their baby’s needs9.
CASE STUDY
Powys Healthy Pre-Schools Scheme
The aim of the Powys Healthy Pre-Schools Scheme is to help give children the best possible start in life, by encouraging and supporting pre-school settings to create a healthy ethos and environment, form healthy habits, as well as promoting a healthy lifestyle to children, families, staff and the community. The setting works to achieve a series of standards set within the following health areas:
• Nutrition & oral health • Physical activity & active play • Safety • Hygiene • Mental & emotional health, well-being & relationships • Environment • Workplace health
23 Story 2 “I did have some of my immunisations, but my mam was concerned about the safety of the measles, mumps and rubella immunisation”
Childhood Immunisations and Vaccinations
“The two public health interventions with the greatest impact are clean water and vaccination” World Health Organisation
Fig 9: Powys Teaching Health Board trends in routine childhood Vaccinations are one of the best methods of protecting children against many immunisations 2004 - 2011 Quarter 4 infectious diseases that can cause serious illness or even death. The childhood immunisation programme in the UK protects against diseases that continue to kill such as measles and diptheria.
Not only do vaccinations protect the individual against disease but they also interrupt the spread of infection and protect the whole population. For example, by giving MMR vaccines to infants, pregnant women are protected from rubella (German Measles). Low immunisation rates in a community mean that there is a risk of an outbreak of the disease.
Source: Public Health Wales Quartely Cover reports, correct as of March 2012. Vaccine Preventable Disease Programme 2012
24 How many children receive their vaccines in Powys? Childhood vaccination coverage data is used to monitor trends in uptake and improve immunisation coverage through regular feedback to local areas.
Data for Powys teaching Health Board shows that there has been an increased uptake of childhood vaccines in recent years (figure 9). Powys has similar uptake levels for most vaccinations compared with Wales, an improvement from previously being well below the Welsh national average.
• Development checks • Hearing screening • Peer to peer support Key actions • Parenting courses Immunisations during • • Early years education pre-school • Smoking cessation for family years • Speech and language support
• Happy and positive • Ready for primary school • Healthy weight Key • Good language and communication skills outcomes • Free from disease and illness by age 5 • Free from decayed, filled or missing teeth
25 Part C: Primary school children - the foundation years
What are the key health issues for primary school aged children? Environment Healthy eating The primary school years are a period of accelerated growth in personal, social, behavioural and emotional development. As children grow in independence, their peers and other external factors such as advertising will affect their choices and subsequently their health. They need to be given the knowledge and skills to make the healthy choices.
Physical Activity Exposure to second hand smoke
Accidents Story 2 Story 1 and injuries “I am 4 years old and I have to go the Hygiene “I have to clean my teeth every morning in dentist. It isn’t very nice as I have to the nursery. “ have a filling.”
Oral Health
Oral health is defined as the ‘standard of health of the oral and related tissues which enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment and which contributes to general well-being’ (Department of Health). Oral disease has detrimental effects on an individual’s physical and psychological well- being and reduces quality of life. The main oral disease of childhood is dental caries (tooth decay).
26 Trends in oral disease Data on dental health in 5 year olds shows that Wales has higher rates of decayed, missing or filled teeth (dmft) compared with England and Scotland10.
Two fifths of 5 year olds in Powys have experience of dental caries. In 2007-08, 38.9% had at least one decayed, missing (due to caries) or filled tooth. This was significantly lower than the figure for Wales (47.6%). Whilst Powys might be one of the better areas in Wales, overall Wales’ rates are the worst in the 10UK . Although children’s oral health has improved on average, inequalities remain. The average dmft for 5 year olds for Powys was 1.60. The dmft in the four super output areas of Powys range from 1.37 to 2.36 (table 2). Efforts need to be focussed on South Powys Upper Super Output Areas (Powys U004), which had an average dmft higher than the Welsh Government target (1.77)10.
Fig 10: Average dmft for 5 year olds, 1999-2006, Wales compared with England and 5.0 Scotland Upper Super Output Areas, Powys Fig 11: Upper super output areas in Powys
LA Boundary 4.0 Upper Super Output Area Boundary t f m d
n 3.0 ea m
2.0
1.0
0.0 1999-00 2001-02 2003-04 2005-06
England Scotland Wales
% of 5 year olds Average Upper super Output area with dmft greater dmft than 0 Powys U003 1.37 34.3 Powys U002 1.44 38.5 Powys U001 1.57 40.9 Powys U004 2.04 41.7
Powys Teaching 1.6 38.9 Wales 1.98 47.6
Produced by Public Health Wales Observatory Table 2: Indicators of caries prevalence in 5 year olds. 2007-08, for Upper Super Output ©Crown Copyright and database right 2012. Ordance Survet 100044810 areas in Powys Health Board 27 CASE STUDY Designed to Smile
Designed to Smile is an Oral Health Improvement programme to improve the dental health of children in Wales; its overall aim is to reduce inequalities in oral health.
Designed to Smile adopts a multi-agency approach using nursery and schools settings. Participants in Designed to Smile are involved in preventive programmes such as twice yearly fluoride varnishing, toothbrushing activities and health promoting policies such as healthy food and drinks.
• Healthy schools Key • Recreational and leisure facilities actions • Education during • Mental health support primary • Parenting classes Integrated family support school • years
• Happy , confident and positive • Ready for secondary school • Good educational attainment including Key numeracy and literacy outcomes • Healthy weight by age 11 • Good communication skills
28 Part D: Secondary school children - freedom to grow, learn and enjoy a healthy life
Giving young people the freedom to grow Hobbies Mental ill health and interests Secondary school aged children may choose risky health behaviours including alcohol e.g music consumption, unprotected sex with more than one partner, smoking and substance misuse. Individuals are more likely to engage in risky behaviours if they have low levels of self esteem and limited job prospects11. There is a danger that the risky behaviours adopted in adolescence continue into adulthood. Figure 12 illustrates how there tends Physical Activity to be clustering of risky health behaviours during adolesence. Alcohol
Smoking
Fig 12: Risk behaviours encountered during adolescence
Friends, family Smoking Smoking and supportive community
Sexual Alcohol Substance activity Confidence and misuse self-esteem
Substance misuse
Mental health risk factors e.g. low self-esteem
29 80% said it was easy to get alcohol What does the data show?
The Community Safety Partnership commissioned an on-line survey called ‘Viewpoint’ in 2011 for all 38% said they first drank alcohol aged High Schools in Powys. This showed: 10 or younger
Alcohol 32% said it was ok to get drunk Alcohol misuse causes problems to individuals and society, and yet it is culturally more readily accepted than other substances e.g. smoking and illegal substances12. 74% said they had Alcohol is responsible for: drunk more than a sip of alcohol • 1,000 Welsh deaths per year • 18,000 violent crimes in Wales in 2007/8 • An increase in hospital admissions • Half of respondents in the British Crime Survey perceive alcohol as a major cause of crime13
Mental Health
There is increasing evidence that many people experience mental health symptoms in adolescence. 14 Findings from a UK birth cohort tracked over time found : Fig 13: Risk and protective factors for mental health problems in children and young people • No mental health symptoms in adolescence or adulthood 45% • Adolescent onset with repeated symptoms during adult life 35% • Adolescent onset with good outcome 6% P r o b l e m s o l v i n g s k i l l s P o v e r t y • Adult onset of symptoms 14% R e s i l i e n c e C o n f l i c t b e t w e e n c a r e r s F e e l i n g s a f e F a m i l y b r e a k d o w n G o o d r e l a t i o n s h i p This means that 71% of adults with mental health problems first had symptoms in adolescence. B u l l y i n g Symptoms of depression and anxiety in adolescence persisted into adulthood in all but a small w i t h p a r e n t s S u p p o r t i v e c o m m u n i t y S u b s t a n c e m i s u s e proportion of people.
There are a range of risk and protective factors that can influence mental health and well being, which is illustrated in figure 13.
30 CASE STUDYPowys Healthy Schools is an accredited member of the National Network of Healthy Schools Schemes. The scheme provides guidance and support for schools to achieve national standards set through the Healthy Schools National Quality Award (NQA). The scheme recognises developments through a structured award programme, accrediting schools in the following health aspects:
• Food and Fitness • Mental and Emotional Health and Well Being • Personal Development and Relationships • Substance Use and Misuse • Environment • Safety • Hygiene
Number of personal injury road casualties occuring in Powys by age category, Figthree 14: year rolling average, 2005 - 2010, persons, all ages Produced by Public Health Wales Observatory, using road accidents and safety data (STATS19)
0 - 15 16 - 24 25 - 39 40 - 54 55 - 69 70+ Road traffic accidents 250
Road traffic accidents are the biggest killer of young people aged 10-24 200 worldwide. 150 Figure 14 shows personal injury road crashes occurring in Powys from 2005 to Yearly average 100 2010. Overall, there has been a reduction in the number of road casualties in all age groups, except for those aged over 70 years. 50
0 2005-2007 2006-2008 2007-2009 2008-2010
31
Key stage 4 educational attainment, 2008-2010 FigMSOA, 15: mean score Education 482 to 513 (2) 451 to 482 (3) 420 to 451 (7) 389 to 420 (3) 358 to 389 (4) Key stage 4 marks the end of compulsory education. Educational attainment is a critical indicator of MSOA boundary
future education and employment prospects. The mean average score at key stage 4 for Powys pupils Local authority boundary was higher than the Wales average score and was one of the highest in Wales.
The two highest (best) scores (figure 15) occurred in the north of the local authority in the area around Llanfyllin. The lowest (worst) scores occurred in the more densely populated areas such as Llandrindod Wells, Brecon, Ystradgynlais and Ystradfellte15.
Opportunities to ensure every teenager has the freedom to
grow, learn and enjoy life Produced by Public Health Wales Observatory, using PLASC (WG) ©Crown Copyright and database right 2012. Ordance Survey 100044810
• Healthy schools Recreational and leisure facilities Key actions • • Education during • Mental health support secondary • Sexual health services school • Substance misuse services years
• Happy , confident and positive • Free from illness and disease Good educational attainment Key • • Young people remain in education, training or employment outcomes • Healthy weight by age 18 • Good communication skills
32 Part E: Working age adults - live healthy, happy prosperous lives
The working years
Stress Housing On reaching adulthood, the majority of people will be looking to secure employment, find a home to live in, develop new family ties, and have a good social support network around them.
Being in work is important for physical and mental health and well-being. Unemployment is associated with a decrease in life expectancy, and higher rates of mental health Healthy problems. workplace In Powys, there are low levels of people claiming unemployment benefit overall. However, there is variation within Powys, and the highest levels of claims are in areas such as Unemployment Llandrindod Wells, south west of Newtown, Ystradfellte, Coelbren, Ystradgynlais and Cwm Twrch (Figure 16). Employment related benefit uptake rates are generally highest in the more urbanised areas of Powys15. Physical Activity
Percentage of working-age population claiming employment related benefits, FigNovember 16: 2009 - August2010 MSOA 17.6 to 20.4 (2) 14.8 to 17.6 (1) 12.0 to 14.8 (0) 9.2 to 12.0 (5) 6.4 to 9.2 (11)
MSOA boundary Smoking Healthy eating Local authority boundary
Produced by Public Health Wales Observatory, using claimants data (ONS) & (DWP) ©Crown Copyright and database right 2012. Ordance Survey 100044810
33
Story 2 Story 1 “I am 16, I leave school and get a job in “I get a job in advertising and William the local cafe. There aren’t many jobs in works in IT” Bryn Gobaith.”
