Gwent Healthcare NHS Trust Annual Report 2004-2005

Gwent Healthcare CONTENTS THE TRUST BOARD

The Trust Board 3 Trust delivers quality healthcare to more than 600,000 people

Chairman’s/Chief Executive’s Report 4-5 in south-east Wales and is one of the busiest and largest in the

United Kingdom.

PART ONE It is led by the Trust Board of the chairman and seven non-executive directors, supported by the chief Review of 2004/05 6-10 executive and four executive directors, plus two staff representatives.

Patients 11-13

Staff 14-16 The full membership comprises: Nursing 17 Dr Brian Willott CB, Chairman Innovation and Leadership 18-19 Mr Michael Badham, Vice Chairman (until March 2005) Mr Peter Sampson, Vice Chairman (from March 2005) The Future 20-21 Prof Chris Butler Mrs Beryl Melvin OBE Mrs Carol Morgan Mr David Murray PART TWO Ms Patricia Smail

Divisional Profiles 22-35 Executive Directors Mr Martin P Turner, Chief Executive Mr Andrew J Cottom, Finance Director Dr Stephen Hunter, Medical Director PART THREE Ms Tracy Myhill, Personnel Director Ms Christine Baxter, Nurse Director (until December 2004) Corporate Governance 36 Mrs Wendy Warren, Nurse Director (from February 2005)

Medical Education 37-38 Staff Representatives Mr Chris Jones Research and Development 39 Mr Paul Thomas

Audited Accounts 40-49

Key Trust Information 50 Five committees have direct responsibility to the Board

Audit Committee Charitable Trust Funds Committee Remuneration Committee Equality and Diversity Committee Quality and Clinical Governance Committee (Key to membership)

2-3 Gwent Healthcare model. A number of capital projects were CHAIRMAN’S / finally approved during the year, including the new cardiology and orthopaedic units at the Royal Gwent CHIEF EXECUTIVE’S REPORT and St Woolos respectively and the integrated health and social care facility in Monmouth which should be completed during the 2005-6 financial year. This year again proved demanding with ever-growing pressure It has been an extremely busy year on the staff front. on our services, increasingly tight performance standards and In addition to handling the day to day pressures, the new Consultants’ contract has been put in place and the continuing development of our longer term clinical strategy. the major task of implementing Agenda for Change has continued. All this, together with changes in the career development of junior doctors, is leading Once again the Trust succeeded in breaking even the year, well over the Wales average, to 104 by the to much restructuring of services, such as the financially after much hard work to manage budgets end of March – well below the Welsh average. It “Hospital at Night”, the development of new roles and reduce costs. We achieved our main waiting has continued to fall after the year end. and expansion of multi-disciplinary team working. time targets – 4 months for cataracts, 6 months for Staff have risen magnificently to the challenge angiography, 18 months outpatients and 12 months The involvement of patients in our activities of making these changes while continuing to for all other treatments. This was a real achievement and service development continues to grow. The provide quality care and we cannot commend given the surge of emergency admissions in January Patients’ Panel goes from strength to strength and them too highly. and February. individual members have been involved in the development of specific services. Patient safety Finally, a word about the longer term clinical A particular challenge, however, was the new is always an overriding priority, addressed strategy which has been developed over the past Dr. Brian Willott, Chairman target of dealing with 95% of all Accident and actively through the Board’s Quality and Clinical two or three years. This is a strategy to provide Emergency attendances within 4 hours. The Governance Sub-Committee. Hospital acquired seamless care and to bring our services closer to the Accident and Emergency Department at the Royal infections, like MRSA, have received a much patient. It involves complete reconfiguration of all Gwent, in particular, was only designed to handle higher profile nationally and have always been a the hospitals across Gwent, of which the plans for half the number of attendances it now gets; major Gwent priority; we have maintained our active Caerphilly and Blaenau Gwent are forerunners. reshaping of the service, the facilities and the programmes which have continued to keep Gwent A successful major public engagement has been processing of patients is being carried out in order below the Welsh and well below the UK average carried out, in partnership with the LHBs and the to achieve the new standard. levels of infection. Community Health Council, on the broad concept Martin P Turner, Chief Executive of the case for change which will now, in the light Major reductions in delayed transfers of care The new Out of Hours Primary Care Service of the comments, be submitted to the Welsh (“bed-blocking”) were achieved during the year in which we introduced with the support of the LHBs Assembly Government for approval. When partnership with the LHBs and Local Authorities. across Gwent following the new GP contract, has implemented this will provide a real 21st Century The total number fell from 227 at the beginning of proved highly successful and is widely seen as a good service to the people of Gwent.

4-5 Gwent Healthcare PART ONE to address the demands placed on the Royal Gwent capacity pressures had a serious impact on treating where severe emergency pressures impacted on its elective patients. ability to meet its target. The Trust set itself an internal target of a maximum This includes separate streaming of minor injury outpatient wait of 15 months, compared to a Welsh patients using experienced nurse practitioners, the target of 18 months and by the end of the year was streamlining of the discharge process to free up beds achieving this in all specialities except orthopaedics, REVIEW OF 2004-05 in the hospital at crucial times and re-designing of which was excluded to enable clinical staff to meet the A&E department to improve flows of patients. the 12 months treatment target.

The continued challenges of increasing demand and tougher The appointment of a “navigator”, a qualified nurse The end of year total of patients on Trust waiting to facilitate the transit of patients and overcome lists showed a 25% reduction on those waiting targets, and their impact on key services, were major factors specific blockages and delays, has been important. over 12 months for an outpatient appointment compared with the previous year, but a 2% throughout the year. Elective admissions were particularly badly hit increase in total patients waiting, despite staff during January and February when through- over-performing against activity targets. put was reduced by over 20% because of Given the continuing pressures on both emergency The input of the Medical Assessment Unit (together increased emergency admissions. It also impacted There was a major reduction in patients waiting and elective services, financial constraints and with the new Neonatal Assessment Centre opened on day surgery where units had to be used to over 12 months, the figure falling from 1536 to 131, delays in settling income levels, it was a significant during the year) became clearly visible. Against accommodate emergencies, the latest symptom all of whom had received a second offer of treatment achievement for the Trust to break even on its a total demand of adult medicine referrals and of the increasing pressures. elsewhere but had declined. The number of patients budget for the sixth year in succession and to attendances of 30,510, the MAU was successful waiting for treatment decreased by 15%. meet the SaFF targets established by the Assembly in reducing admissions by 3226. Compared with Key waiting time targets however, were again Government 2003/4, demand increased by 7% from 28,592, achieved. The Trust has been engaged with LHBs in finding whereas admissions only rose by 2.6%. an effective way of sustaining low waiting times But 2004/05 also saw considerable innovation in The six month angiography, four month cataract throughout Gwent. Work is underway jointly to service delivery and progress in new investment. Outpatient attendances increased by 2% to 392,461, and 18 month outpatient targets were met by March reduce emergency medical admissions by 5%, With all services changing and evolving at an of which 115,348 were new outpatients. with the Trust performing consistently against these essential as a major component to ease capacity increasingly rapid rate, the Trust, together with its targets throughout the year. pressure and planned to be phased in from healthcare partners, took forward its long term Mental Health inpatient admissions again fell, by 2% September 2005. However, a review by independent vision for local care and the first steps in introducing to 2,883. Reversing the trend since 2001/2, outpatients The 12 month target for patients waiting for consultants has concluded that at current activity sustainable patterns of clinical services that will be rose by 1% to 21,871, of which 3,458 were new cases. treatment was also met, even though breaching of and performance levels, there is a shortfall of 170 effective, deliverable and affordable. ringfenced beds at both the Royal Gwent and Nevill beds to achieve the 85% occupancy level generally The steady rise in pressure on A&E continued, Hall hospitals during the winter months due to regarded as being optimal. Performance with attendances at A&E/Minor Casualty rising Once again, the consistent pressure of activity to 158,670, 2% higher than the previous year and against a limited number of beds, required 7% more over three years. This places a challenge constant juggling of emergency and elective in particular on a very busy city centre unit like the admissions. Royal Gwent Hospital, originally designed to cater for 40,000 attendances a year but now receiving 2004/5 saw a slight (0.6%) fall in inpatient almost double that amount at 75,000. admissions to 83,277. Of these, 82% or 68,260 were non elective or emergency, up by 1% on the Achieving the target set by the National Assembly, previous year, while elective admissions at 15,017 of discharging or admitting 95% of all A&E patients accounted for 18% and were down by 8%. This within four hours, will be a challenge. Caerphilly reflects the fact that the average length of stay for District Miners’ Hospital met the target of 95% and an emergency inpatient was twice as long as the Nevill Hall achieved 92%, a creditable performance average elective patient, so each unplanned emergency considering the emergency pressures staff faced admission displaces two elective admissions. during the year. An action plan has been drawn up

