Mid MattersSpring 2020 The official newsletter of the Mid Wales Joint Committee for Health and Care Welcome…

We were due to hold a Mid Wales Joint Committee meeting on 23rd March 2020 but due to the current circumstances this was cancelled in order to allow colleagues the time to concentrate on the planning work required for Covid-19.

Our next meeting is scheduled for Monday 29th June 2020 in County Council Offices, County Hall, but in light of the current situation we will keep this date under review.

In the mean time this newsletter will bring you up to date with our work and some of the things that have been going on across the area by our partner organisations.

1 School of Nursing

In our last newsletter we provided some information on the proposed School of Nursing at Aberystwyth University. We can now confirm that Sally Hore BN, MSc Nursing, PGCert HE, Registered Nurse, TCH, SfHE has been appointed and commenced in post in February 2020. Sally will be leading the planned development of healthcare education at Aberystwyth University.

As a registered nurse with over 27 years’ experience Sally has held a variety of roles in clinical practice, research and education. Since 2002 she has developed and delivered multidisciplinary healthcare education. In 2018 Sally was seconded to Hywel Dda University Health Board as the Senior Nurse for Education and Training. Sally has a passion for designing and delivering innovative healthcare education which incorporates evidence-based patient centred care that has a positive impact on both practitioners and patients. She has been heavily involved in both internal and external curriculum quality assurance and programme approval processes over the last 10 years and currently acts as a registrant quality assurance visitor for the Nursing and Midwifery Council.

If anyone wishes to contact Sally to find out more about the Aberystwyth University School of Nursing you can do so using the following details: Sally Hore - Principal Lead for Healthcare Education, Faculty of Earth and Life Sciences, IBERS, Penglais, Aberystwyth, SY23 3FG. 01970 622254 MRI Scanner in Bronglais General Hospital Funded by Welsh Government, this new MRI is the most advanced equipment in Hywel Dda.

This new MRI will significantly reduce travel for patients needing to obtain diagnostic tests as it will remove the need to travel south for such advanced services.

In addition, its advanced functionality will allow Bronglais General Hospital to provide new models of care by utilising MRI in the first instance, which will reduce the need for invasive and more uncomfortable diagnostic tests e.g. Prostatic Biopsies.

Work is now complete on the installation and the MRI has been operational since February 2020. Delivering Excellent Rural Acute Care; A Strategy for Bronglais General Hospital

At its Public Board meeting on 28th November 2019, Hywel Dda University Health Board approved the Clinical Strategy for Bronglais General Hospital.

An implementation plan is currently being drafted which will detail the work required to bring this strategy to life. As part of this work local experts with an interest in health and care from a wide range of disciplines will be invited to sit on a Public Advisory Group which will feed their expertise in to the Implementation Group.

The Mid Wales Joint Committee’s work will help support this strategy to develop sustainable services and the Mid Wales Clinical Advisory Group will be a key group in helping to deliver this strategy. 2 Mid Wales Ophthalmology Clinical Lead

The three Health Board’s across the Mid Wales area have agreed to support and fund a Joint Clinical Lead for Eye Care Services / Consultant Ophthalmologist for Mid Wales. Hywel Dda University Health Board have agreed to be the hosting Health Board for this role and will oversee the recruitment process. The job description has been submitted to the Royal College of Ophthalmologists for approval which is hoped to be obtained by Summer 2020.

Ceredigion Carers Unit achieves Gold Level County Council’s Carers Unit is the first council in Wales to be awarded with a Gold level under the Investors in Carers (liC) scheme. IiC is a quality assurance scheme that ensures that organisations and services are identifying and supporting unpaid Carers. The scheme covers Carers of all ages and situations. They include Carers under the age of 18, young adult Carers from 18 – 25, parent Carers who care for a child with a disability or mental health issue, sibling Carers and older people caring for each other. To be awarded with a Gold level the Carers Unit have demonstrated an advanced understanding of Carers issues, an extremely high level of service delivery to Carers, how they have supported cultural change through working with and supporting council teams to be more Carer aware and they had to demonstrate clear evidence of results.