The employed
Powys has higher rates of self employment across all main sectors than elsewhere in Wales. For example, self employment in Powys in manufacturing and in distribution, hotels and restaurants is twice as high as the Welsh average. Although there are high levels of employment, the employed tend to be low paid. In 2009 the average weekly wage in Powys was £434, compared to £506 for Wales. Powys ranked in 39th position in the UK for unaffordable houses, based on house price to income ratio. This could make it difficult for young families to remain in the area16, 17, 18.
The Workplace: Why is it important? The workplace provides an environment which can reinforce positive health messages through social networks, supporting behaviour change and providing an opportunity to monitor and evaluate interventions. There is also the potential to disseminate messages to families and social networks of employees, resulting in an indirect positive effect on the health of the community.
What impact does the workplace have on health? The working environment can have a direct effect on an individual’s physical and mental health and their life expectancy. There are also costs to business due to poor health19: • Mental health problems cost the Welsh economy £1.2 billion per year • The cost of smoking borne by employers in Wales is around £80 million
CASE STUDYCorporate Health Award
Powys Teaching Health Board and Powys County Council, the two biggest employers in Powys are leading the way as exemplary employers. These organisations have achieved the Gold Corporate Health Standard Award and it is anticipated that they will achieve platinum level by 2013. Both organisations are now working together to share best practice and joint working to improve the health of their staff.
34
Percentage of households living in poverty, 2007/08 MSOA Fig28.8 17: to 31.8 (2) 25.9 to 28.8 (2) 23.0 to 25.9 (4) 20.1 to 23.0 (7) Poverty 17.2 to 20.1 (4) MSOA boundary
Local authority boundary Low income can lead to poor health and vice versa. A low income is likely to reduce a household’s ability to access healthy food and maintain warm accommodation. Those on low incomes are more likely to engage in health damaging behaviours, such as smoking and eating high calorie foods as coping mechanisms20.
Across Powys, model-based estimates for the proportion of households estimated to be living in poverty range from 17.2% to 31.8%. Figure 17 shows higher levels in the south west of Newtown, Llandrindod Wells, Welshpool, Knighton and Presteigne15.
Produced by Public Health Wales Observatory, using model-based estimates (ONS) ©Crown Copyright and database right 2012. Ordance Survey 100044810
Opportunities to enable every adult in Powys to live a healthy, happy and prosperous life.
• Promote the health and well being of staff employed by the public and private sector through the well-being in work scheme • Support lifelong education and training Key actions • Accessible and affordable childcare facilities Mental health first aid courses during • • Recreational and leisure facilities working life • Affordable, safe housing • Mental health support and well-being
• Free from illness and disease Key • Free from injury and accidents Ability to maintain healthy lifestyle outcomes • by age 64
35 Part F: Older people - live healthy, happy lives
Healthy Healthy and Active Ageing: The age of opportunity Alcohol diet The National Service Framework for Older People in Wales defines an older person as someone aged over 50 years. This creates a diverse group of people, with some still working whilst others are in a care home. Similarly, some may be in extremely good health or extremely poor health.
Social network There are three stages in the life of an older person, as illustrated in figure 18:
Physical activity • Entering old age and preparing for retirement • Transitional, where health problems may emerge • Frail and vulnerable, where the individual has high levels of need for health and social care services
Smoking
What are we hoping to achieve in Powys? Healthy ageing is about creating the conditions to support older people in Powys to lead healthy, active lifestyles and continue to play an active role in society. F r a i l I n c r e a s i n g l e v e l s o f n e e d Why is healthy ageing important? As the baby boomer (people born between 1946 and 1964) generation continue to T r a n s i t i o n a l
retire and move through old age, Powys will see a rapidly ageing population. As people E m e r g i n g h e a l t h p r o b l e m s get older they are more susceptible to long-term conditions, although poor health is not inevitable. E n t e r i n g o l d a g e
The benefits of healthy ageing are clear; improved quality of life for individuals, 5 0 + r e t i r e m e n t a g e reduction in need for health and social care services, and the positive contribution individuals can make to their friends, families and communities. Fig 18: Stages in the life of an older person
36 Story 2 Story 1 “I am 55 and I am in a lot of pain, I am waiting for a “Now I am 65 and retired, but keep knee replacement. The Doctor told me to lose weight, busy with my work on the local Church but I am in so much pain I can’t do any exercise. I Committee.” have thought about giving up smoking too, but I don’t see the point now.” Healthy lives
Older adults can live healthy, happy and longer lives by staying socially connected, increasing their physical activity levels, eating a healthy diet, refraining from smoking, reducing their alcohol consumption and taking steps to reduce their risk of injuries. This involves using a holistic approach, with a drive to provide a wellness service that aims to take a whole-person and community approach to improving health21,22.
The Welsh Health Survey (2009–2010) assessed the number of people who followed a healthy lifestyle: not smoking, eating 5 portions of fruit and vegetables, being active on 5 or more days and drinking below the recommended daily units of alcohol. It found that only 8% of adults reported all four healthy behaviours in Powys29.
% who meet physical activity guidelines, 2003/04-2009 FigUSOAs, 19: percentage (age-standardised) 35.2 to 38.5 (9) 31.8 to 35.2 (13) 28.4 to 31.8 (30) 25.0 to 28.4 (32) 21.6 to 25.0 (10) Physical Activity USOA boundary Local authority boundary
Health board boundary
Keeping active has many important benefits. It can improve strength, balance and flexibility, improve bone Wales: 30% density, thus helping reduce risk of fractures. It can lower the risk of heart disease and stroke as well as improving mental health and providing opportunities for social interaction. Physical activity can include walking, gardening, dance, as well as sports such as football.
Current physical activity guidelines recommend that an adult undertakes at least 30 minutes of physical activity, of moderate intensity, on five or more days each week23. Although Powys is comparably more active than much of Wales, less than half of the population meet the recommended physical activity guidelines (Figure 19).
Produced by Public Health Wales Observatory, using Welsh Health Survey (Welsh Government) ©Crown Copyright and database right 2012. Ordance Survey 100044810
37 % currently smoking, 2003/4-2009 FigUSOAs, 20: percentage (age-standardised) 31.5 to 35.8 (4) 27.1 to 35.1 (30) 22.7 to 27.1 (33) 18.3 to 22.7 (25) 13.9 to 18.3 (2)
USOA boundary Smoking Local authority boundary Health board boundary
Smoking is the largest single cause of avoidable ill health and early death in Wales. Smoking and passive Wales: 25% smoking have been linked to a range of serious illnesses including cancers and heart disease. Smoking prevalence in Powys is 21%, which is slightly lower than the Welsh average (23%)24. Smoking rates vary across the county, as seen in figure 20.
Produced by Public Health Wales Observatory, using Welsh Health Survey (Welsh Government) ©Crown Copyright and database right 2012. Ordance Survet 100044810 Breast Cancer Screening
The aim of the breast screening programme is to reduce mortality from breast cancer
by detecting breast cancer early. In Powys, 71.7% of women invited for screening took Table 3: Uptake of Breast Screening of eligible women aged 50-70 years for Wales and Powys up the offer25. This is above the minimum target of 70% set by Welsh Government, but Teaching Health Board for period 1 April 2010 to 31 March 2011 Population All-Wales Powys Teaching HB below all Wales screening uptake levels. All eligible women are invited for screening Percentage 74.7% 71.7% within a three-year period, which means that a one year period is sometimes unrepresentative as only a proportion of women may be invited from a defined Number eligible women tested 98,956 1,119 geographical area. Source: Data from Screening Division, Public Health Wales
38 Opportunities to ensure older people can live healthy, happy lives
• Increase opportunities for social and physical activities • Increase opportunities for volunteering • Health information Key actions • Recreational and leisure facilities Affordable, safe housing for older • • Mental health support people • Promote the Agored Cymru Community food and Nutrition course to those who work with older people, carers, and service users
• Free from illness and disease Ability to maintain healthy lifestyle Key • • Free from injury and accidents outcomes • Maintain independence by age 74
39 Part G: Elderly People - Remain happily independent
Support Flu The golden age: remaining happily independent services People are living longer and for many older people, advancing age is associated with frailty. Frailty describes individuals who have physical or mental disabilities that may interfere with the ability to independently perform activities of daily living. Physical activity As people age, there is a greater likelihood of developing chronic diseases e.g. diabetes, coronary heart disease and cancers. Some older people are more susceptible to falls, accidents and injuries, and gradual deterioration in vision and Social network hearing. This results in a greater likelihood for them to need health and social care services26. Falls and fractures
Influenza (flu)
Influenza is a viral infection which is usually a self limiting illness. However, for vulnerable groups such as the very old and those with chronic conditions, residents in long stay care homes or pregnant women it can be much more serious. Flu vaccination would protect these groups from serious complications of flu. Other groups that should receive the flu vaccination are carers for an elderly or disabled person, those working as first aiders for third sector and NHS frontline staff.
The aim of vaccinating individuals is to reduce their risk of serious illness and death, as well as to reduce the number of hospital admissions due to flu.
40 Flu immunisation uptake The national target for flu vaccination uptake is 75%. In 2011/12, Powys flu immunisation uptake in patients aged 65 years and older was 66.5% (figure 21). For the same period uptake in those aged below 65 years with clinical risk conditions was 47.6% (figure 22).
Out of all the risk groups, uptake was lowest in pregnant women (32%) and highest in patients with diabetes (65%)27.
Fig 21: Uptake of flu immunisation in Welsh Health Boards in patients aged 65 years Fig 22: Uptake of flu immunisation in Welsh Health Boards in patients aged 6 months Source: Publicor Health older, Wales 2009/10 Vaccine – 2011/12 Preventable Disease Programme. Seasonal Influenza vaccine uptake in Wales - 2011/12, May 2012. Cardiff: toPublic 65 yearsHealth with Wales one or more clinical risks, 2009/10 – 2011/12.
CASE STUDYRaising awareness among British Red Cross staff
Red Cross staff and volunteers have contact with vulnerable people through their work such as Home from Hospital, Therapeutic Care, Transport and Escort and Medical loan.
In 2011, the British Red Cross successfully bid for a Well-being and Activity Grant, with the aim of raising awareness amongst their staff and volunteers. A series of workshops were held to improve staff knowledge of the effects of flu and the need for immunisation in targeted groups.
In total, 92 Red Cross Health and Social Care Staff and volunteers attended workshops across Powys. All workshop participants received flu information leaflets for distribution to clients.