6-7 PART ONE Gwent Healthcare A very substantial achievement was the care centres and engaged a network of doctors and reduction achieved in partnership with LHBs nurses to triage cases and deliver care at home and local authorities in the numbers of “delayed or in a number of centres. Employing around transfers of care” patients - those who were ready thirteen GPs, supported by self employed GPs, for discharge from hospital put could not leave triage nurses, call handlers and support staff, the because the appropriate package of outside service has established an effective framework of support was not available for them. This had a delivery that is consistently meeting high standards major impact on bed availability especially at for response and care outside normal surgery hours. times of maximum emergency demands. Construction began also during the year on two At the beginning of 2004/05, there were 227 new facilities that will play a significant role in the patients in this category. By the end of the year Trust’s future. that figure had been reduced to 104 - less than half. Monmouthshire County Council and the Local priorities. Agenda for Change has been a huge This gave a reduction in bed days lost of 64%, In Newport, work was started on a new orthopaedic Health Board. and challenging task, job evaluation is ongoing compared to the Welsh target of 30%. block at St Woolos Hospital. The £6million project and the Trust is entirely up to speed with the was commissioned by the Trust following an The requirements of the New Deal for junior implementation timetable. The numbers of patients whose discharges were orthopaedic services review two years previously doctors and the European Working Time Directive delayed the most - more than 57 days - dropped and will provide two new operating theatres and 36 for doctors in training has led to substantial The Trust performed well against the Welsh Risk from 108 to 36 in the year. Particularly noteworthy beds. These will be specifically dedicated to meet the changes in clinical jobs and staffing. The Trust Pool standards and received a positive report was the reduction in the social care reasons for needs of elective orthopaedic surgery and reduce invested in more junior doctors, support staff and from CHI who carried out a full inspection of the the delays from 71 in April last year to just 12 in waiting lists, away from the pressures of demand especially in nurse practitioners which allowed it to Trust’s community and mental health services. March this year. on beds caused by emergency needs. achieve high compliance levels. Focus continued on developing capacity and capability using “Lean Project “techniques as a The Trust, in agreement with the LHB’s, Construction began too on Wales’s first health and The implementation of Consultant’s Contracts way of improving quality and efficiency for people launched a new primary care Out of Hours social care facility contained under one roof at required a fundamental review of each who use Trust services. service for Gwent. When the new GP contracts Monmouth. Replacing the former Monmouth consultant’s workload and job plan. Service were introduced in the autumn and no longer Hospital, the new purpose-built centre will support changes and improvements were introduced, Future Developments provided for out of hours cover, the Trust on a range of care needs that until now have been aligned to performance and modernisation “Clinical Futures” is at the centre of the Trust’s behalf of the five Local Health Boards, created a delivered in separate buildings. This PFI project call centre service through a number of primary has been a very successful partnership with

WORKING TOGETHER

Partnership is at the centre of the five Local Health Boards, together with the chief equation for change. officer of Gwent Community Health Council. The Out of Hours services were Trust-led on Improving healthcare and managing demand behalf of the LHBs and are working effectively is an agenda that is being met by the Gwent and efficiently on a Gwent-wide scale achieving Health Community as a whole. It requires real benefits for patients. working across boundaries and an integrated approach is essential. The major new hospital plans for Blaenau Gwent and Caerphilly were joint initiatives also Clinical Futures was a prime example of the joint involving social care and local government with approach producing results. The Project Board the CHC having an important role in engaging involved the chief executives of the Trust and the patients and the public.

8-9 PART ONE Gwent Healthcare future strategy - the structure that will radically Stakeholders and senior staff were consulted, then change the way local health and social care is a wide ranging “engagement” process began with provided over the next ten years. patients, staff and the public for their views on the general principles proposed. More than two years ago, the Trust began outlining the ideas needed to ensure patients and The Trust and its partners outlined their ideas service users could maximise their healthcare. and asked local people what they thought. Nine The vision was to develop modern integrated out of ten agreed changes were needed and they health and social care services providing a seamless supported the new model of “care closer to home” patient pathway delivered as close to people’s homes that was proposed. as can be safely achieved, supported by a centre of excellence in major acute and specialist care. In parallel, certain elements of the strategy have been taken forward. Detailed plans for the In 2004, that vision took a major step forward with reconfiguration of all hospitals in Caerphilly the establishment of the Clinical Futures Project. Borough, including the replacement of PATIENTS The Project Board included the chief executives of Caerphilly District Miners’ Hospital, by a each Local Health Board in the Trust area and the new Local General Hospital at Ystrad Mynach, chief officer of Gwent Community Health Council. were put to widespread public consultation Patient care and patient safety remained at the core of the Together as the Gwent Health Community, the and a detailed business plan reflecting this first task was to develop the “Strategic Outline consultation was put to the National Assembly Trust’s priorities and significant steps were taken during the Case” which establishes the rationale for changing for approval. A business plan for a new General from the current structure and the main elements Hospital in Blaenau Gwent was also put to the year to develop the patient input into our services. of the future strategy. National Assembly.

Key to this, in line with the Improving Health in and hospital development proposals to carrying Wales initiative, was the continuing development out detailed ward inspections which produce wide of the Patients’ Panel and the expanding role ranging recommendations for improvement from a its members now have in Trust strategy and patient’s perspective. service delivery. The health and safety of all patients is always crucial. It has been in existence for just two years and during this time has developed its role both as a The Trust has given high priority to minimising collective panel and in the individual contributions hospital acquired infections, especially MRSA. of its members. National figures showed that patients in the Trust hospitals were less likely to be affected than else- Panel members now provide key inputs in where in the UK. Endoscopy Improvement, CPaT and Lean Projects, Research Scrutiny Committee, PPI, In terms of occupied bed days, acute hospitals Clinical Futures, Infection Control and Risk like the Royal Gwent at Newport, Nevill Hall at Management Groups, the Chepstow Project team, Abergavenny and Caerphilly District Miners’ ENT review Group, Multi-disciplinary meeting Hospital are the busiest in Wales, but infection review, ophthalmology service review, pathology rates were only two thirds the Welsh average and service review, radiology ultrasound group, and below half the average levels of hospitals several of our members have commented on draft in England. patient dental leaflets. Much of this success can be attributed to the high The Community Health Council has also played priority put on infection control. The Trust has an extremely important role, ranging from chairing built a large pro-active infection control team with public meetings on the various Clinical Futures a monitoring officer carrying out crucial cleanliness

10-11 PART ONE Gwent Healthcare A high volume of correspondence is maintained records, a review of consent procedures for young with AMs and MPs - some 220 throughout the people and changes in the design of X-ray year. Where concerns are raised about service request forms. provision, this is addressed, but many letters are requests for comment or information. Three Ombudsman final reports were received. Changes to procedures for emergency gastro- The Trust received six independent review reports enterology and for pre-operative assessments as during the year which led to new guidelines in an outpatient before admission for surgery were maternity care, the frequency of auditing nursing implemented.

audits and surveillance. The National Patient Safety This was well above the Welsh average of 65%. Agency (NPSA) Cleanyourhands campaign went Clinical care led to the most complaints (224) and live in the Trust in March and the introduction of there was an increase to 137 (from 109 the previous alcohol hand rubs by each acute patient bedside year) of concerns about waiting times, delays As well as attending and participating in was achieved. and cancellations. Complaints about car parking our regular meetings, some of our Panel also rose. members have become involved in working The infection control team investigate all issues parties, projects, Committees and groups at the raised by patients, families or visitors and offer Each person who complained was written to by Trust, providing the patient perspective. These people the change to meet an infection control the Trust at the conclusion of investigations into patients are participating on an equal basis with officer if they want to discuss specific matters. the complaint with full details of the findings. For their colleagues in the Trust and their input Any new case is followed up in order to trace the first time complaint investigators graded the has become an essential part of their groups. likely sources of infection. They also undertake severity and importance of complaints and the Our members are being listened to by clinical educational programmes in all wards. Trust Complaints Group met routinely to identify and administrative staff and their views and the consequences of the outcomes across PATIENT’S PANEL opinions valued. Clinical governance is another key factor in the Trust. patient care. A personal view from the chairman… The Panel is also now being represented at A total of 21 examples of improved practice were Nina Weaver national level with two members attending As part of the priority given to the quality of made as a result of the careful monitoring which bi-monthly meetings of the All Wales Patient patient care and clinical governance, the Trust has led to new policies in minor injury treatment, The Panel had its first meeting in July 2003 and, Representatives’ Group. The Group has Board’s Quality and Clinical Governance a new follow-up system for chest X-rays and at the time, I don’t think any of us knew quite written a chapter in the Guide to Good Practice Committee oversaw the development of a robust practices to reduce cross infection. Increased staff, how it would develop. I am proud to say that called Building Partnerships which outlines the three year strategy with increasing emphasis better monitoring of home visits and management it has become a strong, independent group of patients’ role in service improvement. on strategic clinical audit and research and of delays have been introduced in the Out of people whose aim is to help the Trust to improve development projects. Hours service. its service to the community of Gwent. Gwent’s Patients’ Panel is very much envied . by many patient representatives from other Attention was also on ensuring that the evidence In order to improve the quality and speed of Inevitably our membership includes people Trusts and some of them have already and lessons to be drawn from such projects, from responses, the Trust has established a Call Centre who have had bad experiences at the Trust and expressed interest in forming their own Panels inspections and other incidents, are fully taken on to which telephone complaints are routed. These some of them are still feeling bitter about what along the lines of the Gwent Panel. Nationally, board and communicated effectively across the Trust. are logged and passed immediately to the most has happened to them or their loved ones. We the Gwent Patients’ Panel is held up as a good appropriate senior manager with the requirement are trying to help them to recognise that they example of patient participation in service Despite the increases in emergency pressures and for a return call where possible the same day. The cannot change what has happened, to assist improvement. demand for beds, the number of people who feel Centre has eliminated problems of callers being them in laying the experience to rest and to they have not received an appropriate service passed between departments if no one appropriate move on with their lives. I guess this is going to This was strongly underlined, when the then was 0.1% of the total. The Trust received 528 could take the call. be an ongoing process as new members join the Health Minister Jane Hutt chose Gwent as complaints from patients or their families in Panel and we want to ensure that they become the first Patient Panel in Wales to visit and 2004/05 and eight out of ten of these were dealt The Trust’s website now carries a facility for people positive members of the group. talk to members. with within the target of twenty working days. to e-mail complaints.