Heather West is Ceredigion County Council’s Carers Development Officer. She said: “We are really delighted, and I am very proud of the team! The panel were particularly impressed with the range of work undertaken, working across all parts of the council, and the evident corporate commitment to embedding Carers as a priority across all areas. One of the Panel members said the panel were really tough to achieve gold, the highest award.” Ellen ap Gwynn is the Leader of Ceredigion County Council. She said: “To have been awarded with a Gold level in the Investors in Carers quality assurance scheme is a fantastic achievement for the Carers Unit. We are very pleased that our Carers Unit have received recognition for their excellent work in supporting Carers and their families in Ceredigion. All staff are commended for their hard work.”

Carers provide unpaid care by looking after a family member, friend or partner who is ill, frail, disabled or struggling with mental health, drugs, or alcohol. Three out of five of us will be a Carer at some time in our lives. Helping a loved one get the most out of life can be incredibly rewarding, but it can also be very tough. Getting the right advice for Carers at whatever stage of the caring role can make a huge difference to their health and the health of those they are looking after.

For more information about the Investors in Carers scheme visit: www.hywelddahb.wales.nhs.uk/carers or for useful advice for Carers, visit: www.ceredigion.gov.uk/carers.

3 Update on Integrated Health and Care projects across Mid Wales

Cylch Caron project WRW Construction Ltd have now been commissioned by Mid Wales Housing Association to progress with the design element along with their final costings for the scheme. A revised application planning was submitted by WRW in mid-December 2019. Stakeholder and community engagement events are in the process of being organised and these will be key in finalising the Full Business Case.

Aberaeron Ambulance station A planning application for the proposed new Ambulance Station in , which will co-located with the Aberaeron Integrated Care Centre, has been approved. The final design proposals are currently being drafted

Cardigan Integrated Care Centre Cardigan’s new Integrated Care Centre opened its doors to the public on Monday 9th December 2019, bringing joined-up care to local communities. The opening of the centre follows on from the launch of a similar initiative in Aberaeron, and represents a decisive step forward in the way that we deliver health and social care services in a largely rural landscape in the 21st Century.

As well as providing a modern, fit for purpose healthcare service including a GP practice, dental service and pharmacy, the new centre – which has been developed with £23.8m of Welsh Government funding – will host a range of other clinics and services delivered by Hywel Dda University Health Board, the third sector, local authority and partner organisations.

Bro Dyfi Integrated Health and Care A Stakeholder ‘relaunch’ workshop will be arranged in order to share with interested parties the recent developments and discuss progress.

North Powys Well-being Programme Much engagement has taken place over recent months, this has involved numerous public, staff and stakeholder inputs to enable a review of the final draft model of care. The draft Model of Care for North Powys has been approved by Cabinet and PTHB Board. A Public facing version of the Model of Care is under development and will include a technical document, summary and leaflet.

Successful recruitment to key posts - Service Planner, Change Manager and Clinical Change Manager have all been recruited to and start dates anticipated or confirmed (all by April 20). The next stage of work involves commencing work on the Programme Business Case and appoint contractor for Strategic Outline Cases, continue with delivery of acceleration for change projects and finalise business cases, commence work on outcomes framework, prepare for the next stage of work – to include detailed programme plan and confirmation of 4 approvals and set up clinical and professional networks to support the next phase of detailed design. New era for endoscopy as camera pill introduced in hospitals

State of the art technology to diagnose abnormalities in the small bowel is now available for patients in North Wales.

Capsule endoscopy is ideal for investigating obscure Gastrointestinal bleeding (GI) in patients and those who may have inflammation in the bowel from conditions such as Crohn’s disease.

The capsule is swallowed by the patient, who is then free to go back to work or home. On its journey through the esophagus, stomach, and small intestine it takes around 100,000 images, which are then transmitted to a data recorder on a belt. Eight hours after swallowing the pill, the patient returns to the Endoscopy Department where the belt is removed and the images downloaded and reviewed by a clinical endoscopist. The pill containing the camera is disposable and is simply flushed away by the patient. Wrexham Maelor Hospital’s Endoscopy department, who began offering the service towards the end of 2019, are already seeing the benefits of the new service.