41 Long term conditions
The most common long-term conditions are heart disease, diabetes, stroke, Fig 23: cancer and chronic respiratory diseases. Figure 23 shows the factors that can G e n e r a l I n d i v i d u a l s o c i o - e c o n o m i c , L i v i n g lead to these long-term conditions. Our cultural, environmental and economic l i f e s t y l e f a c t o r s I n t e r m e d i a t e M a i n c h r o n i c c u l t u r a l a n d a n d w o r k i n g r i s k f a c t o r s d i s e a s e s conditions shape our living and working conditions, which in turn can influence e n v i r o n m e n t a l c o n d i t i o n s A g e a n d our health behaviours. This, combined with our genetics, leads to intermediate c o n d i t i o n s g e n e t i c s risk factors such as raised glucose levels or abnormal blood lipids, culminating in chronic disease. Research has shown that unhealthy diet, physical inactivity and 28 tobacco use are the major contributory factors to long-term conditions . Adapted from World Health Organisation33
How many people in Powys have long-term conditions? The proportion of adults who report being treated for a long term condition is generally lower in Powys compared with Wales (table 4 and figure 24).
% currently being treated fro a chronic illness, 2003/04-2009 FigUSOAs, 24: percentage (age-standardised) 53.1 to 56.3 (14) 49.9 to 53.1 (19) 46.7 to 49.9 (19) 43.5 to 46.7 (25) 40.3 to 43.5 (10)
Table 4: Welsh Health Survey results (observed) for selected conditions for persons USOA boundary
Indicator:aged 65Currently and over, 2008-10 treated for (%) Powys Wales Local authority boundary
High blood pressure 50 51 Health board boundary
Heart condition 25 29 Wales: 48% Respiratory condition 17 22 COPD (proxy*) 5 7 Mental Illness 8 10 Arthritis 27 33 Diabetes 14 15
* reports of currently being treated for emphysema and / or bronchitis is used as a proxy for COPD Source: Public Health Wales Observatory, using Welsh Health Survey data (WG).
Produced by Public Health Wales Observatory, using Welsh Health Survey (Welsh Government) ©Crown Copyright and database right 2012. Ordance Survet 100044810
42 Mental Health
Mental health underpins our overall health. Mental health contributes to the extent to which people feel able and motivated to adopt healthy lifestyles29. Poor mental health is associated with obesity, alcohol misuse and smoking as well as a number of long term conditions such as diabetes, coronary heart disease and chronic obstructive pulmonary disease. The Welsh Health Survey (2009 and 2010) showed that those who reported a higher number of healthy behaviours also reported better mental health and well-being24.
Dementia
Dementia is a debilitating progressive illness that is characterised by a widespread Population estimated to have dementia, Powys Teaching Health Board, males and females aged 75-79, 2011-2030 Fig 25: impairment of mental function29. Produced by Public Health Wales Observatory, using data from Daffodil (WG) & 2008 LA Population Projections
Males Females 95% confidence interval As the condition progresses, individuals will have more complex needs, especially in the 400 later stages. This means that they become increasingly dependent on health and social 350 care services as well as carers, friends and family. The Alzheimer’s society has estimated 300 that dementia costs the UK £23 billion. This is more than the cost of cancer, stroke and 250 heart disease combined30. 200 150 People with dementia have on average, longer lengths of stay in hospital. For example 100 a report by the Alzheimer’s Society found that the average duration of stay following 50 0 a hip fracture for a dementia patient was 43 days, compared to 26 days in a patient 2011 2015 2020 2025 2030 without dementia31.
Risk factors for dementia
Population estimated to have dementia, Powys Teaching Health Board, males and females aged 80-84, 2011-2030 Dementia prevalence increases with age, roughly doubling every 5 years for people Fig 26: Produced by Public Health Wales Observatory, using data from Daffodil (WG) & 2008 LA Population Projections aged over 65 years. One in 14 people over 65, one in 6 people over 80, and one in three people over 95 has some form of dementia32. Males Females 95% confidence interval 800
700 The evidence suggests that the best advice for preventing dementia is adopting the 600 mantra, “what is good for your heart is good for your brain”. The evidence suggests that maintaining or adopting lifestyle changes such as physical activity, stopping smoking, 500 healthy diet, mental stimulation, and socialising is especially important in those aged 400 40-64 years33. 300 200 Dementia in Powys 100 0 The number of people with dementia aged between 75 and 84 years is estimated to 2011 2015 2020 2025 2030 increase from 839 in 2011 to 2522 in 2030 (Figures 25 and 26).
43 Opportunities to ensure older people can live healthy, happy lives
• Supportive community network Key actions • Health information Integrated health and social support services during • • Mental health support retirement
• Ability to maintain independence Free from injury and accidents Key • • Ability to maintain a healthy lifestyle outcomes by age 74
44 CHAPTER 5 Ffion’s story retold - Can you change my life?
My name is Ffion and this is my story. It is 15th April 2011, and I don’t exist yet. My mam has just brought home a pregnancy test and is anxiously waiting for the result. She already has three boys and doesn’t want another child. My dad, Cai works in the local garage and my mam works in the supermarket. They are struggling to make ends meet as the cost of living keeps rising.
My mam cannot cope with the stress of three young children. She continues to smoke when she is pregnant, she is so stressed out; harm to me is the last thing she is thinking of. When she went along to see the midwife, she was asked about her smoking habits and how she was feeling. The midwife listened to her concerns and referred her to the smoking cessation service, the local counselling service, and the council to get some money advice. This made her feel much better and she was able to give up smoking.
On 8th October 2012, I am born in Bryn Gobaith. I am born a healthy weight. My mam starts to breast feed me, but as soon as she goes home, she finds it really difficult. She has my brothers to look after, so is busy rushing around after them. The community midwife came to visit and gave her some support. She also referred her to a local breastfeeding support group where she was able to receive mutual support from other mums.
The local authority gave her some advice and helped her access local childcare, so she was able to continue working part time.
I am 3 years old when I go to the local playgroup for a few hours each day. I really enjoy it since I can play with the toys and look at books. When my mam picks me up, we only go to the local fish and chip shop for chippies as a rare treat.
I am 4 years old and I have to go to the dentist. I was given the all clear. I did eat a few sweets occasionally, but I made sure I brushed my teeth, which I had been told about at school.
When I am nearly 5, I start reception class in school. My mam made me some sandwiches for lunch. The school gave my mam lots of advice on healthy eating.
I am 14 years old now and in secondary school. I am doing well in school but some of my friends don’t think school is cool and there is a lot of pressure not to try too hard.
I am 15 years old now and my friend Laura is killed riding on the back of motorbike. I don’t know how to deal with it. My mam takes me to the local Doctor and he refers me to a counselling service. I think it really helps, as I am able to let off some steam and talk about how I feel.
45 I go on to study A ‘levels. I leave school and get a job working for the local council. I eat quite a lot as we always have cakes to eat when it’s someone’s birthday or when someone comes back from holiday.
I am 21 when I meet Andy in the local pub. I soon become pregnant with our first child. When I go for my booking with the midwife, she gives me advice about my weight so that I don’t put myself and my baby in danger.
I am really pleased as I am able to have Sian at home, with Andy by my side. This is lucky as my car has broken down and I can’t afford to have it fixed. After I give birth to Sian, I find it difficult to get the weight off and I feel very depressed about it. The health visitor tells me about a local buggy fit group. I meet a new group of friends, which really helps with the depression, and I am able to keep fit at the same time.
I go back to work at the Council. I find it really difficult to balance work and home and become very stressed. Luckily they have a healthy workplace scheme and are able to help me manage the stress.
I am 45 years old now. To be the honest the weight has crept back on me a little and my back has started to hurt. I go to my Doctor and he advises me that I need to keep active to help lose weight. I go to a weight management programme, which is fantastic as it isn’t just about diet, it was about changing the way I think about myself and food. I am offered counselling, exercise and nutrition advice. I am able to exercise at the local leisure centre so don’t have to travel too far.
I am 55 now. I have started leading some walking groups with a local charity. This is great as I feel I can put something back into the community.
I am an old lady now. I’ve had a long healthy and happy life. I couldn’t ask for anything more and I hope my children and grandchildren will experience the same.
Diolch yn fawr......