14-1512-13 PART ONE Gwent Healthcare the European Working Time Directive) and the example has been the introduction of fitted, need to secure increasing efficiency have involved knitted bed linen which has revolutionised usage staff across the organisation in major reconfiguring and handling of hospital bed linen. of jobs and roles. A review of staffing levels and staffing needs for a typical ward over 24 hours for New Pay Modernisation initiatives have represented instance has indicated the need to redistribute the biggest changes that have been undertaken in staff cover. the way the NHS employs its staff and the Trust played a leading role in their positive introduction. Called the “Hospitals at Night” project, it uses complete data analysis to develop new structures The new NHS pay system ‘Agenda for Change’ that ensures the right people with the right skills are has been the key service issue. A Pay Modernisation available at the appropriate times. By appointing Team has been established and is making good advanced nurse practitioners, the project offers progress towards implementation in partnership patients the most efficient working cover at all with Trade Union representatives to nationally STAFF hours. A pilot is being run at Caerphilly District agreed timescales. The introduction of revised Miners’ Hospital and is due to be rolled out at Terms & Conditions of service have been other acute sites. implemented with minimum service disruption Meeting the highest standards of healthcare can only be attained and initial feedback suggests it is a positive aid As another example, staff have been working in to service planning. with a high quality workforce who have the skill, the confidence collaboration with Torfaen Social Services and the Local Health Board to improve medical loan Over the past twelve months the Trust has and the support to deliver key services and frontline achievement. services to patients in the community to speed the successfully implemented the amended Consultant supply of much needed equipment to patients at Contract for NHS Wales. This new contract is home and enable faster discharge of patients from intended to further facilitate the modernisation of The Trust is extremely fortunate in the superb The total staff numbers continued to grow at hospital. There have been innovative approaches services and to improve the working lives of NHS quality of its staff. It places great emphasis on 4%, reaching 13,048 ( or 9,887 Whole Time to the negotiation of contracts for the supply of consultants. Implementation was achieved through giving all staff the opportunity to develop and Equivalents). Particular increases arose from staffing goods and it is anticipated that these will reduce an effective partnership approach that fully involved reach maximum potential for their career up the Out of Hours Service and moving to the Trust’s supply costs by in excess of £500,000 all consultants and staff representatives. progression. Professional leadership and a positive implement the Single Patient Record. Much effort in the 2005/06 financial year and re-direct cash to environment of success is a key formula that has been directed to recruitment and retention of improve patient care. The implementation of the European Working applies to support and frontline personnel alike. staff. At the year end, vacancies were 3.7%. Particular Time Directive for Doctors in Training, reducing progress has been made in reducing qualified nursing Improving patient safety is always crucial too. Lean the working week to 48 hours by 2009, has The Trust offers courses that are designed to vacancies which stood at 4.9%, reflecting a 40% Project and Performance initiatives have been used fundamentally changed the way doctors are deployed improve individuals’ performance, which are reduction in nursing vacancies since 2003 and a 60% as part of a Service Improvement programme within the Trust. Achieving compliance required a strongly focused on their specific job roles. An reduction in D Grade vacancies. Turnover rose by to improve efficiency and take out waste. A good rethink of working practice, new job roles, service example was the Leadership and Empowered 0.5% to 11.3%, still 1.8% lower than the national Organisation Programme (LEO) giving staff the benchmark average. opportunity to explore the concepts of leader- ship, healthy work relationships, risk taking and The theme continued with successful recruitment problem solving. The Trust was the first in Wales initiatives on a local and international perspective. to train its own facilitators. 36 D grade nurses from the Philippines joined the Trust, bringing its total overseas recruitment to 157 During the year, the new Division of Personnel nurses over the past four years. Their career and Support Services was formed to bring together progression and development has been evident a wide range of staff covering Support Services, with over 34% being promoted. Customer Services, Clinical Governance and Education, Employment Practices and Operational The demands of increasing performance targets, Personnel, and Workforce Modernisation and modernisation of terms of employment (for example, Efficiency. Agenda for Change, Consultants’ Contracts and

14-15 PART ONE Gwent Healthcare models and service reconfiguration. At the end of the to support staff in taking forward the Equality & year, the Trust compliance was 94 %. Diversity Strategy were significant developments.

The introduction of a Knowledge and Skills During the year, the Health & Safety function was Framework supported the modernisation of services reviewed, resulting in a divisional level approach, and staff now have an annual personal review and which ensured a comprehensive Health & Safety an individual development plan. Management System was embedded within the Trust. This has been supported by key changes The Welsh Assembly Government has set the in the Health & Safety Team and the training NHS in Wales a sickness absence target of 4.20%. provided in the various Health & Safety packages. The Trust sickness rate for 2003/04 was 5.30%. Members of the Personnel team have been The Risk Management Support Team has been working closely with managers in ensuring that restructured to ensure the integration of incident sickness absence is managed effectively as well reporting. A new Clinical Risk Manager was as continuing the workplace health initiatives appointed and a new Risk Management Strategy NURSING following the achievement of the Corporate within the Trust was developed and launched. Standard for Health at Work. The Occupational Health Team has reviewed its services and is developing a Staff Wellbeing Service More than 5,500 nurses, midwives and health visitors carry out High priority for equality and diversity policies and a Service Modernisation Strategy. continued to be a focus for the Trust Board. An a wide range of duties at the forefront of patient healthcare. Equality and Diversity Strategy was launched and The Trade Unions Learning in Partnership (TU- a comprehensive revision of our Race Equality LIP) Project continues to improve essential skills Scheme undertaken. There was continued active within the Trust, which is working in partnership They work across all clinical and medical divisions for its newly qualified nurses received accreditation involvement of the Black and Ethnic Minority with Unison, Cardiff and Vale NHS Trust and the of the Trust and extensively in community areas. at diploma and degree levels. The programme has Advisory Group and Disability Advisory Group Trade Union Congress (TUC) to deliver courses in Maintaining the highest quality is a challenge for been a significant contributor to reducing nurse in promoting equality for both patients and staff literacy, numeracy, IT and communication skills. all nurses but one it has continued to meet. vacancies in the division of surgery and is seen as a through an ‘Equality roadshow’. key element in nurse retention strategies. Consultant psychiatrist Dr Mike Shooter was During the year, Trust nurses consistently set new The launch of a new range of equality and diversity awarded the CBE for his services to health and the standards, two examples being Bridie O’Connor, Almost fifty staff have accessed the RCN clinical training programmes including cultural awareness, major role who has played in developing children’s lead sister, who was awarded an MBE for her leadership programme leading to tangible race equality and Welsh in the Workplace and having services in the Trust. He is the president of the services to urology and Sue Bale, associate nursing improvements in patient care. One - “Patient Story ‘Equality Champions’ identified in each division Royal College of Psychiatrists. director R&D, who was conferred as a fellow of Telling” - has already been identified by the the Royal College of Nursing in recognition of her Assembly as good practice. exceptional contributions to nursing research. Patient and Public Involvement is one area of care Colleagues presented fourteen papers at national and where two way communication is an essential remit. international levels. They achieved national awards and commendations and had contributions in peer- An executive nurse leads the Child Protection Group reviewed journals both in the UK and abroad. which develops child protection arrangements in line with the Carlisle Review and the Laming Inquiry. The Trust too strengthened its leadership in appointing nurse consultants and nurse practitioners The Trust chaplaincy service works with nurses to meet the new demands of speedier and more and other staff to help patients as they struggle to effective care. It was the first in Wales to have a find meaning and hope in the midst of sickness and lead nurse dedicated to children in the community uncertainty. Over the past year, spiritual, pastoral and the first Trust to have a designated research and sacremental care has been developed to enable

health visitor. chaplains at the larger district hospitals to be on site ONE

each weekday and Sunday and offer a comprehensive PART The Trust’s innovative programme for development 24 hour, seven days a week emergency service.

16-17 PART ONE Gwent HealthcareGwent Healthcare These allow doctors to access latest tests results, patients do not have to wait and staff are freed up for all medical records and personal information at a more specialised work. patient’s bedside saving them time having to print and copy information before they see the patient. A new electronic system for calling patients to clinic The trolleys also mean patients can see results and was the first of its kind in the UK when it was have a better knowledge of and involvement in their installed at Chepstow Community Hospital. care packages. As in all the Trust services, people were key. The Trust won the NHS Best Practice Award for energy efficiency at the Wales Environmental Research into the experiences of patients who Awards. Ten best practice actions identified then underwent cancer surgery, gave research fellow have since been rolled out to all trusts in Wales. Mike Stephens evidence to re-address national guidelines on diagnosis. His research paper was Patients who suffer from personality disorders named the best in the Association of the Surgeons INNOVATION & LEADERSHIP now have the first service of its kind in Wales. The of Great Britain and Ireland and was presented to Gwylfa Therapy Service provides clinical support acclaim in the USA. for highly disturbed patients who cannot be Setting high standards of healthcare for patients is the primary managed at community level. Dr John Saunders, a consultant physician at Nevill Hall, was awarded honours by two of Trust priority - but one that is only achieved year on year by a Patients waiting for medicines at the Royal Gwent Wales elite medical education establishments. He Hospital are now getting delivery by high technology. became an honorary professor in the University commitment throughout the organisation to the key qualities of The Trust has installed a robot that will store up of Wales School of Health Science at Swansea to 54,000 boxes of medicines and sort, collect and and an honorary senior lecturer at the university’s innovation and leadership. dispense 2,500 prescription packs a day, ensuring College of Medicine in Cardiff.