46 References
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2. Bull, J., Mulvihill, C., Quigley, R. Prevention of low birth weight: assessing 8. Dyson A, Hertzman C, Roberts H, Tunstill J and Vaghri Z. Childhood the effectiveness of smoking cessation and nutritional interventions. development, education and health inequalities. Report of task group. Evidence Briefing: Health Development Agency, 2003 Available at:http:// Submission to the Marmot Review. 2009. Available at: http://www.ucl. www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/ ac.uk/gheg/marmotreview [Accessed 6th August 2012] prevention_of_low_birth_weight_assessing_the_effectiveness_of_ interventions_evidence_briefing.jsp [Accessed 6th August 2012] 9. Royal College of Psychiatrists. No health without mental health: the case for action. Royal College of Psychiatrists position statement PS4/2010 3. The NHS Information Centre. IFF Research Infant Feeding Survey 2010: October 2010. Available at: http://www.rcpsych.ac.uk/pdf/Position%20 Early Results 21 June 2011 Available at: http://www.ic.nhs.uk/webfiles/ Statement%204%20website.pdf [Accessed 6th August 2012] publications/003_Health_Lifestyles/IFS_2010_early_results/Infant_ Feeding_Survey_2010_headline_report2.pdf [Accessed 6th August 10. Maria Morgan Profile of dental health in Powys Health Board. Welsh 2012] Oral Health Information Unit, in association with the Public Health Wales Dental Public Health Team. Cardiff University Available at: http:// 4. Centre for Maternal and Child Enquiries (CMACE). Maternal obesity www.rcpsych.ac.uk/pdf/Position%20Statement%204%20website.pdf in the UK: Findings from a national project. London: CMACE, 2010 [Accessed 6th August 2012] Available at: http://www.oaaanaes.ac.uk/assets/_managed/editor/File/ CMACE/CMACE_Obesity_Report_2010_Final%20for%20printing.pdf 11. Jackson C, Sweeting H, Haw S. Clustering of substance use and sexual [Accessed 6th August 2012] risk behaviour in adolescence: analysis of two cohort studies. BMJ Open 2012;2:e000661.doi:10.1136/bmjopen-2011-000661 http://bmjopen. 5. Marie Lewis. Maternity services outcomes for women and babies in bmj.com/content/2/1/e000661.full.pdf+html [Accessed 6th August relation to their BMI at booking. Audit Report: Powys teaching Health 2012] Board. Powys Teaching Health Board 2011 12. Alcohol Concern. A drinking nation? Wales and alcohol. November 6. National Institute for Health and Clinical Excellence. Improving the 2010 Available at: http://www.alcoholconcern.org.uk/assets/files/ nutrition of pregnant and breastfeeding mothers and children in low- Publications/Wales%20publications/A%20drinking%20nation%20-%20 income households March 2008 http://www.nice.org.uk/nicemedia/ November%202010.pdf Accessed 6th August 2012] live/11943/40097/40097.pdf [Accessed 6th August 2012]
47 13. National Public Health Service. A profile of alcohol and health in Wales. 20. National statistics for Wales Welsh Health Survey 2009 and 2010: 2009. Available at http://www.wales.nhs.uk/sitesplus/888/page/43761 Combined health lifestyle behaviours of adults Welsh Government. May [Accessed 1 June 2012] 2012. Available at http://wales.gov.uk/docs/statistics/2012/120522sb432 012en.pdf [Accessed 6th August 2012] 14. Frieldi L and Parsonage M. Promoting mental health and preventing mental illness: the economic case for investment in Wales All Wales Mental 21. NHS Confederation from Illness to Wellness: Achieving efficiencies and Health Promotion Network. October 2009. Available at:http://www. improving outcomes. Briefing 224. London: NHS confederation. 2011 publicmentalhealth.org/Documents/749/Promoting%20Mental%20 Available at www.yorkshireandhumber.nhs.uk/document.php?o=6004 Health%20Report%20(English).pdf [Acccessed 6th August 2012] [Accessed on 13th August 2012]
15. Public Health Observatory Wider determinants of Health Powys 22. Buck D, Frosini F. Clustering of unhealthy behaviours over time. Teaching Health Board. April 2012. Available at: http://www2.nphs.wales. Implications for policy and practice Kings Fund. 2012. Available at nhs.uk:8080/PubHObservatoryProjDocs.nsf/61c1e930f9121fd08025 http://www.kingsfund.org.uk/publications/unhealthy_behaviours.html 6f2a004937ed/6f04c0b165fa8f2d802579e40035bb04/$FILE/WDoH_ [Accessed on 1st September 2012] report_Powys_v1.pdf [Accessed on 10th August 2012] 23. Department of Health, Physical Activity, Health Improvement and 16. Wilcox S. The Geography of affordable and unaffordable housing and Protection. Start active, stay active: a report on physical activity from the ability of younger working families to become home owners. Joseph the four home countries’ Chief Medical Officers. July 2012. Available Rowntree Foundation. 2006. Available at: http://www.jrf.org.uk/sites/ at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/ files/jrf/1951-affordability-housing-regions.pdf [Accessed on 6th August documents/digitalasset/dh_128210.pdf 2012] 24. Welsh Health Survey 2009 and 2010 http://wales.gov.uk/topics/ 17. Cyngor Sir Powys County Council Powys Unitary Development Plan statistics/headlines/health2011/1109131/;jsessionid=CwpXT3BMb65S Affordable Housing for Local Needs Supplementary Planning Guidance lMgDpLpy2K1zfG1jhT4Xyr1fhLtxdwv5Nyymgs6M!1249552498?lang= (SPG) Adopted March 2010. Available at: http://www.powys.gov.uk/ en [Accessed 6th August 2012] rep_2010-09-28b1_298c_en.pdf?id=47 [Accessed on 6th August 2012] 25. Hillier S. Report on Population based National Screening Programmes 18. Cyngor Sir Powys County Council Powys Local Development Plan Draft in Powys Teaching Health Board. 21 March 2012. Population & Housing Topic Paper. August 2011. Available at: http://www. powys.gov.uk/rep_2011-08-08ldp1_36.1b_en.pdf?id=47 [Accessed on 26. Cornwell J. The care of frail older people with complex needs: time for 6th August 2012] a revolution. The Sir Roger Bannister Health Summit, Leeds Castle Kings Fund. March 2012. Available at: http://www.kingsfund.org.uk/publications/ 19. Welsh Assembly Government Healthy Working Wales. Health, Work and care_revolution.html Accessed [6th August 2012] Well-being Action Plan for Wales 2011-2015. Available at: http://wales. gov.uk/docs/phhs/publications/110517actionplanency.pdf [Accessed on 27. Public Health Wales Vaccine Preventable Disease Programme. Seasonal 6th August 2012] Influenza vaccine uptake in Wales - 2011/12. May 2012. Cardiff: Public Health Wales.
48 28. World Health Organisation. Preventing chronic disease vital investment. World Health Organisation. Available at http://www.who.int/chp/ chronic_disease_report/contents/part2.pdf [Accessed 6th August 2012]
29. National Institute for Health and Clinical Excellence. Dementia -Supporting people with dementia and their carers in health and social care. 2006. Available at: http://www.nice.org.uk/nicemedia/pdf/ CG042NICEGuideline.pdf [Accessed 6th August 2012]
30. Alzheimer’s Society. Dementia UK - The full report. Alzheimer’s Society. 2007. Available at: http://www.alzheimers.org.uk/site/scripts/download_ info.php?fileID=2 [Accessed 6th August 2012]
31. Alzheimer’s Society. Counting the cost Caring for people with dementia on hospital wards. Available at: http://alzheimers.org.uk/site/scripts/ download_info.php?fileID=787 [Accessed 6th August 2012]
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33. Alzheimer’s Society. Welsh dementia prevalence and diagnosis rates: Powys Teaching Health Board. Available at: http://alzheimers.org.uk/site/ scripts/directory_record.php?recordID=1776 [Accessed on 6th August 2012]
49 If you would prefer to have a Welsh language version of this report or wish to provide feedback on the contents, please contact:
Powys Public Health Team The Courtyard Bronllys Hospital, Bronllys, Brecon, Powys LD3 0LU or
[email protected] FOR DISCUSSION
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 5.1
FINANCIAL PERFORMANCE TO MONTH 6 (SEPTEMBER 2012)
Report of Director of Finance
Paper prepared by Director of Finance Purpose of Paper The purpose of this report is to inform the Board of the financial performance of the Powys Teaching Health Board (tHB) for 2012/13 Action/Decision required The Board is asked to note the financial performance of the tHB. Link to ‘Doing Well, Doing N/A Better: Standards for Health Services in Wales’ Link to Health Board’s Living within our Means Corporate Plan
Acronyms and ABHB – Aneurin Bevan Health Board abbreviations ABMU – Abertawe Bro Morgannwg University Health Board ACCP – Accelerated Clinical Change Programme AWCP – All Wales Capital Programme CHC – Continuing NHS Healthcare CIP - Cost Improvement Programme EMAs – Emergency Medical Admissions HR - Human Resources HQ - Headquarters MH - Mental Health NWIS – NHS Wales Informatics Service NWSSP – NHS Wales Shared Services Partnership PCT – Primary Care Trusts PSPP - Public Sector Payment Policy RJAH – Robert Jones and Agnes Hunt NHS Trust SaTH – Shrewsbury and Telford NHS Trust tHB - teaching Health Board VER – Voluntary Early Release WHSSC – Welsh Health Specialist Services Committee WOD – Workforce and Organisational Development Ytd – Year to Date
Financial Performance to Month 6 Page 1 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION FINANCIAL PERFORMANCE TO MONTH 6 (SEPTEMBER 2012)
BACKGROUND
This paper presents the 2012/13 year to date and forecast outturn performance of the organisation against the Statutory Financial Duties of the Board.
SUMMARY
Having taken stock of the first 6 months of 2012/13, the Health Board has reviewed its current and forecast financial position in order to assess the likely outturn and associated risks.
The year to date position is £5.2M and assessed year end outturn is £8.8M.
The forecast puts the organisation at a slight deterioration to the 2011/12 position (£0.9M, 0.4%) when eliminating the impact of the early draw down but noting in doing so, the organisation has had to manage in-year cost increases for which no financial uplift was allocated from Welsh Government.
In making this assessment, there are a number of upside and downside risks which may affect the position to the end of the financial year. The organisation has put in place a number of strategies with a view to managing these risks and secure an improved performance to the end of the financial year. Our risk range has been assessed to be between £5M and £13M overspend.
In assessing our likely performance against the plan our forecast predicts an achievement of 5.8% (£13.3M) against a required savings target of 8.2% (£19M).
The Health Board are currently in discussion with the Welsh Government regarding the year to date and forecast position.
With the exception of the revenue resource limit, all other statutory financial targets are on track for full achievement.
ANNUAL FINANCIAL PLAN
The Annual Financial Plan against which performance is measured is the updated plan presented to the Board in September 2012. No further amendments to the plan have been made since the last Board meeting.
The plan is based upon the assessment of £19M in-year costs pressures which need to be addressed in order to achieve a fully balanced position. Of these costs pressures, £17.252M of cost reductions have been targeted leaving a planning shortfall of £1.748M to be covered through other means. This paper will present the means by which this planning shortfall will be covered.
Financial Performance to Month 6 Page 2 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION REVENUE EXPENDITURE – YEAR TO DATE
Expenditure to Date
The summary position to date is shown in Table 1 below which identifies an overspend at month 6 of £5.184M and forecast overspend of £8.790M
Table 1 Income and Expenditure position to Month 6 Performance to date and forecast outturn at Month 6 by Primary Budget holder
Annual Budget Actual Variance Forecast Budget to Date to Date to Date at Month Locality / Directorate £000 £000 £000 £000 06 Mid Locality 30,603 15,691 16,473 (782) (1,598) North Locality 65,571 34,228 35,450 (1,222) (4,378) South Locality 52,824 27,018 28,257 (1,240) (2,215) Finance 2,735 664 792 (129) (6) HR (WOD) 1,057 606 623 (17) (13) PH and Planning 35,709 17,894 18,365 (472) (729) Corporate Services 1,411 705 824 (118) (266) Medical 5,823 2,938 2,843 95 335 Mental Health 17,831 9,051 9,093 (43) (315) Nursing 3,251 1,625 1,644 (19) (9) Women and Children 11,571 5,785 6,175 (389) (562) Therapies Management 742 390 365 25 28 Community Health Councils 3,783 1,884 1,884 0 0 Reserves 983 (1,874) (1,000) (874) 938 Total Expenditure 233,894 116,604 121,788 (5,184) (8,790) Revenue Resource Limit (233,894) (116,604) (116,604) 0 0 Grand Total 0 0 5,184 (5,184) (8,790)
(Brackets within the variance column denote overspend)
Financial Performance to Month 6 Page 3 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION Variance Analysis to month 6
The year to date and forecast variances are comprised of the following key elements;
Year to date Forecast Variance Variance £M £M
Financial Planning Gap (£1.748M/12*6) (0.874) (1.748) Continuing Healthcare (0.256) (0.413) Commissioned Service (incl Income) (3.395) (9.024) Directly provided services (0.574) (1.059) Prescribing 0.800 Reserves 2.686 Other (0.084) (0.032) Total (5.184) (8.790)
An analysis which describes how these variances affect individual budget holders is presented in Appendices 1 and 2 for both the year to date and forecast.
A description of the issues affecting the year to date and forecast variance is presented below in Table 2.
Table 2 Current and Forecast Variance Analysis Service Year to Forecast Assessment and Action Date Variance Variance £M £M Financial (0.874) (1.748) The Board will recognise this as the residual Planning Gap risk in drawing together a fully balanced financial plan. This risk will be offset by the reserves identified below, which include income arising from successful bids in-year. North Locality (1.000) (2.000) The North Locality set itself an ambitious Planning Gap target of cost reduction against its commissioned services over the past two years (£4.6M target against SaTH contract of £21M). Reassessment in-year against fully worked up savings programmes have identified a £2M shortfall in identified savings strategies. Whilst actions continue to pursue further cost reductions around changed pathways, referral management and unscheduled care, the £2M shortfall reflects their current assessment for the year. The ACCP will assist through sharing learning, this will be critical in preparing for 2013/14.
Financial Performance to Month 6 Page 4 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION Localities - (0.344) (0.593) The Health Board identified that not all Income income was being collected for services delivered to patients from other Health Boards and English organisations. An exercise lead by the commissioning team over the previous 6 months has assisted in putting in the systems necessary to ensure income due is collected.
However, coinciding with this work, some Health Boards have taken deliberate steps to repatriate activity previous undertaken within Powys into their own local services in order to reduce their costs. As a result, the opportunity for income generation is diminishing. This is a particular issue between Ystradgynlais Hospital and ABMU Health Board and hence the scale of variance against income within the South Locality (£0.217M forecast). The measures identified above continue and discussions are on-going to minimising the impact of income reductions from other Healthcare organisations. Localities - (0.256) (0.468) Forecast slippage against the General CHC Continuing savings programme (£0.302M) account for Healthcare the majority of the forecast overspend along with volume growth. Localities are receiving further support from the Nurse Director in identifying alternative strategies to reduce cost. Localities – (0.525) (0.707) The Health Board has targeted volume Commissioning reductions worth £3.5M from its range of Elective Care providers through repatriation, referral management, managing growth, changing pathways and managing waiting times. Profiled performance identifies slippage on the programme. The ACCP has established two workstreams around theatres and outpatients with a view to securing further reductions in elective care costs to supplement the work already progressed by the localities. This further targeted approach is critical to ensuring increased costs reductions in 2013/14 and beyond. Localities – (0.795) (1.759) The Health Board has targeted volume Commissioning reductions worth £2.3M across its range of Emergency providers but to date has seen limited Medical success. The ACCP has been established Admissions with a view to ensuring the success of this targeted reduction, focussing initially on the Financial Performance to Month 6 Page 5 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION South Locality but with learning and methodology being rolled out across the county. Success in its implementation will be critical to securing an improved position in 2013/14. Localities – (0.354) (1.920) Volume in activity which exceeds expected Commissioning levels and not directly attributable to non Growth achievement of savings has been experienced within the previous 6 months. The current trajectory suggests this will reach £1.9M by year end. Major areas of concern are at Wye Valley NHS Trust, Robert Jones and & Agnes Hunt NHS Trust, ABMU and ABHB. Additional support has been allocated to localities, alongside an external consultant identified through the financial management review to unpick the drivers to volume increases and set in place targeted action. Planning – (0.345) (0.733) The Health Board invested £1M in specialist Commissioning services at the start of the year. Current WHSSC trajectory indicates that Powys tHB will be charged £0.7M over and above this investment as part of the risk sharing agreement with the other Health Boards The overspend attributed to Powys is arising as a result of increasing volume increases with specialist services within NHS England. The Planning Director is pursuing measures with WHSSC to reduce the charge to the Health Board. Mental Health (0.043) (0.315) A 10% reduction (£2M) target was established for the Mental Health team to reduce costs across the range of activities. Good progress is being made in reducing CHC costs with the target anticipated to be fully achieved. Slippage on savings is assumed within the forecast against the 3 Welsh providers of Mental Health Services. However this is still being pursued and therefore some improved performance maybe seen before the end of the financial year. Discussions also continue with the council regarding the use of Health Board funding for learning disabilities with a view to reducing costs. Women and (0.389) (0.562) A small target was applied (£0.2M) against Children the women and children’s directorate to achieve reductions in directly provided services and reductions in out of county services. Planned savings are currently not Financial Performance to Month 6 Page 6 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION being fully achieved and volume growth has occurred within commissioned services. The Nurse Director is leading work to improve the current trajectory. Localities – (0.140) (0.482) The organisation targeted savings Provider specifically at catering and cleaning Catering and services across its directly provided services Cleaning of £0.570M. Whilst limited progress has been achieved, additional support is being provided to the Localities to improve performance through the Director of Planning. Localities & (0.316) (0.780) The organisation planned £2.1M savings HQ – Provider against pay and £0.6M against non pay at services the start of the year. Reduction in costs have been planned across the breadth of the organisation’s workforce and other non pay costs including £0.5M reductions within HQ function.
Trend analysis on our directly provided services have indicated that overall our workforce costs (which account for 75% of provided services spend) are relatively static and therefore slippage against plan is creating the overspend.
The Workforce and OD Directorate have been providing support to the organisation on workforce redesign with a view to identifying where costs can be further reduced.
Further analysis of pay spend identifies that variable pay (pay spend that is beyond contractually bound payments) is low in value and therefore opportunity to reduce costs are limited to natural turnover.
The Health Board has been successful in obtaining £0.8M funding for Voluntary Early Release (VER) through a spend to save bid with Welsh Government and is in the process of reviewing applications with a view of reducing costs in the second half of the year. The forecast currently assumes £0.2M reduction in costs through use of VER and this will be refined once the VER process has concluded.
The NHS Wales Shared Services
Financial Performance to Month 6 Page 7 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION Partnership identified the potential for savings on non pay within all Health Boards at the start of the year and have been tracking performance. To date, not all savings expected have been identified locally. The Finance Directorate are working with NWSSP to ensure all control measures are being applied. Localities - (0) 0.800 A change in pricing for Category M drugs Prescribing from October alongside unused funding held aside for high cost cases will realise an underspend against the prescribing budget. Reserves (0) 2.686 Analysis of reserves held identify opportunities for use of funding set aside as contingencies e.g. NICE costs within secondary care, assuming they remain unused to year end. In addition, income successfully secured from bids to Welsh Government for Orthopaedics and Unscheduled care will assist the organisation in reducing its costs to year- end. This income has been placed into reserves pending distribution. A fuller analysis of the figures contained within the reserves is set out in Appendix 3 Other 0.197 (0.209) Variances across a range of other services not covered above Year to Date / 5.184 8.790 Assessed as the most likely outturn based Forecast on performance to month 6 and analysis of outturn actions currently planned for the remainder of the year. This forecast is subject to a range of both upside and downside risks as set out in the risk assessment section
Financial Performance to Month 6 Page 8 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION FORECAST POSITION
The Health Board is reporting a forecast outturn at £8.8M.
The forecast puts the organisation at a slight deterioration to the 2011/12 year end position when eliminating the impact of the early draw down. However, in making this comparison it should also be noted that the organisation has had to manage in-year cost increases for which no financial uplift has been allocated from Welsh Government. The comparison to 2011/12 is set out below:
£M 2011/12 underlying position 3.9 (Pre early draw drawn) 2012/13 early draw down of allocation 3.9 Year end formal outturn position Balance
2012/13 forecast outturn position 8.7 (Incl repayment to WG) Less impact of 2012/13 early draw down (3.9) 2012/13 underlying position 4.8 (excluding early draw down impact)
Net variation between years 0.9 (0.4% of income) (comparison of underlying positions)
SAVINGS ANALYSIS
Overall the tHB is predicting savings of £13.366M (5.81%) against the planned savings of £17.252M (7.5%). This is set out in table 3 below. Issues affecting performance and actions being taken are set out in the variance analysis above.
Table 3 Forecast performance against savings plan Planned Forecast % of Savings Programme £M Spend £m %
General Continuing Healthcare 0.382 15.00% 0.175 6.87% Commissioning (excl WHSSC) 8.641 12.36% 6.817 9.75% Prescribing / Dispensing 0.791 2.87% 0.791 2.87% Directly Provided services (excl HQ, W&C & Dental) 2.159 5.21% 1.126 6.23% Mental Health incl CHC 2.000 9.57% 1.284 2.72% Women and Children 0.200 2.87% 0.071 1.01% Dental 0.050 7.14% 0.050 7.14% HQ and other supporting Functions 0.629 6.00% 0.652 6.00% Accounting Treatments 2.400 2.400 Total 17.252 7.50% 13.366 5.81%
Financial Performance to Month 6 Page 9 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION RISK ASSESSMENT
The organisation has taken an assessment of the year to date and profiled the expected performance to year end using a combination of financial analysis and local intelligence around expected savings delivery. This analysis has and has identified a most likely outturn of £8.8M with a risk range of £5M - £13.8M.
Table 4 below sets out the analysis of risks which have been considered within our risk range. The major aspects of both upside and downside risks included in this analysis are set out in the narrative below.
Table 4 Analysis of Risks
Worst Case Most Likely Best Case £M £M £M Forecast Outturn (8.790) (8.790) (8.790)
Retrospective CHC Cases (0.900) CHC variability risk (0.200) 0.200 Waiting list management (England & Wales) (1.700) Contract challenges (Wales providers) (0.440) Pricing (Wales providers) (1.000) Mental Health Challenge with Welsh providers 0.500 Primary care underspends 0.200 LD Service with Council (0.150) 0.350 Other Balance Sheet 0.320 Non requirement for reserves held e.g. NICE 0.370 Use of WG new allocated funds (0.650) 0.350 Challenging the WHSSC risk sharing agreement 0.700 Targeting further improvement in provider services 0.500 Reductions in EMAs facilitated through ACCP 0.200 Reductions in Elective Care facilitated through ACCP 0.100 Total (13.830) (8.790) (5.000)
Financial Performance to Month 6 Page 10 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION • The tHB has received 42 new retrospective CHC cases in recent days. These have been generated as a result of a recent awareness raising campaign running within England. These new cases have not been factored into our forecast position but are noted in our worst case scenario has having a possible impact. Assessment of their validity and likelihood of settlement will be undertaken within the next few weeks • Waiting list management risks are associated with the decision by the Board to manage waiting lists to the 36 week backstop with a view to reducing volume in the final quarter of 2012/13. The Health Board is currently issuing this mandate to all providers to work to this target with the reduction in volume and associated savings included in the forecast position. The risk arises from the acceptability of the Health Board’s approach with Welsh Government and other providers of healthcare. At present there is no indication of problems in implementation. • Within the forecast position the Health Board is assuming that it will be successful in enforcing terms and conditions with Welsh providers, achieving contract challenges of £0.44M. This approach is not accepted by the other Health Boards and therefore represents a risk to our position. The finance director is supporting localities and directorates in enforcing this approach with other organisations and is in the process of meeting with other Welsh Health Board Finance Directors to find resolution. We have signalled to Welsh Government that arbitration maybe required. • The Health Board has continued to push for a 1.8% deflator with Welsh providers and a specific pricing reduction with Aneurin Bevan. Again this is assumed within our forecast position but has not been accepted by Welsh providers posing a risk to our position. As with contract challenges above, this continues to be pursued with the Health Boards. • The Health Board has requested responses on the use of Mental Health funding to the 3 provider health Boards within Wales, using the transfer of service schedule as a guide to its usage. Only Aneurin Bevan Health Board has responded to date with responses awaited from BCU and ABMU. The Health Board has not assumed success with cost reductions within its forecast position but has noted that there maybe opportunity. • The Health Board has queried the use of £1.4M Section 28a funding with Powys County Council for Learning Disability services. A response is awaited from the Council regarding its use. Some success is assumed in reducing the current cost within the current forecast and the worst and best case scenarios describe the risk uncertainty. • Further assessments continue to be made against corporately held reserves and balance sheet items for their release into the organisation’s position. There is the potential that further scope maybe realised but given there is still 6 months to run to year-end the likelihood for the need for additional costs i.e. NICE / High cost drugs or claims against liabilities estimated at the time of closing the 2011/12 annual accounts cannot be firmly established but will become clearer closer to year end • The Health Board will be pursuing actions with WHSSC to ensure the risk sharing agreement is appropriately discharged and that measures are taken to reduce costs with NHS England • The Mid Year reviews led by the CEO have focussed on improving current performance with an specific focus on improving directly provided services costs to year end Financial Performance to Month 6 Page 11 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION • The ACCP has commenced and there maybe scope to improve current trajectories on volume to year end.