A genuine openness to innovation and change The Trust has appointed the first Allied Health exists across the Trust. The constant willingness Professional consultant in Wales. Two physiotherapists to innovate at all levels is shown by the volume of form part of a new multi-professional triage and submissions – more than any other trust – to the treatment service for patients suffering from annual Innovations In Care Conference run by the musculo-skeletal problems. National Assembly. Links with primary care were strengthened when TOP STROKE UNIT Associate Clinical Director for Orthopaedics, an associate medical director for primary care was Robin Rice, emphasised the Trust’s impressive appointed and a Joint Clinical Governance Group Nevill Hall Hospital was named as This included screening and scanning record of innovation and leadership. At the was established to set a framework and action plans having one of the top stroke care units of patients, therapy and drug assessments, National Innovations in Care Conference, the for much closer working. in the United Kingdom. rehabilitation and home visits before discharge. Trust had 54 abstracts and forty posters on display and Mr Rice was awarded the top prize for The development and implementation of joint In a national audit carried out by the Royal Staff at Nevill Hall achieved an overall score of his work on multidisciplinary assessment and incident reporting, audits of referral and discharge College of Physicians, every stroke unit was 81%, the highest in Wales and good enough to triage clinics. letters, research approval and a joint education assessed for clinical effectiveness against put them thirteenth of the 203 trusts nationally. event were key initiatives. The development of a twelve key patient care indicators. The UK average was 60%. The launch of the Out of Hours service was an contact centre and access to hospital test results example of a major innovation during the year that and patient information were vital links piloted The findings informed stroke clinicians and The unit has received some 400 stroke victims has already greatly impacted on patient care. during the year. managers how they performed against each year since it was opened in 1999 with three pre-determined standards within National specialist doctors and 35 nurses supported by a Positive leadership was crucial here to aim for the Innovation with a direct immediate impact on Clinical Guidelines and the National Service multi-disciplinary team. highest standards possible. However, that was mirrored patients was piloted at key hospitals when “wireless Framework. on many occasions at all levels in the Trust. PC trolleys” were tested on wards.

20-2118-19 PART ONE Gwent Healthcare Monmouth should be walking into their new Open communication supported by high joint facility and the new cardiology unit at the standards of corporate and personal Royal Gwent will be in full operation. integrity

Effective management will continue to be of critical Listening to and understanding partners importance to the Trust in delivering both its short so that it can respond to their needs and term and longer-term objectives. The Trust needs to inform their plans ensure that the vast majority of operational problems are resolved locally. To achieve this and everything Providing modern and safe environments else vital to the needs of local people, the Trust that meet the needs of patients, visitors recognises continuous improvements in patient care and staff are crucial. Clear aims and values will be set and met. In practical terms, progress in many areas of Recognition of the central role of patients development and improved services is already THE FUTURE and carers in the planning, delivery and well underway. monitoring of services The Trust’s Operational Plan for 2005/06 The strategic context for the development and delivery of the Respect and encouragement for staff recognises key targets set out within the Service throughout the organisation so that they and Financial Framework (SaFF) from the Assembly. Trust’s services continues to change and evolve at an achieve their full potential Achieving the four hour waiting time for 95% of increasingly rapid rate. Valuing diversity of patients, communities patients is a major priority for the Trust during and staff the coming year. It will involve the delivery of an A&E Project Plan with streaming of minor injuries The publication of “Designed for Life,” the national After the successful establishment of the framework Making the best use of NHS resources by as a short term measure and service and process strategy for NHS Wales by the Welsh Assembly and the positive engagement with the public during focusing on minimising waste and using redesign work as ongoing investments. Government, will have a critical impact on future 2004/05, a Strategic Outline Case for Clinical resources in creative ways direction as well as specific targets and ongoing Futures will be presented as the next step to the Key investment will be vital to achieve better development of the Trust. Assembly for their approval. With its support, Commitment to improvement and waiting times, the NSF for children, young people detailed plans can be developed for the major progress as an integral part of its work and maternity services and the target of a 5% Current drivers at national level continue to be the investment proposals that it will require to provide reduction in emergency medical admissions. NHS plan “Improving Health in Wales” and the the new local healthcare services. Balancing innovation with evidence based Working together to make the best use of scarce Review of Health and Social Care in Wales. In decision making investment will be essential. addition, wider policy documents such as “Making A full public consultation on the new model of the Connections” need to be taken into account, service will take place, leading to the completion of driving towards better co-ordination and co- an Outline Business Case in 2006. operation between sectors and emphasising the key role that individuals and communities should The two major immediate investment proposals play in the planning and delivery of top quality linked to Clinical Futures, reconfiguration of services public services. in the Borough of Caerphilly and the new community hospital at Ebbw Vale, should be given approval, Key to this for the Trust is its delivery of a sustainable allowing project structures and comprehensive configuration of services that can deliver both access project plans to be reviewed in readiness for and excellence for patients in the foreseeable future. construction phases by the end of the year. Fixed boundaries between primary, community and secondary care need to be dissolved to make way for The orthopaedic project at St Woolos Hospital a pathway-based approach that provides appropriate will be operational, giving a massive boost to support to patients as close to their homes as possible. elective treatment and reductions in waiting Clinical Futures will be the key driver. times for patients. Health and social care users in

20-21 PART ONE GwentGwent HealthcareHealthcare PART TWO Orthopaedics. Of the 4140 patients on the on the day on which their surgery will be orthopaedic waiting list at the start of the year, 400 undertaken. were waiting for longer than 12 months for their treatment. At the start of April this year no patients, The Ear, Nose and Throat Directorate has other than those who had decided not to take up extended its nurse practitioner services to include a second offer of treatment were waiting for more casualty referrals and a new screening system for than 12 months. The last year has also seen hearing problems in babies. The new electronic DIVISIONAL PROFILES significant changes in the management of trauma test is carried out on new-born babies within the which will support the achievement of the 4 hour hospital, detecting hearing problems at a much waiting time in A&E target. earlier stage. The Trust delivers its healthcare services through eight divisions While waiting list targets remain a priority for The Personal Dental Service continues to be which are at the core of all medical and clinical practices the Division, there are other significant issues successful in providing care for people not being addressed. The recruitment and retention registered for NHS dental care. The oral health and policies. of staff, particularly qualified nurses, emergency promotion programmes provided by the medical and surgical admissions, delivering the Community Dental Services have been expanded Clinical Governance Agenda, compliance with the to include a comprehensive programme for the Each has responsibility for the efficient delivery requirements of New Deal for junior doctors and older person in residential homes. of its own services and is fully accountable to the The divisions are: continuing capacity problems on the Royal Gwent Chief Executive and the Trust Board. Each is Surgery and Critical Care site are key. The Directorate of General Surgery experienced led by a general manager and a chief of staff Medicine a rise in emergency admissions by 239 cases this who have the task of ensuring that the division Obstetrics and Gynaecology The High Dependency Unit at the Royal Gwent year. Despite this 5% increase, general surgery meets its agreed clinical and financial targets Pharmacy and the Critical Care Unit at Nevill Hall both has reduced the length of time that patients and its corporate priorities and develops initiatives Diagnostics and Therapies underwent a partial refurbishment. Considerable need to stay in hospital to complete their episode that meet the ever-increasing demand on Community Services work was undertaken in integrating the HDU and of care. The directorate are now looking at Trust services. Children and Family Services Intensive Care facilities at the Royal Gwent and developing emergency assessment processes for Mental Health now nursing staff routinely rotate between the two surgical patients at Nevill Hall and the Royal areas improving flexibility and skills development. Gwent hospitals.

This year saw the growth of the outreach service The appointment of a new consultant in and an extension of business hours from 8am to ophthalmology with a special interest in diabetes will 8pm at the Royal Gwent. In anaesthetics, further allow the Trust to fully participate in the national efforts are being made to implement pre-admission diabetic retinopathy screening programme. The SURGERY AND CRITICAL CARE services allowing patients to be admitted to hospital Directorate has also appointed a Pre-admission Glyn Griffiths, General Manager Rod Jones Chiefs of Staff Dermot Hughes

The Division of Surgery provides a wide range of internal target of ensuring that no patients waited surgical services across three main sites within the for longer than 15 months. Trust. The Division has a subsidiary responsibility for the management of support services including a It continued to maintain a maximum waiting time medical secretariat and a medical records service. for the treatment of cataracts at four months and through the second offer scheme to reduce the The major challenges this year have been linked to maximum waiting time for treatment of all other waiting times and achieving targets. Maintaining the conditions to 12 months. maximum time patients wait for an outpatient appointment at 18 months was key. In fact in all The challenge to reduce waiting times over the but one speciality, the Trust set and achieved an last year was nowhere greater than in Trauma &

22-23 PART ONE Gwent Healthcare DIVISIONAL PROFILES

Nurse to assist in screening patients directly from The lack of adequate car parking has long been outpatients. an issue for the Newport hospitals. The Trust is exploring options for improvements on site and A successful recruitment programme has seen the possible use of a park and ride scheme with vacancies within the theatre directorate reduce Newport City Council. by nearly 50% in registered staff and by 70% in unregistered staff. MEDICINE The Directorate have also sought to improve theatre Sian Martin, General Manager usage by introducing new systems which ensure Steve Hutchison, Chief of Staff An Accident and Emergency workforce development Medical Assessment Unit (MAU) at Caerphilly that if theatre sessions are likely to be lost through group has been set up. One early improvement has & District Miners’ Hospital which has played an annual leave they can be used by other surgical Increasing demand on acute medical emergencies been the development of the Emergency Nurse important role in reducing delays for admissions and teams. Nearly 200 theatre sessions have been remained a major challenge for the Division during Practitioner role. After the appropriate training, speeding up the treatment for people not requiring protected in this way over the last year. the year. Achieving the 4-hour transit time target in these nurses are able to treat some minor injuries in-patient care. Another development saw Accident & Emergency was not sustainable due to cases independently, which will reduce waiting times. the opening of the Clinical Skills Laboratory. A pilot scheme to trial a Ward Housekeeper role the increasing volume and volatility of admissions. to separate responsibility for the catering and Commissioning plans have been reviewed and The philosophy of acute assessment and decision A project to redesign the Care of the Elderly cleaning services was completed and patient planned changes in alternatives to attendance and making regarding the need for admission to a (COTE) services is underway at the Royal Gwent satisfaction surveys indicated a very positive admissions are being implemented. hospital bed or alternative treatment and discharge and St Woolos hospitals. Patients with complex reaction to these changes. has been developed during the past year. On needs will be transferred into the service within 24 Accident and Emergency services were again average over 35% of patients attending the MAU hours of admission and will receive the full package Overall cleanliness audits were carried out jointly under increased pressure during the year. New at the Royal Gwent Hospital are ‘assessed out’ of Clinical and Social Care required. with the Community Health Council on 30 occasions patient activity increased by over 5000 cases at the without an inpatient bed being required. It is in the final quarter of 2004/2005. The Hospital three major units, constituting a 3% increase at proposed to roll out a similar model at Nevill Hall A notable success in the past year was the Patient Environment audit carried out by the the Royal Gwent Hospital, a 4% increase at Nevill Hospital over the coming year. introduction of a dedicated ward at the Royal Community Health Council in March commented Hall Hospital and a 7% increase at Caerphilly & Gwent Hospital for patients whose length of stay on a “noticeable improvement” since the last audit. District Miners’ Hospital. The Division has worked collaboratively with all was estimated on admission to be less than 72 partners across the health community in Gwent, hours. This enabled the average length of stay for in developing a programme that is aligned to the medical patients in the hospital to be reviewed vision for Clinical Futures and centred on the by focusing attention on fast-tracking short stay needs of the patient. patients through the system.