Reported position to Welsh Government
The tHB has reported a forecast out-turn over spend of £4M in its month 6 monitoring returns to Welsh Government. This is based on discussions held with them shortly before the submission of the returns and their expectation of the Board’s continued performance improvement to year end. The Health Board has clearly flagged within the narrative of the return the currently assessed most likely outturn position as £8.8M with associated upside and downside risks described.
The Health Board has been asked to resubmit its position by 19th October. The Board will be updated on the latest position and discussions with WG at the Board meeting.
PERFORMANCE MANAGEMENT PROCESS
The Board has previously been appraised of the performance management processes adopted to performance monitor progress with developing and implementing plans to reduce costs.
Since the last meeting a series of mid year reviews have taken place with each primary budget holder to assess their position and agree remedial action. The variance analysis and risk assessment describe the actions being taken to secure and improve the current trajectory in light of residual risks being held.
The major drive for budget holders is to ensure their directly provided services costs are reduced in the second half of the year.
The programme office secured via NWIS are currently completing their end to end process mapping of the financial recovery programme with a view to aiding improvement in the current performance management processes.
Financial Performance to Month 6 Page 12 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION CAPITAL RESOURCE LIMIT PEFORMANCE
Table 5 below presents the capital allocation, spend to date and planned expenditure for the year at the 30th September 2012.
Table 5 Capital Resource Limit Performance Scheme Capital Annual Planned Expenditure to Resource Expenditure at 30th Limit £M September 2012 £M £M Discretionary Capital 0.316 0.114 0.041
AWCP Welshpool 1.495 1.584 1.024 Renal AWCP Orthopaedics 0.400 0.513 0.513 Llandrindod AWCP Orthopaedics 0.853 0.853 0.041 Brecon AWCP - Bronllys 0.045 0.045 0 Sewerage TOTAL 3.109 3.109 1.619
Discretionary Capital £0.316M
The discretionary capital limit was set at the beginning of the year at £0.342M. This has been reduced in-year by £0.026M by Welsh Government for central purposes, leaving a discretionary Capital balance of £0.316M.
From this allocation there is a requirement to allocate funding to the AWCP schemes, where discretionary capital schemes were brought forward to utilise slippage against these schemes during 2011/12. Use discretionary capital funding for this purposes is £0.089M for Welshpool Renal and £0.113M for Orthopaedics Llandrindod. The remaining £0.114M has been prioritised in light of the restricted discretionary capital funding available and the prioritised schemes have commenced with a spend of £0.041M to date.
AWCP Welshpool Renal £1.495M
This scheme continues from 2011/12. The build is progressing well with £1.024M spent to date. It is anticipated that all funding will be utilised prior to December 2012. This includes funding allocated to the scheme from the tHB’s discretionary allocation as described above.
AWCP Orthopaedics Llandrindod £0.400M
This scheme continues from 2011/12. The work is progressing well and it is anticipated that all funding will be fully utilised by October 2012. This includes funding allocated to the scheme from the tHB’s discretionary allocation as described above.
Financial Performance to Month 6 Page 13 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION
AWCP Orthopaedics Brecon £0.853M
This scheme is due to commence during October 2012. There has been some enabling and external works undertaken during September to ease the programme transition between the two theatre schemes. This is necessary as the tHB cannot have both theatre’s closed for work at the same time, therefore the Brecon scheme will be started as the Llandrindod scheme is nearing completion however the tHB is working with the contractor to ensure as much preparatory work is undertaken in Brecon prior to its formal closure. The same contractor is undertaking both schemes so there is a joined project plan of works for both schemes. Current profile indicates that all funding will be fully utilised prior to the end of February 2013.
AWCP - Bronllys Sewerage Hydraulic Modelling Assessment Phase 1
Funding has been agreed to undertake a modelling assessment of the sewerage system on the Bronllys site. This expenditure will be committed before March 2013.
AWCP – Other
The tHB is awaiting confirmation of further capital funding from the All Wales Capital Funding Programme for the following schemes;
Llandrindod Wells Hospital Reconfiguration £0.120M
Mansion House Decant (M Ward & L Ward Roof) £0.190M
Mansion House Decant (IT) £0.195M
Anti Ligature Works Mental Health £0.160M
The above four currently unapproved schemes were discussed with Welsh Government colleagues at its meeting held on the 9th October 2012 and is on-going in terms of receiving formal confirmation of funding. Preparatory is currently underway to ensure completion of schemes prior to 31st March but poses a financial risk to the organisation should formal approval not be received.
PUBLIC SECTOR PAYMENT POLICY
The tHB is required to pay 95% of non-NHS suppliers within 30 days and is currently on track to meet this target. The tHB currently achieves a cumulative position of 95% of non NHS invoices paid within 30 days by value and 96% by number of invoices.
Table 6 Public Sector Payment Policy Performance Cumulative Performance at 30th September 30 days 10 days Value of invoices 95% 75% Number of invoices 96% 85%
Financial Performance to Month 6 Page 14 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION CONCLUSION
• The tHB has identified an overspend of £5.183M to month 6 • The tHB has reported, based on current performance, a most likely forecast overspend of £8.8M to month 12 with associated risks identified • The tHB is on track to achieve its capital resource limit target • The tHB is on track to achieve the Public Sector Payment Policy • The tHB is forecasting savings of 5.8% (£13.3M) against a required savings target of 8.2% (£19M).
RECOMMENDATION
The Board are asked to NOTE the financial performance of the tHB to month 6 and forecast for 2012/13 and to note the further actions in place to limit the risks against our forecast performance.
Report prepared by: Presented By: Rebecca Richards Rebecca Richards Director of Finance Director of Finance
Financial Performance to Month 6 Page 15 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION Appendix 1 - Year to date variance analysis by budget holder
Funded Joint Locality / Commissionin Provide Primar Prescribin Continuin Nursin Financin Incom Reserve Plannin Grand Directorate g r y Care g g Care g Care g e s g Gap Total £000's £000's £000's £000's £000's £000's £000's £000's £000s £000's £000's Mid Locality (843) 138 0 0 (58) (19) (782) (1,222 North Locality (684) (259) (0) (0) (192) 7 (94) ) (1,240 South Locality (871) (111) 0 0 (40) (217) ) Corporate Services (118) (118) Finance (0) (116) (13) (129) PH and Planning (345) (127) 0 (472) HR (WOD) (17) (17) Nursing 4 0 1 (24) (19) Mental Health (100) 97 29 (68) (43) Women and Children (285) (109) 5 (389) Medical 76 19 (0) 0 95 Therapies Management 25 25 Shared Services (0) Community Health Councils (0) Reserves (874) (874) (5,184 (3,051) (574) 0 0 (256) (24) (61) (344) (874) )
Financial Performance to Month 6 Page 16 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION Appendix 2 Forecast variance analysis by budget holder
Funde d Joint Locality / Commissioni Provid Primar Prescribin Continuin Nursin Financin Incom Reserve Plannin Grand Directorate ng er y Care g g Care g Care g e s g Gap Total £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s Mid Locality (1,713) (70) 50 266 (94) (37) (1,598) North Locality (3,592) (578) 50 214 (309) 18 (181) (4,378) South Locality (1,436) (690) 50 320 (65) (394) (2,215) Corporate Services (266) (266) Finance (5) (20) 19 (6) PH and Planning (733) 4 (0) (729) HR (WOD) (13) (13) Nursing 41 0 (0) (50) (9) Mental Health (537) 326 46 (150) (315) Women and Children (570) (0) 8 (562) Medical 154 181 (0) 0 335 Therapies Management 28 28 Shared Services (0) Community Health Councils (0) Reserves 2,686 (1,748) 938 (8,431) (1,059) 150 800 (413) (50) (132) (593) 2,686 (1,748) (8,790)
Financial Performance to Month 6 Page 17 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR DISCUSSION Appendix 3 Reserves, Balance Sheet and Planning gap
Planning Gap / Reserves & Annual Month 6 Annual Contingencies / Balance Sheet Budget at variance Forecast write backs M06 £M Variance £M £M Financial Planning Gap (1.748) (0.874) (1.748) Held Pending 2.924 0.902 Contingency for likely spend 1.345 0.922 Contingency 0.862 0.862 Balance Sheet Write Backs (2.400) Total 0.938 (0.874) 0.938
Financial Performance to Month 6 Page 18 of 18 Board Meeting 24 October 2012 Agenda Item 5.1
FOR APPROVAL
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 6.1
REGISTER OF SEALINGS REPORT
Report of Chief Executive
Paper prepared by Corporate Governance Manager
Purpose of Paper The purpose of this paper is to report to the Board the use of the Common Seal.
Action/Decision required The Board is asked to NOTE the application of the Common Seal.
Link to ‘Doing Well, 1. Governance & Accountability Doing Better: Standards for Health Services in Wales’:
Link to Health Board’s N/A Corporate Plan
Acronyms and N/A abbreviations
Register of Sealing Report Page 1 of 4 Board Meeting 24 October 2012 Agenda Item 6.1
FOR APPROVAL
REGISTER OF SEALINGS REPORT
Background
The common seal of the tHB is primarily used to seal legal documents such as transfers of land, lease agreements and other important/key contracts. Where it is decided that a document shall be sealed it shall be fixed in the presence of the Chair or Vice Chair (or other authorised Independent Member) and the Chief Executive (or another authorised individual) both of whom must witness the seal.
The Board Secretary shall keep a register that records the sealing of every document. Each entry must be signed by the persons who approved and authorised the document and who witnessed the seal. A report of all sealings shall be presented to the Board at least bi-annually.
Summary
Since the last Board Report detailing the use of the Common Seal, Board’s Common Seal has been affixed to the following document:
Articles of agreement relating to remodelling of bedrooms at Brecon War Memorial Hospital, Brecon between Powys teaching Health Board and C J Construction (Wales) Ltd (Sealing Number 78 in the Register of Sealings).