Projects being progressed already are the redesign Fast tracking medical patients to MAU at the Royal of A&E services at the Royal Gwent and the Gwent Hospital from Accident and Emergency emergency assessment and admission process and began. It is anticipated that this will reduce the appointment of an Acute Care Physician at Nevill number of inappropriate admissions from Accident Hall Hospital, the review of Care of the Elderly and Emergency. services and hospital discharge, the implementation of an Estimated Date of Discharge for all acute The Rheumatology day case unit at Nevill Hall admissions and of interim service models within Hospital was officially opened and proved to be Caerphilly Borough, developing new models of very successful, reducing inpatient stays and service focused on Chronic Disease Management, provided a range of day case treatments. The an Endoscopy Programme and automated Osteoporosis service has been completely dispensing in pharmacy. reorganised, with three of the consultants now providing dedicated sessions. Waiting times Recent developments include the opening of the have been significantly reduced.

24-25 PART TWO Gwent Healthcare DIVISIONAL PROFILES

An Upper GI Nurse Practitioner has been funded As a result of the launch of the Midwife as the through Newport Local Health Board Wanless Lead Professional, midwives are now able to monies who will work as a nurse endoscopist in practice autonomously to the full extent of their secondary care and establish her own nurse-led role and provide a holistic pregnancy and birth clinics. The Endoscopy Programme has been rolled experience for low risk women. To support this, a out across all sites. Achievements have included the midwifery led birth area within the Maternity Unit introduction of new information leaflets developed at the Royal Gwent Hospital, promotes “normality” in collaboration with patients. of the birth experience and to date 389 women have given birth there. The Directorate of Cardiology has worked with by a Midwife Clinical Specialist. Nevill Hall Hospital was re-awarded its Baby Friendly Torfaen, Caerphilly and Blaenau Gwent LHBs The Hanbury Midwifery Team has been fully Status, the Royal Gwent Hospital and Caerphilly to plan expansions to One-Stop Heart Failure and operational since January. They provide a package of A Birth Discussions Service provides debriefing Birth Centre are being re-assessed. Chest Pain clinics in localities across the county midwifery care to a caseload of 240 women within and extra support for women who have which will reduce waiting times for urgent treatment. the Torfaen area. These women can choose to experienced a previous traumatic birth. They Caerphilly midwives, were rewarded by a “Highly give birth at either Nevill Hall Hospital, the Royal are helped to achieve a more positive experience, Commended” award in Team of the Year category The Respiratory Directorate has been improving Gwent Hospital or, if there are no pregnancy or many opting to aim for normal birth after a in the British Journal of Midwifery Awards 2004. services for patients in North Gwent by starting an medical complications, at Caerphilly Birth centre previous Caesarean section. early discharge scheme with the Rapid Response or at home. Team and a project to reduce outpatients’ waits to At Nevill Hall Hospital, the Thrombosis and PHARMACY two weeks. In the south, the Directorate has focused There is a drive to improve the home birth rate to Research Fund donated £15,000 to fund the Sian Martin, General Manager on improving the inpatient services at the Royal 10%, in line with the recommendations from installation of a ‘Birthing Pool’ with en-suite Jenny Joy, Chief of Staff Gwent Hospital. “Delivering the Future for Wales”. In 2004, facilities. Funding from Blaenau Gwent LHB will the Trust achieved a 3% home birth rate, an allow conversion of another four–bedded room The Pharmacy Division undertook two major improvement on the 2% in 2003 and better into Labour, Delivery, and Postnatal Rooms. schemes aimed at modernising and improving the OBSTETRICS than the national average of 2% across England efficiency of its services. AND GYNAECOLOGY and Wales. In gynaecology, the Directorate achieved all its Sian Martin, General Manager waiting times targets. A key objective for this year The Aseptic Unit at Nevill Hall Hospital consists of Iain Stokes, Chief of Staff Women with more complex care needs have also will be sustaining and reducing them. a series of “cleanrooms” that are maintained by a benefited from the establishment of an Assessment positive flow of filtered air, which results in a particle During 2004 there were many initiatives & Admissions Unit within the High Risk Ward The One Stop Hysteroscopy service is now well and bacteria free environment. Within the rooms, introduced at all three Trust obstetrics units. Area at the Royal Gwent Hospital. The Unit is led established and 70% of the patients recently state of the art glove box cabinets are sited. It is in surveyed at the Royal Gwent Hospital felt that it these cabinets that complex drugs are prepared. provided an excellent service. In addition, over These include intravenous nutritional solutions, 80% of the patients with suspected gynaecological intravenous antibiotics and drugs used in cancer cancer continue to be seen within the required chemotherapy. 10-day period. The up to date facilities result in an environment Since October, the Directorate has been running in which these drugs can be prepared safely and an emergency gynaecology clinic every Wednesday without contamination. It also provides a safe afternoon at the Royal Gwent Hospital. The environment for pharmacy staff handling the purpose of this clinic has been to avoid or chemotherapy. reduce emergency admissions to the hospital wherever possible. This initiative has proven to An additional advantage of the upgrade is that be successful, and ideally, when funding allows, the unit can be prepared for licensing with the should be available every weekday on both district Medicines and Healthcare Regulatory Authority, general hospital sites. the government body that regulates the quality of

26-27 PART TWO Gwent Healthcare DIVISIONAL PROFILES

medicines manufactured in the UK. If successful, DIAGNOSTICS AND THERAPIES this would allow the working practices of the unit Marie Thorn, General Manager to be extended, making products on a batch basis so Brian Sullivan that commonly used preparations can be prepared Grant Robinson Chiefs of Staff in advance of patients attending clinics. Angela Hillier

The automated dispensing system (Robot) installed 2004-05 was another busy year for the Division in the pharmacy in the Royal Gwent consists of with a growth in service provision in key areas. a number of inter-linked storage systems (total Many of the reasons for this growth in demand size 18m long, 6m wide and 3m high) each with a can be traced to national service improvement robotic picking arm. All the drugs are stored by the initiatives for patients. the Medicine Division and A&E services, partly as camera and a multi-slice CT scanner. Torfaen and robotic arm(s) which reads the bar code and puts a consequence of increasing emergency services. Blaenau Gwent LHBs also purchased new X-ray them in a numbered location. There are significant pressures on service capacity On average, 84% of biochemistry tests are now equipment to improve services at the County and particularly for inpatient and Mental Health dietetics being turned around within one hour, compared to Blaina hospitals. When a drug is requested by a member of services, speech and language therapy support for 64% this time last year. By continuing to redesign pharmacy, the robot “delivers” the drug via a rehabilitation and acute inpatients, speech and service processes and introduce new technology, the Waiting times have been reduced for a number of system of conveyors to one of a number of locations language and occupational therapy services for department plans to maintain these improvements. services within the Division including Physiotherapy, within the department. The transition time can children with special needs. There is increasing Children’s Community Speech & Language vary depending on how busy the system is, but on demand for many diagnostics services particularly Services have been helped because, for the first Therapy services (reduced from 1,460 to 489). The average packs are delivered within 10-25 seconds. pathology and many radiology services including time in many years, the Division is fully staffed in Radiology Directorate won a national award for As the packs are stored and picked via their bar code MRI and CT. Speech and Language Therapy services and has enhancing patient care in Barium Enema services. the system is accurate and removes human error in halved its use of agency staff in Physiotherapy. picking the packs. Much of the growth in demand for pathology tests Despite a national shortage, two new radiologists There have been some excellent services that have has come from GPs who have been encouraged to were recruited, although there are still difficulties in been developed in the last year in partnership The automated system has enabled pharmacy staff improve monitoring and screening for coronary recruiting radiographers with LHBs and Local Authorities. Examples to be ward based, facilitating the development of heart disease and diabetes in line with the National include Gwent Early Language Project, a joint the medicines management system. Pharmacists Service Frameworks. This has resulted in a 21% The Trust Board approved a capital investment equipment store and integrated service model for are developing their roles to assist the clinical team increase in biochemistry tests and a 16% increase in of more than £3m in total for diagnostics Occupational Therapy, the appointment of District help patients in making best use of their medicines, overall workload to support primary care. modernisation and service redesign schemes. They Head Occupational Therapist in the Division of ease the pressure on medical staff and improve include the replacement of the old MRI scanner Mental Health and Learning Disabilities, the first discharge times. There has also been a big growth in demand from at the Royal Gwent hospital, the redesign of the joint health-education Occupational Therapy post, main x-ray dept and of the pathology laboratory at better hospital Social Services aids and equipment the Royal Gwent Hospital and Caerphilly Miners’ and the secondment of an Intermediate Care hospital. The pathology scheme is underway and Co-ordinator. the radiology extension to house the new MRI scanner will commence as soon as planning There have also been some new and innovative approval has been granted. services that have been introduced this year in order to provide a better and more appropriate These schemes are designed to enable new working service to patients. An extended GP practice- practices, improve the environment for both staff based dietetics service in Torfaen and the patient and patients and support the installation of new empowerment pilots in Podiatry and the Multi- equipment that should improve both the performance Professional Triage and Treatment Team (MPT3), and the efficiency of diagnostic services. clinically led by the first consultant physiotherapist to be appointed in Wales. New hi-tech radiology equipment has been fitted at Nevill Hall Hospital, including a new Gamma There have been a number of changes in working