Counterpart Under lease relating to Unit 13, Lambourne Crescent, Cardiff Business Park, Llanishen, Cardiff between Powys teaching Health Board and Estelle Jones (Sealing Number 79 in the Register of Sealings).
Deed of Covenant relating to Unit 13, Lambourne Crescent, Cardiff Business Park, Llanishen, Cardiff between Powys teaching Health Board and Cardiff Business Park Ltd. (Sealing Number 80 in the Register of Sealings)
Lease relating to rooms within Bronllys Hospital for Creche, Bronllys, between Powys teaching Health Board and Mrs Dawn Sweeney. (Sealing Number 81 in the Register of Sealings)
Agreement for the appointment of the Contractor for the new Renal Dialysis Unit at Victoria Memorial Hospital, Newtown between Powys teaching Health Board and Read Construction Holdings Ltd. (Sealing Number 82 in the Register of Sealings)
Lease relating to part second floor offices at 12, Cathedral Road, Cardiff CF11 9LT between Powys teaching Health Board and Alpha UK Property Fund Asset Company Ltd. (Sealing Number 83 in the Register of Sealings).
Register of Sealing Report Page 2 of 4 Board Meeting 24 October 2012 Agenda Item 6.1
FOR APPROVAL
Contract relating to Brecon and Llandrindod Wells Operating Theatre refurbishments. Contract between John Weavers Ltd (Contractors) and Powys teaching Health Board (Sealing Number 84 in Register of Sealings)
Renewal Lease with reference to existing Lease of Hafran Resource Centre, Rhayer. Renewal Lease between Powys County Council and Powys teaching Health Board (Sealing Number 85 in Register of Sealings)
Lease relating to the Renal Unit, Llandrindod Wells Community Hospital Powys, between University Hospitals Birmingham NHS Foundation Trust and Powys teaching Health Board (Sealing Number 86 in Register of Sealings)
Engrossment transfer of Ground Floor Reception, Old Way Centre, Orchard Street, Swansea. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 87 in Register of Sealings)
Engrossment transfer of ground floor, Oldway Centre, Orchard Street, Swansea. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 88 in Register of Sealings)
Engrossment transfer of ground and basement floors, Centurian House, Oldway Centre, High Street, Swansea. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 89 in Register of Sealings)
Engrossment transfer of ground floor, Cwmbran House, Mamhilad Park Estate, Pontypool. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 90 in Register of Sealings)
Engrossment transfer of first floor, Cwmbran House, Mamhilad, Park Estate, Pontypool. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 91 in Register of Sealings)
Engrossment transfer of sixth floor, Churchill House, Churchill Way, Cardiff. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 92 in Register of Sealings)
Engrossment transfer of ground floor office and stores, Brecon House, Mamhilad, Park Estate Pontypool. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 93 in Register of Sealings)
Engrossment transfer of ground floor office and stores, Brecon House, Mamhilad, Park Estate Pontypool. Land registry transfer between Velindre NHS Trust and
Register of Sealing Report Page 3 of 4 Board Meeting 24 October 2012 Agenda Item 6.1
FOR APPROVAL
Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 94 in Register of Sealings)
Engrossment transfer of Eleventh Floor, Oldway Centre, Orchard Street, Swansea. Engrossment transfer of ground floor office and stores, Brecon House, Mamhilad, Park Estate Pontypool. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 95 in Register of Sealings)
Engrossment transfer of Eight Floor, Oldway Centre, Orchard Street, Swansea. Engrossment transfer of ground floor office and stores, Brecon House, Mamhilad, Park Estate Pontypool. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 96 in Register of Sealings)
Articles of Agreement relating to Refurbishment of existing hospital wards at Ystradgynlais Hospital, Glynrhyd Road, Ystradgynlais. Agreement between T Richards Jones (Betws) Ltd and Powys teaching Health Board. (Sealing Number 97 in Register of Sealings)
Articles of Agreement relating to Relocation of Podiatry from Bronllys to Brecon Hospital and refurbishment of Podiatry Department, Brecon Hospital. Agreement between J L Stephens Ltd and Powys teaching Health Board. (Sealing Number 98 in Register of Sealings)
Engrossment transfer of Eight and Eleventh Floors, Oldway Centre, Orchard Street, Swansea. Land registry transfer between Velindre NHS Trust and Powys teaching Health Board (establishment of NHS Shared Services). (Sealing Number 99 in Register of Sealings)
Renewal Lease by reference to an existing lease of Dental Suite, Hafran Resource Centre, Rhayder between Dr Jimmy Jamil Charro and Powys teaching Health Board. (Sealing Number 100 in Register of Sealings)
Agreement of Section 33 of the National Health Service (Wales) Act 2006 overarching partnership agreement. Agreement between Powys County Council and Powys teaching Health Board. (Sealing Number 101 in Register of Sealings)
Recommendation
The Board is asked to NOTE the application of the Common Seal.
Report prepared by: Presented By: Rani Mallison Andrew Cottom Corporate Governance Manager Chief Executive
Register of Sealing Report Page 4 of 4 Board Meeting 24 October 2012 Agenda Item 6.1
FOR DISCUSSION
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 6.2a
REPORT FROM THE CHAIR OF THE AUDIT COMMITTEE SEPTEMBER AND OCTOBER 2012
Report of Audit Committee Chair
Paper prepared by Corporate Governance Manager
Purpose of Paper The purpose of this paper is to provide the Board with an update on the key issues discussed and any decisions made by the Audit Committee at its meetings in September 2012 and October 2012.
Action/Decision required The Board is asked to RECEIVE this update for information and DISCUSS any issues arising.
Link to ‘Doing Well, 1. Governance and accountability framework Doing Better: Standards for Health Services in Wales’:
Link to Health Board’s Improving Health & Well-Being Annual Plan Ensuring the Right Access Striving for Excellence Involving the People of Powys Making Every Pound Count
Acronyms and N/A abbreviations
Audit Committee Briefing Page 1 of 4 Board Meeting September and October 2012 24 October 2012 Agenda Item 6.2a
FOR DISCUSSION
REPORT FROM THE CHAIR OF THE AUDIT COMMITTEE SEPTEMBER AND OCTOBER 2012
PURPOSE
The role of the Audit Committee is to advise and assure the Board and the Accountable Officer on whether effective arrangements are in place to support them in their decision making and in discharging their accountabilities for securing the achievement of the organisation’s objectives, in accordance with the standards of good governance determined for the NHS in Wales.
Therefore, the purpose of this paper is to provide the Board with a summary of the discussions held and any issues arising from two meetings of the Audit Committee held in September and October 2012.
INTERNAL AUDIT
The Committee received the following:-
September 2012 3 year Internal Audit Strategy 2012/13 – which was approved by the Committee Internal Audit Plan Progress Report Internal Audit Charter – which was approved by the Committee Thematic Audit of Health and Safety Management - which was approved by the Committee
October 2012 Internal Audit Plan Progress Report Internal Audit Operational Plan Internal Audit Report – Locality Review Ystradgynlais Hospital Committee noted that this audit had been rated ‘amber’ and therefore provided the Board with some assurance that the arrangements upon which the organisation relies to manage risk, control and governance within those areas under review, and the operational compliance noted, are suitably designed and applied effectively. Committee noted a number of recommendations made by internal audit and the management response provided to these. Committee acknowledged that there was significant work to do in respect of the management of policies within the organisation.
CAPITAL AUDIT
The Committee received the following;-
September 2012 Capital Audit Plan: Progress Report Capital Systems Report Capital Audit : Follow up Report
Audit Committee Briefing Page 2 of 4 Board Meeting September and October 2012 24 October 2012 Agenda Item 6.2a
FOR DISCUSSION EXTERNAL AUDIT
The Committee received the following:-
September 2012 Audit Outline 2012 (Progress Report) tHB Financial Systems and Control Report This report concluded that the Health Board’s financial systems and controls provide assurance that the financial statements are free from material misstatement, although there are some specific areas where improvements can be made. Contractor Services Report This report concluded that Health Board auditors can place assurance on the suitability, design and operating effectiveness of controls, subject to some additional work.
October 2012 External Audit Plan: Progress Update
GOVERNANCE & ASSURANCE
The Committee received the following:-
September 2012 Internal Audit: IT General Controls Progress Report Internal Audit: Information Governance Progress Report The Head of Quality and Safety Unit advised the Committee that a phased approach was required to put in place systems and processes in support of Information Governance across the organisation. The Committee noted the commitment and necessary steps taken to make improvements in respect of Information Governance management. Committee Workplan 2012/13 Risk Strategy Implementation: Progress Report Committee noted that a significant amount of work had started within Localities and Service Directorates to review their current risk registers to ensure ‘active’ registers were in place and reporting was undertaken in a timely manner.
October 2012 Committee Workplan 2012/13 Review of Standing Orders 2012 Committee noted and supported the improvement actions necessary to ensure compliance is reached on each of the key areas which ultimately would form the basis upon which the LHB’s governance and accountability framework was developed. Committee agreed that an update on non compliant standing orders would be presented at the end of the financial year in March 2013 and thereafter on a six monthly basis. Single Tender Action Losses and Special Payments Quarterly Report Outstanding Audit Recommendations
Audit Committee Briefing Page 3 of 4 Board Meeting September and October 2012 24 October 2012 Agenda Item 6.2a
FOR DISCUSSION
RECOMMENDATION
The Board is asked to RECEIVE this update for information and DISCUSS any issues arising.
Report prepared by: Presented By: Rani Mallison Gareth Jones Corporate Governance Manager Chair of Audit Committee
Audit Committee Briefing Page 4 of 4 Board Meeting September and October 2012 24 October 2012 Agenda Item 6.2a
FOR DISCUSSION
BOARD MEETING
24 OCTOBER 2012
AGENDA ITEM 6.2b
REPORT FROM THE CHAIR OF THE QUALITY & SAFETY COMMITTEE SEPTEMBER 2012
Report of Quality & Safety Committee Chair
Paper prepared by Corporate Governance Manager
Purpose of Paper The purpose of this paper is to provide the Board with an update on the key issues discussed and any decisions made by the Quality & Safety Committee during September 2012.
Action/Decision required The Board is asked to RECEIVE this update for information and DISCUSS any issues arising.
Link to ‘Doing Well, 1. Governance and accountability framework Doing Better: Standards for Health Services in Wales’:
Link to Health Board’s Improving Health & Well-Being Corporate Plan Ensuring the Right Access Striving for Excellence Involving the People of Powys Making Every Pound Count
Acronyms and N/A abbreviations
Q&S Committee Briefing Page 1 of 5 Board Meeting September 2012 24 October 2012 Agenda Item 6.2b
FOR DISCUSSION
REPORT FROM THE CHAIR OF THE QUALITY & SAFETY COMMITTEE SEPTEMBER 2012
PURPOSE
The role of the Quality and Safety (Q&S) Committee is to provide: evidence-based and timely advice to the Board to assist it in discharging its functions and meeting its responsibilities with regard to the quality and safety of healthcare; and assurance to the Board in relation to the tHB’s arrangements for safeguarding and improving the quality and safety of patient-centred healthcare in accordance with its stated objectives and the requirements and standards determined for the NHS in Wales.