28-29 PART TWO Gwent Healthcare DIVISIONAL PROFILES national attention for its nurse-led model of The introduction of a Care of the Elderly integrated service. The Division hosted several Development Plan has led to important changes. visitors from other UK NHS trusts who wish to An identified and structured medical model, the replicate the service. establishment of multi-disciplinary team working in the Royal Gwent Hospital, development of the During 2004/2005, there was a considerable role of the Ward Sister/Charge Nurse and the decrease in the number of delayed transfers of links with the Discharge Liaison Nurses and other care. This remarkable reduction has been achieved specialist nurses. not only through the additional funding for home care placements, but also because of the continued A review of therapeutic input, the development proactive management demonstrated by community of specialist care of the elderly wards in the Royal managers, to ensure there were no unnecessary Gwent Hospital, the reconfiguration of beds and delays for health reasons. services in St Woolos and the County Hospitals and the piloting of a unified assessment process One of the biggest challenges facing the Division in the Royal Gwent Hospital/St Woolos Hospital has been the management of Continuing Care. were completed.

practices in other teams too where clinical staff have and social crises they encounter. The Division continues to implement its plan for Whilst the challenges presented to the Division extended their roles to improve services to patients. a more cost effective and clinically effective service during 2004/05 have been considerable, the Extended scope practitioners in physiotherapy have Such development of community services offers delivery. This entails the appointment of health achievements have been even more significant. worked with Orthopaedic consultants in a number a number of opportunities, in particular the and social care workers offering greater continuity of service initiatives to reduce long waiting times. opportunity to rationalise other, more traditional of care for patients in their homes. Due to new Radiographers have undergone training to enable health services. Rationalisation also complies with National Assembly guidance, the policy has been CHILD AND FAMILY SERVICES them to report plain films and have also been the service model proposed through “Clinical revised and this presents major concerns not only Sam Crane, General Manager trained to undertake barium enemas. Futures” and gives opportunities to re-organise in relation to the additional resource required to Ian Bowler, Chief of Staff family planning clinics and district nursing operate the requirements of this policy, but also the weekend working. anticipated increase in demand. The Division continues to work towards delivering COMMUNITY SERVICES child friendly, family centred services within both Sian Millar, General Manager The Division undertook responsibility on behalf The Division has been instrumental in high- the acute and community setting, working closely Pradeep Khanna, Chief of Staff of the Trust and the five LHBs for the new Out of lighting the need for a more proactive approach with all groups as a key partner in the development Hours Service. It was a unique challenge, but one to patient care in the acute settings, particularly of joint service provision across Gwent. Important The year was a time for change for the Community that was met by commitment and professionalism around comprehensive assessments for those developments across the directorates over the last Services Division and it was both rewarding and - to an extent that it is now regarded as one of the with complex needs and for more dynamic year have been vital in maintaining the highest challenging to be part of the rapid progress made in more successful in Wales.The introduction of the discharge planning. standards of service. the development of intermediate care. new GMS contract has been challenging every- where. The withdrawal of GPs from 24 hours Divisional Managers and staff have been responsibility for their patients affected not only comprehensively involved in planning and setting their primary care patients, but also those whom up new services aimed at maintaining people they managed within Community Hospitals in in the community and reducing the need for General Practitioner beds and Minor Injury Units. hospital admission. These are crucial developments and should impact on the Trust in reducing The first nurse practitioner for minor injury units delayed transfers of care and both acute and in community hospitals was appointed at Chepstow community hospital lengths of stay and facilitate to develop a nurse-led service supported by A&E. meeting the four hourly target for A&E. The service will treat patients as locally and as More importantly, these developments will safely as possible, minimising the need for transfer impact on the people by enabling them to to an acute A&E. remain at home wherever possible and provide a more effective way of dealing with the health Gwent continence services continue to generate

30-31 PART ONE Gwent Healthcare DIVISIONAL PROFILES

In the Child Health Directorate, a multi-disciplinary partial booking into Community Paediatric clinics. feeding clinic at the Royal Gwent Hospital has received very positive response from users. It’s a The School Health Nursing Service has successfully “one stop shop” for patients and families with taken the BCG Immunisation Campaign to over consultant, therapist, dietitian and nurse involvement. 15,000 children. During this campaign all school A High Dependency Unit development at the health nurses were trained to administer this hospital has been important. vaccination, which has proved to be the first School Health nursing service in Wales to carry out this Work has been carried out towards an integrated type of training programme. model of care with the appointment of joint acute/ The Directorate has welcomed the attention paid Two working groups with multi-agency community paediatrics posts and with an orthopaedics The Community Children’s Nursing in the to CAMHS by the National Assembly. representation were established to look at issues service at Nevill Hall for child consultations in the Division has appointed a Palliative Care Lead for Black and Minority Ethnic patients and Children’s Outpatients’ area. A paediatric nurse is Nurse to care for children that have life limiting, It has enabled the development of Primary Mental women’s mental health and to develop appropriate now in place there. life threatening illnesses. This appointment is the Health resources in partnership with Monmouth- action plans. These plans are nearing completion first in Gwent dedicated to children. shire Local Health Board, supporting training and will shortly be considered by the Division’s In the care of neonates, the Directorate was the initiatives across the five Local Health Board areas. Clinical Governance Board. first in Wales to develop a discharge pathway in Gwent is now an active member developing an All intensive care. Both this and the transitional Wales approach to palliative care for children as part Funding was also secured for new CAMHS Services In adult mental health, a review of the Pillmawr arrangement to keep mother and child together of a clinical network. Again within the Community in Blaenau Gwent, Caerphilly and Torfaen, and the Ward at St Cadoc’s Hospital led to its focus being have been presented at Innovations of Care and Children’s Nursing Team there is now a dedicated social services department in Newport has seconded changed to that of continuous assessment and its the Clinical Fayre. Play Therapy Service in each borough. a member of staff to our service. management has been transferred to the adult service. This change is enabling patients who were The neonatal liaison service has developed “Tales The Health Visiting Service continues to modernise With a full complement of Child and Adolescent previously placed out-of-county, to be brought back from the Community” - a monthly feedback to meet the needs of children and families. The Consultant Psychiatrists, the waiting list for specialist to Gwent for their treatment. system from parents. In community nursing, key service has undertaken a caseload profiling exercise CAMHS has been reduced from over 18 months to developments have included moving some elements to ensure equity of service delivery across Gwent. under 9 months. All boroughs are now working towards the of work back to Primary Care (Baby clinics etc), implementation of a self-help book prescribing developing a strategy for the management of The Blaenau Gwent Sure Start team have earned Priorities for the current year include improving facility with the LHBs. This is a proven therapeutic Educational Medicine and joint pathways for specific praise for good practice they have developed across support to primary care and non-specialist services, intervention and in the Monmouthshire borough, a conditions with Child and Adolescent Mental the borough and have been congratulated by the developing substance misuse services for children multi-agency project group has been established to Health Services (CAMHS) and the introduction of Centre for Health Wales. and young people, setting up assessment services implement this service. Similar implementation for children with Autistic Spectrum Disorders, processes exist in the other areas and work will improving services for patients with Eating continue during 2005/06 with its introduction Disorders and bringing down our waiting lists throughout Gwent. to under six months. The Personality Disorder Service is now fully operational with all posts successfully appointed. MENTAL HEALTH This includes the first Nurse Consultant post in Ian Thomas, General Manager adult services. Pauline Ruth, Chief of Staff Each Borough team has had an impressive year. The Division achieved considerable success with In Torfaen, the Assertive Outreach service has the bids submitted to the Local Health Boards for been very successful. Several evaluations having Wanless funding for adult and older adult services been undertaken and these have demonstrated enabling a number of key services initiatives to be significant improvements for those patients within successfully introduced. the target group.

32-33 PART TWO Gwent Healthcare DIVISIONAL PROFILE

Funding was obtained for the development of a in older adult mental services the ECT provision First Access service for the area signpost referrals to is being centralised at Maindiff Court and the most appropriate service to meet the assessed will be managed under the auspices of the needs of the individual. Monmouthshire team.

In Caerphilly, a borough-wide Early Onset Work is continuing towards achieving the Service was implemented which also has some recommendations set out in the Day Activities crisis response ability and a health and social care review undertaken across Health and Social day service. Care in Monmouthshire. In anticipation of the impending service changes, staff have identified The Trust, Coleg Gwent and UniGlam are innovative practices that include specific therapy providing training opportunities for service users in the community. in Monmouthshire and the service is also working closely with the LHB and other stakeholders in the The staff on Ty Bryn ward are now following development of a local strategy for adult mental up patients who have been placed in nursing health that will give direction to the future or residential homes with a view to providing provision of services in the borough. advice and support to the staff employed in these establishments. A Home Treatment team is being introduced in Blaenau Gwent and has been agreed in Torfaen. Future plans involve the creation of both functional In Caerphilly, a second Intensive Home Treatment and dementia assessment beds on Ty Bryn and Team has been established, in Newport, a Crisis Llanvair wards for Monmouthshire patients, the Resolution/Home Treatment team is being implementation of the Day Activities review, securing developed in phases. funding for a Liaison Nurse for the borough and the relocation of Overmonnow Day Hospital into As a result of other service changes in the Trust, the new Monnow Court development.

The ASSIST Project in Blaenau Gwent has been for carers and former carers of people with extended to include two extra care flats, which dementia, is proving to be an effective have been equipped with a range of technology advocacy group. to support people who are being discharged from hospital. The Directorate’s Forensic Service undertook a six-month pilot study at the Newport courts The Project was cited as an example of good concerning the Court Diversion scheme into practice of joint planning and service provision in psychiatric services. Discussions will be ongoing a report drawn up by the Health & Social Services during 2005 with the LHB regarding future Committee of the Assembly. funding to establish a permanent service.

The collaborative Respite for Carers Service has In an important decision for the future planning further expanded. This was developed as a of Learning Disabilities, the capital investment partnership between the Trust, Social Services board of the Assembly gave the go-ahead for the and Crossroads and is now firmly established. reconfiguration of residential services at The Friends of Oak Parc, a support group Llanfrechfa Grange.

34-35 PART TWO Gwent Healthcare PART THREE

TRUST GOVERNANCE

The Trust embraces all the principles of the Code of Conduct

and Accountability and the Code of Practice and Openness of NHS Wales. Continuous reviews of its governance policies in MEDICAL EDUCATION line with NHS Wales guidelines, ensure full compliance. Gwent Clinical School, the title bestowed upon the Trust in

The Trust holds six formal Board meetings and an The Chief Executive and the Executive Directors recognition of its teaching activity, has continued to provide high Annual Public Meeting each year. Members of the hold permanent appointments and were appointed public are actively encouraged to attend all of these in accordance with national guidelines. quality clinical placements in all five years of the undergraduate meetings in line with its policy of openness. The Trust’s provision of effective and efficient curriculum, second in number only to Cardiff University. The Secretary to the Board is responsible for the healthcare services to the communities it serves, provision of information about the Trust. He is continues to be achieved through important available via: engagement with its health and social care partners 2004/05 has seen the full cohort of 290 under- recognised that the new Institute would provide a and with the Welsh Assembly Government. A high graduate medical students reach year four of the significantly enhanced education environment for Trust Headquarters, Grange House, priority continues to be the successful engagement it curriculum which has again increased the number all healthcare disciplines throughout the Trust and Llanfrechfa Grange, Torfaen NP44 8YN has with patients and the public, especially through of clinical placements within the Trust. Once in the surrounding healthcare community. By telephone at 01633 623623 its PPI initiatives and its Patients’ Panel. again the Trust will be hosting the intermediate By fax at 01633 623836 examinations for year three students. They are All four Education Centres in the Trust continue The Trust website, www.gwent-tr.wales.nhs.uk It is working within its Clinical Governance organised by the Undergraduate Department, to see an expansion in educational activity on a Development Plan which is updated annually, with a number of Trust consultants acting as multi-disciplinary basis. Close integration of The Audit Committee oversees the governance setting out critical development potential and examiners over the two days of examinations. policies and the sharing of good practice continues and financial management of the Trust. Only continuous monitoring. to be a priority, enhanced following the Deanery non-executive directors are members of this The merger between Cardiff University and the Commissioning Visit when the Trust received an committee. A register of directors’ financial and University of Wales College of Medicine has been excellent report representative of all the work taking general interest is available at Trust Headquarters. completed and the Trust continues to work closely place in the four Centres. Statements relating to the Welsh Risk Management with Cardiff University further developing Standards and the Directors’ remunerations are education links with the new organisation. At the Royal Gwent Hospital, a Generic included in the annual report. Training Programme for consultants’ continuing The Outline Business Case for the new Health professional development has been developed. Clinical governance policies and principles and Sciences Institute at the Royal Gwent site has The programme includes sessions on issues such the systems supporting them are monitored by the been approved and the Full Business Case is as teaching the teachers, appraisal and dealing Quality and Clinical Governance Committee. It is being developed. If this is successful, work on the with the media. The programme attracts led by the chairman, with the Chief Executive as new building should begin in the autumn and the consultants from across the Trust and it is the responsible officer and the Medical Director building should be complete early in 2007. The anticipated that similar sessions can be held in undertaking the lead role. Trust remains committed to this project as it is the North in the near future.

36-37 PART THREE Gwent Healthcare The library service has seen a significant increase in literature searching and to encourage staff to use in multi-disciplinary use which has been widely the resources available to improve patient care. welcomed. The Trust has played an important role in under- The Library Strategy Group meets monthly, ensuring taking a pilot scheme for the Foundation Programme a robust network throughout the Trust allowing all 2 posts as a result of Modernising Medical Careers. Trust staff access to a uniformly high quality library Twelve posts were centrally funded and the pilot service. The new library management system will has proved to be successful. allow the Library Strategy Group to begin working on a comprehensive strategy for the Trust. The Trust has had an opportunity to recognise teaching activity by creating fixed sessions in The profiles of the Trust libraries as an education consultant job plans as part of the new consultant and information resource for all staff, are being contract and expansion across the Trust is reflecting raised. Training programmes are being formulated teaching activity. RESEARCH AND DEVELOPMENT

A five year strategy has been produced by the Research and

Development team and approved by the Trust Board.

It has five key aims to ensure the R&D programme The year saw the evaluation of major health continues to produce the best opportunities for staff. service initiatives in the Trust through securing funding for the new Personality Disorders Service It will develop and consolidate the infrastructure and the Out of Hours Service, two nursing to support R&D in the Trust and to expand the initiatives, the Clinical Supervision project and research workforce to increase research capacity and the Clinical Teachers project and conducting and to improve the quality and relevance of research. evaluation of nurses’ attitudes towards research. The strategy will maintain and further develop a culture in which research evidence-based practice Public and Patient Involvement was improved and policy making can occur, it will improve the by appointing a member of the Trust Scientific ability of staff in the Trust to participate in multi- Scrutiny Committee to develop ‘Expert Patient’ disciplinary, multi- agency research projects across input to research projects, to collect data on the Wales, United Kingdom and internationally and number of projects that have involved Public and will strengthen the integration of R&D with clinical Patient Involvement in designing studies. effectiveness, evidence-based medicine and audit. Two important appointments saw the R&D Success has been achieved in priority areas during Associate Nurse Director to project boards of the year. Some worthy of note, include the aligning some new health service initiatives and the Trust of Trust Small Grants funding priorities with R&D Manager chairing the All Wales R&D those of Welsh Assembly Government Health Managers Forum Priority Areas and forging closer partnerships and integration with Universities including Cardiff The honorary appointments of the Associate University (Schools of Nursing, Psychology and Nurse Director, membership of Trust staff to Sociology, Centre for Health Sciences Research the Research Committee of Health Education and Cardiff Institute of Society, Health and Institutes and membership of Institute staff to Ethics), Glamorgan University, Newport City Trust Research Governance Committees are Council and charitable organisations. key landmarks.

38-3940-41 PART THREE Gwent Healthcare SUMMARY SUMMARY OF ACCOUNTS OF ACCOUNTS Operating and financial review The Trust has met 2 of its 3 financial targets for 3. Creditor payment the year ended 31 March 2005. These are: The Trust is required to pay 95% of the number of non-NHS bills within 30 days of receipt of 1. Breakeven goods or a valid invoice (whichever is the later). A copy of the full accounts of the Trust are available from the The Trust has reported a deficit of £74k, (2003-04 The Trust has achieved the following results: £30k surplus). The Trust is considered to have met Finance Director, Gwent Healthcare NHS Trust, Grange House, its breakeven target if any deficit arising falls within Number the materiality threshold of the lesser amount of Total number of non-NHS Llanfrechfa, Torfaen, Wales NP44 8YN. £500k or 0.5% of the Trust’s operating income. bills paid 2004-05 183,327 The deficit falls within this threshold. This is the sixth successive year that the Trust has met its Total number of non-NHS breakeven target. bills paid within target 155,369

2. External Financing Limit Percentage of non-NHS The Trust is required to meet this target set by the bills paid within target 84.7% National Assembly for Wales, which represents the cash-flow to the Trust that is external to income The Trust has not met the target. received for patient services, and effectively finances the Trust’s capital programme. The Trust has met its external financing limit.

Foreword to the accounts

The accounts for the year ended 31 March 2005 schedule 2 of the National Health Service and have been prepared by the Gwent Healthcare NHS Community Care Act 1990) in the form in which Trust under section 98(2) of the National Health the National Assembly for Wales has, with the Service Act 1977 (as amended by section 24 (2), approval of Treasury, directed.

Contents Other Disclosures Main Statements Directors’ Remuneration Income and Expenditure Account Senior Managers’ Pay Statement of Recognised Gains and Losses Management Costs Balance Sheet Related Party Transactions Cash Flow Statement Public Sector Payment Policy Private Finance Transactions

The accounts have been prepared under the Statement of Internal Control historical costs convention, modified to account for The Trust’s Statement of Internal Control is the revaluation of fixed assets at their value to the incorporated within the Trust’s published accounts. business by reference to their current costs.