Therefore, the purpose of this paper is to provide the Board with a summary of the discussions held and any issues arising from meetings of the Quality and Safety Committee held in September 2012.
GOVERNANCE & ASSURANCE
Sub-Committees Updates
Information Governance sub-Committee Committee received a verbal update in respect of a review which had been undertaken by NWIS and a number of recommendations made. Although the findings had not been formally received an implementation plan would be presented in draft format at the next committee meeting in November 2012. Committee noted that the Quality & Safety Unit structure would be reviewed to facilitate Information Governance and an update would be presented to committee in November 2012.
Mental Health Act sub-Committee Committee noted that an Informal session with Mental Health Managers would be held on the 25 September 2012 followed by a formal meeting at the end of October 2012.
IMPROVING HEALTH AND WELLBEING
Improving Health & Wellbeing Update Report
The Committee received a report from the Director of Public Health, providing an update in respect of work being carried out to improve Health Wellbeing in Powys.
Committee received a brief overview of the strategic aims and objectives which Public Health were currently focussing on and advised Committee of the two specific areas which required significant focus on the following;
• Develop and Implement Local obesity (health weights) strategy • Increase Flu Immunisation Update
Q&S Committee Briefing Page 2 of 5 Board Meeting September 2012 24 October 2012 Agenda Item 6.2b
FOR DISCUSSION
Children’s Services Update Report
Committee received the Children’s Services report the purpose of which updated Committee on the Child and Adolescent Mental Health Services
Committee noted outstanding actions which had been identified and plans in place to ensure those actions were addressed. In addition, a new Strategy for emotional health and wellbeing was currently under development and would build upon progress made to date and would also consider new legislation and specific areas for improvement.
Children’s Services –Childcare Sufficiency Summary Report
Committee noted the important changes in the needs of data, social and economics required in order to effectively plan and prioritise on a partnership basis the key areas of development to promote welfare of children and young people.
ENSURING THE RIGHT ACCESS
WAO Audit Mental Health Review
The Committee received a report from the Director of Nursing providing a verbal update to Committee the purpose of which updated Committee on the Wales Audit Office review carried out regarding Adult Mental Health.
The Director of Nursing outlined some of the key areas which were identified by the Wales Audit Office during March 2012. Committee noted further improvements were required in the following areas; • Service arrangements to be strengthened • Commissioning • vision for Adult Mental Health • modernisation • Government arrangements
Committee acknowledged that discussions would need to be held with the Chief Executive to ensure that the organisation had sufficient capacity to progress developments in respect of mental health services.
Chronic Conditions Progress Report
The Interim Director of Planning updated Committee on work regarding chronic conditions 2012/13. Committee noted that the development of the single matrix tool had enabled both Powys tHB, PCC and key stakeholders the opportunity to progress certain areas, and the Service Development and Commissioning Directives had enabled strategic direction for redesigning the care of chronic conditions in conjunction with the CCM Model and Framework and the CCM Service Improvement Plan.
Q&S Committee Briefing Page 3 of 5 Board Meeting September 2012 24 October 2012 Agenda Item 6.2b
FOR DISCUSSION
Unscheduled Care Services Report The Medical Director provided the Committee with an update in respect of delivering the Board’s strategic objectives in relation to unscheduled care services, as set out in the Annual Plan 2012/13:-
Objective 5: implement alternative care pathways for category C Objective 6: work with WAST to reduce volume of inappropriate 999 calls Objective 7: work with USC partners to implement 10 high impact steps Objective 8: address variation across Powys in GP access, Clinical Pathways and Minor Injury Units.
Committee noted the progress made to date regarding the delivery of key priority areas to improve unscheduled care services across Powys.
Stroke Services
The Committee received a report from the Director of Therapies and Health Sciences which provided an update on progress made in stroke services over the past year and the Interim Powys Stoke Action Plan for Stroke Services 2012/15.
STIVING FOR EXCELLENCE
Carers Measure Report
Committee received the Carers Measures report which provided progress on the Carers strategies (Wales) Measure 2010 and Carers Strategies (Wales) Regulations 2011.
The Director of Therapies and Health Sciences advised Committee that Powys tHB had been required to consult with appropriate voluntary organisations within its area. The first version of the strategy would be submitted to Welsh Ministers by 31 October 2012, after which Ministers would respond to organisations to inform them of their approval or rejection within 8 weeks. Committee noted that the strategy would cover a 3-year period, but would be subject to review after an 18 month period.
The Committee noted that the Carers Strategy 2012-2015, which had been developed in conjunction with PCC and with voluntary organisations Powys-wide, would be presented to the Board in October 2012 for approval.
Serious Incident Reporting
The Committee received a report which provided an update on the work underway in reviewing and refining the process of serious incident management within the tHB. The Committee noted that good progress was being made and acknowledged improvements in the tracking system, the investigation of individual incidents, the learning from incidents and reporting arrangements. The Committee also received an update in respect of new incidents and closure of completed cases.
Q&S Committee Briefing Page 4 of 5 Board Meeting September 2012 24 October 2012 Agenda Item 6.2b
FOR DISCUSSION
Infection Prevention & Control Update
The Committee received the Infection Prevention and Control and Environment of Care Committee report which provided an updated for April to June 2012.
Care Home/Care Provider Governance
The Committee received an update in respect of the Care Home/Care Provider Governance review undertaken by Internal Audit. The Director of Nursing noted to Committee that a detailed action plan had been put in place but a number of important key issues remained outstanding and key challenges remained.
Standards for Health Services Report
Committee received the Standards for Health Services Report from the Director of Therapies and HS providing an update on the progress made in relation to the Standards.
Committee noted that the Standards Steering Group scheduled quarterly continued to provide support to the localities and corporate teams and was an opportunity to allow teams to share best practice and discuss any difficulties teams encountered. Committee further noted that the Governance and Accountability Module identified a series of improvement actions, which had been mapped to the Annual Plan to ensure a continued improvement process.
1000 Lives Plus Programme
The Committee received a Report of the Director of Nursing which provided an update of the work of the 1000 Lives Plus Programme, including updates in respect of: Improving Leadership for Quality; Reducing Healthcare Associated Infections; Improving Acute Care; Venous Thromboembolism Prevention; Pressure Damage Prevention; Dementia; Transforming Care, TIA/Stroke; and Falls.
Annual Clinical Audit Plans:-
Committee received the Annual Clinical Audit Plans which provided details of Powys tHB clinical audit plan from June to December 2012.
Report prepared by: Presented By: Rani Mallison Gloria Jones Powell Corporate Governance Manager Chair of Quality & Safety Committee
Q&S Committee Briefing Page 5 of 5 Board Meeting September 2012 24 October 2012 Agenda Item 6.2b
FOR DISCUSSION
BOARD MEETING 24 OCTOBER 2012 AGENDA ITEM 6.2c
REPORT FROM THE CHAIR OF THE INTEGRATED GOVERNANCE COMMITTEE SEPTEMBER 2012
Report of Integrated Governance Committee Chair
Paper prepared by Corporate Governance Manager
Purpose of Paper The purpose of this paper is to provide the Board with an update on the key issues discussed by the Integrated Governance Committee at its meeting in September 2012.
Action/Decision required The Board is asked to RECEIVE this update for information and DISCUSS any issues arising.
Link to ‘Doing Well, 1. Governance and accountability framework Doing Better: Standards for Health Services in Wales’:
Link to Health Board’s Improving Health & Well-Being Annual Plan Ensuring the Right Access Striving for Excellence Involving the People of Powys Making Every Pound Count
Acronyms and N/A abbreviations
Integrated Governance Committee Briefing Page 1 of 3 Board Meeting September 2012 24 October 2012 Agenda Item 6.2c
FOR DISCUSSION
REPORT FROM THE CHAIR OF THE INTEGRATED GOVERNANCE COMMITTEE SEPTEMBER 2012
PURPOSE
The role of the Integrated Governance Committee is to: maintain an oversight of the work of the Board’s Assurance Committees, ensuring integration of governance work across all business of the tHB and all issues which fall outside or between the work of the Committees are addressed; and review the tHB’s Assurance Framework, in-line with performance against achievement of organisation’s Annual Plan, ensuring there is an accurate reflection of existing risks, key controls and assurances.
Therefore, the purpose of this paper is to provide the Board with an update on the key issues discussed by the Integrated Governance Committee at its meeting in September 2012.
STRATEGIC INFORMATION MANAGEMENT REVIEW
The Committee received a report from the Interim Director of Planning (Executive Lead for Information) which provided a summary of the outcome of the Strategic Information Management Review, commissioned by NHS Wales Informatics Service (NWIS) on behalf of the tHB. The Committee noted that analysis of the Review indicated that, whilst there are some pockets of excellent practice in place in some departments in the Powys tHB, there is not a systematic organisation-wide approach to Information Management. The Committee was pleased to note that progress had been made in delivery recommendations in respect of:- commencing implementation of organisational alignment of structures, capacity and appointments to key posts in information management and information governance; raising the profile of the information team within the organisation; definition and alignment of key performance indicators to the priority business of the Board and strengthening reporting mechanisms; and establishing a programme office.
FINANCIAL MANAGEMENT REVIEW
The Committee received a presentation from Chris Hurst, External Consultant, on the outcome of an external review of financial management within the tHB. The tHB commissioned the external review in response to the recommendations arising from the Independent Review commissioning by Welsh Government on April 2012. The Committee noted a number of recommendations in respect of:- Financial planning and budget setting; Continuous improvement and cash releasing savings; Financial management; and Other issues raised during review interviews.
The Committee welcomed a report from the Director of Finance which provided a response and action plan in respect of the recommendations raised.
Integrated Governance Committee Briefing Page 2 of 3 Board Meeting September 2012 24 October 2012 Agenda Item 6.2c
FOR DISCUSSION
FINANCIAL SAVINGS UPDATE
The Committee received a Financial Savings Update Report from the Director of Finance. The Committee noted the following: • Savings had been identified as being achieved to date of £1.335M to month 4 against a profile to date of £2.658M realising slippage to date of £1.323M • Self assessment by scheme holders at month 4 suggested that up to £6M of the full year programme could be at risk of delivery against the cumulative savings within our financial plan • The Finance Director had continued to lead a programme of weekly, fortnightly and monthly meeting with Localities & Directorates to receive and test plans for delivery and review performance • A series of Mid Year Reviews had commenced led by the CEO. The results of which would inform the tHB’s revised forecast outturn position for presentation to the Board and Welsh Government • Programme Office Support commissioned via NWIS had commenced an end to end review of the recovery programme process and early conclusions were being drawn.
RECOMMENDATION
The Board is asked to RECEIVE this update for information and DISCUSS any issues arising.
Report prepared by: Presented By: Rani Mallison Roger Eagle Corporate Governance Manager Chair of Integrated Governance Committee
Integrated Governance Committee Briefing Page 3 of 3 Board Meeting September 2012 24 October 2012 Agenda Item 6.2c