40-4142-4340-41 ACCOUNTS Gwent Healthcare SUMMARY OF ACCOUNTS Income and expenditure account for year ended 31 March 2005

2003-2004 Certificate of Chairman, Chief Executive and Finance Director £000 £000

We certify that the abridged version of the Martin P Turner, Chief Executive Income from activities 415,739 368,325 annual accounts set out on pages 40 to 49 is August 2005 Other operating income 26,161 23,644 consistent with the statutory financial statements of the Trust for the year ended 31 March 2005. Total income 441,900 391,969 Operating expenses (434,487) (386,427)

Dr. Brian Willott, Chairman Andrew J Cottom, Finance Director Operating surplus 7,413 5,542 August 2005 August 2005 Profit / (Loss) on disposal of fixed assets 75 (96)

Surplus before interest 7,488 5,446 Interest receivable 1,040 702 Interest payable (255) (203) Other finance costs (209) (310)

Surplus for the financial year 8,064 5,635 Report of the Auditor General for Wales to the Members Public dividend capital dividends payable (8,138) (5,605)

of the National Assembly for Wales on the Summary Retained surplus for the year (74) 30

Financial Statements

I have examined the abridged version of the financial statement’ issued by the Auditing Statement of total recognised gains and losses for year annual accounts set out on pages 40 to 49. Practices Board for use in the United Kingdom. ended 31 March 2005 Respective responsibilities of directors Opinion 2003-2004 and auditors In my opinion the abridged version of the annual £000 £000 The directors are responsible for preparing the accounts is consistent with the statutory financial Surplus for the financial year before dividend payments 8,064 5,635 Annual Report. My responsibility is to report statements of the Trust for the year ended 31 Fixed asset impairment losses (771) (78) my opinion on the consistency of the abridged March 2005, on which I have issued an unqualified Unrealised surplus on fixed assets revaluations / indexation 17,417 10,660 version of the annual accounts with the statutory opinion. Increases in the donated asset and government grant reserves financial statements. I also read the other information due to receipt of donated and government grant finance assets 306 149 contained in the Annual Report and consider the Jeremy Colman, Auditor General for Wales Reduction in the donated asset reserve due to the implications for my report if I become aware of August 2005 depreciation / disposal of donated assets (273) (436) any misstatements or material inconsistencies with Wales Audit Office the summary financial statements. 2 - 4 Park Grove, Total recognised gains and losses for the financial year 24,743 15,930 Cardiff CF10 3PA Basis of opinion Prior period adjustment 0 0 I conducted my work in accordance with Bulletin 1999/6 ‘The auditor’s statement on the summary Total recognised gains and losses in the financial year 24,743 15,930

42-43 ACCOUNTS Gwent Healthcare SUMMARY OF ACCOUNTS Cash flow statement for year ended 31 March 2005

2003-2004 Balance Sheet as at 31 March 2005 £000 £000

31 March 2004 Net cash inflow from operating activities 17,687 18,332 £000 £000 Interest received 1,040 702 Tangible Fixed Assets 249,968 233,342 Interest paid (1) (2) Interest element of finance leases (254) (201) Current assets Net cash inflow from returns on investments and 785 499 Stocks and work-in-progress 3,441 3,375 servicing of finance Debtors: amounts falling due: within one year 35,301 34,861 after one year 31,502 19,220 Capital expenditure Cash at bank and in hand 1,524 1,993 Payments to acquire tangible fixed assets (10,454) (6,361) 71,768 59,449 Receipts from sale of tangible fixed assets 305 1,657 Net cash outflow from capital expenditure (10,149) (4,704) Creditors: amounts falling due within 1 year (30,576) (22,332) Public dividend capital dividends paid (6,117) (9,223) Net current assets / (liabilities) 41,192 37,117 Net cash inflow / (outflow) before financing 2,206 4,904 Total assets less current liabilities 291,160 270,459 Financing Creditors: amounts falling due after more than one year (2,648) (1,984) Public dividend capital received 0 356 Provisions for liabilities and charges (42,027) (38,610) Public dividend capital repaid (2,484) (5,016) Capital element of finance leases (191) (244) Total assets employed 246,485 229,865 Net cash inflow / (outflow) from financing (2,675) (4,904)

Financed by: Increase / (Decrease) in cash (469) 0 Capital and reserves Public dividend capital 163,627 163,612 Revaluation reserve 84,802 68,344 Donated asset reserve 1,279 1,176 Income and expenditure reserve (3,223) (3,267)

Total capital and reserves 246,485 229,865

44-45 ACCOUNTS Gwent Healthcare SUMMARY OF ACCOUNTS Senior managers pay award 2004-2005

Senior Managers pay rises did not exceed 3.225% of the managerial pay bill. Directors' remuneration for year ended 31 March 2005

As 2003-2004 Director £000 £000 Management costs for the year ended 31 March 2005 2003-2004 Non-executive directors' remuneration 116 80 £000 £000 Management costs 17,346 15,267 Executive directors' remuneration: Income 441,795 390,768 Basic salaries 570 558 Management costs percentage 3.9% 3.9% Benefits 8 11 Pension contributions paid* 76 37 The cost information is collected using the definition for Trust management costs from WHC(2000)113.

Total executive directors 654 606

Grand total 770 686 Related party transactions The remuneration of the chairman and chief executive is as follows: As 2003-2004 Gwent Healthcare NHS Trust is a body corporate established by order of the Secretary of State. During Director the year none of the board members or members of the key management staff or parties related to them £000 £000 has undertaken any material transactions with Gwent Healthcare NHS Trust. Chairman Basic remuneration 43 30 The Assembly is regarded as a related party. During the year the Trust has had a significant number of Benefits 2 1 material transactions with the Assembly and with other entities for which the Assembly is regarded as the 45 31 parent, namely:

Chief Executive £000 Basic salaries 153 148 Newport Local Health Board 100,947 Benefits 0 0 Caerphilly Local Health Board 93,247 Pension contributions* 21 10 Torfaen Local Health Board 73,997 174 158 Blaenau Gwent Local Health Board 60,398 Monmouthshire Local Health Board 54,819 The Chief Executive is the highest paid director. National Assembly for Wales 10,783 University of Wales College of Medicine 8,593 Powys Local Health Board 6,967 * Employer’s pension contributions paid by the Trust in 2004-2005 were 14% of pensionable salary. Welsh Risk Pool 6,229 (7% in 2003-2004). Velindre NHS Trust 3,534 Business Service Centre, Pontypool 2,162 Informing Healthcare 2,001 Health Commissioning Wales 1,992 Cardiff and Vale NHS Trust 1,368 Compensation Recovery Unit 1,273 Cardiff Local Health Board 1,134 Caerphilly Borough Council 1,124

The Trust has also received revenue and capital payments from a number of charitable funds, certain of the Trustees for which are also members of the Trust Board.

46-47 ACCOUNTS Gwent Healthcare SUMMARY OF ACCOUNTS Private finance transactions

The private finance schemes operating in the Trust The contract runs until May 2023; the annual Public Sector Payment Policy for year ended 31 March 2005 are as follows: payment is £654,000 and as the scheme is deemed to be on balance sheet the amount charged to Prompt payment code - measure of compliance Newport Hospitals Energy Scheme operating expenses during the year was £208,000. The Assembly requires that Trusts pay all their trade creditors in accordance with the CBI prompt payment The provision of replacement heating and lighting The remainder of the payments are finance lease code and government accounting rules. The target is to pay all trade creditors within 30 days of receipt of systems within Newport Hospitals over a period interest charges and scheduled capital creditor goods or a valid invoice (whichever is the later) unless other payment terms have been agreed with the supplier. of 15 years. repayments.

The contract runs until November 2014; the The capital value of the scheme included in the 2003-2004 annual payment is £567,000 and this sum was fixed asset value on the balance sheet at the Number £000 £000 charged to operating expenses during the year. 31 March 2005 is £3,275,000. NHS Total bills paid 3,030 9,812 11,060 The scheme is deemed off balance sheet, and as Other Schemes Total bills paid within target 2,210 8,417 7,862 such the capital value of £4,000,000 is excluded Percentage of bills paid within target 72.9% 85.8% 71.1% from the fixed asset values on the balance sheet. Monmouth Health and Social Care Facility The Trust has signed a Private Finance Partnership Non-NHS Chepstow Community Hospital Agreement with Monmouthshire Local Health Total bills paid 183,327 121,975 113,985 The financing of a new community hospital over a Board and Monmouthshire County Council Total bills paid within target 155,369 106,631 100,234 period of 25 years. The scheme includes the to develop a health and social care facility in Percentage of bills paid within target 84.7% 87.4% 87.9% provision of ancillary support services. Monmouth.

The contract runs until February 2025; the annual The development commenced in December 2004 Total payment is £1,511,000 and this sum was and is scheduled for completion in early 2006. Total bills paid 186,357 131,787 125,045 charged to operating expenses during the year. The facility will deliver social care services and the Total bills paid within target 157,579 115,048 108,096 health services that are currently being provided by Percentage of bills paid within target 84.6% 87.3% 86.4% The scheme is deemed off balance sheet, and as Monnow Court Social Care Centre, Monmouth such the capital value of £10,000,000 is excluded Hospital and Dixton Road Clinic, Monmouth. from the fixed asset values on the balance sheet. The Late Payment of Commercial Debts (Interest) Act 1998 £1k (2003-04 £2k) interest has been paid arising from claims made by small businesses under this legislation. Nevill Hall Hospital Energy Scheme The provision of replacement heating and lighting systems within Nevill Hall Hospital over a period of 25 years.

The contract runs until December 2026; the annual payment is £445,000 and this sum was charged to operating expenses during the year.

The scheme is deemed off balance sheet, and as such the capital value of £3,300,000 is excluded from the fixed asset values on the balance sheet.

Nevill Hall Hospital Day Surgery Unit The financing of a new purpose built day surgery unit over a period of 25 years. The PFI partner has responsibility for maintaining the building and replacing the equipment used within the unit.

48-49 ACCOUNTS Gwent Healthcare KEY TRUST CONTACTS

The Trust Headquarters are at: Grange House, Llanfrechfa Grange, Cwmbran, Torfaen, Wales, NP44 8YN. Telephone: 01633 623623

The Trust is responsible for three acute hospitals:

Royal Gwent 01633 234234 Nevill Hall 01873 732732 Caerphilly District Miners 02920 851811

They are also responsible for nineteen general, community and mental health hospitals and day case premises covering the five county borough areas.

Aberbargoed 01443 828728 Abertillery 01495 214123 Blaenavon 01495 790236 Blaina 01495 293293 Chepstow 01291 636636 County 01495 768768 Danybryn 01495 353700 Ebbw Vale 01495 356956 Maindiff Court 01873 735500 Monmouth 01600 713522 Oakdale 01495 225207 Redwood 01685 840314 St Cadocs 01633 436700 St Woolos 01633 234234 Talygarn 01495 765725 Tredegar 01495 722271 Ty-Sirhowy 01495 229010 Ysbyty’r Tri Chwm 01495 353200 Ystrad Mynach 01443 811411

The Trust Website is www.Gwent-tr.wales.nhs.uk

50-51 Gwent Healthcare Gwent Healthcare NHS Trust