Mandy Collins, Lead Nurse Endoscopist, said: “The capsule is mostly used to investigate the small bowel to rule out and to investigate obscure Gastrointestinal bleeding (GI) in patients with iron deficiency anaemia and other GI symptoms when an endoscopy and colonoscopy has not identified any obvious cause. It is also used to investigate and assess patients who have Crohn’s disease to assist in determining if there is a need for further treatment. The results we’ve had so far from using Capsule Endoscopy are very promising, with excellent feedback from our patients. It is a non-invasive procedure and allows patients to continue with their daily routine.”

Providing the service in North Wales allows patients to access the procedure closer to their homes, as up until recently they were referred to the Royal Liverpool Hospital.

Consultant Gastroenterologist, Dr Jonathan Sutton, at Ysbyty , who is looking forward to starting this service soon at Ysbyty Gwynedd, said: “The primary benefit of the small bowel endoscope is its ability to provide physicians with complete and direct visualisation for evaluation of the small bowel. This provides us with a greater ability to detect vascular abnormalities that cause GI bleeding and other symptoms. It also allows us to provide patients with a minimally invasive procedure that is sedation-free. The patient can ingest the pill, and go about their normal, daily routine while receiving a full examination of the small bowel, and simply return the equipment at the end of the day. We are really pleased we can soon offer this service at Ysbyty Gwynedd, it will provide an essential gastrointestinal service to our patients locally without having to travel to another hospital.”

5 LGBT+ History Month

LGBT History Month is a celebration of lesbian, gay, bisexual and transgender history, and the history of gay rights and related civil rights movements. Organisations across Wales are strong supporters of the LGBT community and have come together to promote the amazing work being done across Wales.

This month Bronglais General Hospital was the first hospital ever within Hywel Dda University Health Board to raise the flag for LGBT + History month. Alongside it the Welsh Dragon flag is also flying.

Various organisations changed their logos across Social Media platforms to support LGBT + History Month.

Knife Angel

The Knife Angel has been created as a National monument against violence and aggression at the British Ironworks Centre in Oswestry and is a memorial to those whose lives have been affected by knife crime. It is a 27ft high sculpture, which has be designed and created single-handedly using over 100,000 knives surrendered and collected in nationwide amnesties in 2015/2016.

The statue was on display in Newtown, Powys during January2020.

Peter Skitt, MWJC Programme Director visited the statue whilst on a visit to Newtown to update local Councillor Joy Jones, Newtown Patients Forum, on the work of the MWJC and the Bronglais Strategy - Delivering Excellent Rural Acute Care.

6 National Eisteddfod 2020 in , Ceredigion

Tregaron in Ceredigion is due to host this year’s National Eisteddfod from 1st – 8th August 2020.

The National Eisteddfod of is the most important of several that are held annually. Its eight days of competitions and performances are considered the largest music and poetry festival in Europe. Competitors typically number 6,000 or more, and overall attendance generally exceeds 150,000 visitors.

The National Eisteddfod is traditionally held in the first week of August, and the competitions are all held in Welsh. However, settings of the mass in Latin are allowed and this has been controversially used to allow concerts featuring international soloists.

The venue is officially proclaimed a year in advance, at which time the themes and texts for the competitions are published. The organisation for the location will have begun a year or more earlier, and locations are generally known two or three years ahead. The Eisteddfod Act of 1959 allowed local authorities to give financial support to the event. Traditionally the Eisteddfod venue alternates between north and ; the decision to hold both the 2014 and 2015 Eisteddfodau in South Wales was thus seen as controversial, but the decision was later reversed and named as host county for 2015. Occasionally the Eisteddfod has been held in England, although the last occasion was in 1929.

Hundreds of tents, pavilions and booths are erected in an open space to create the Maes (field). The space required for this means that it is rare for the Eisteddfod to be in a city or town: instead it is held somewhere with more space. Car parking for day visitors alone requires several large fields, and many people camp on the site for the whole week. The festival has a quasi-druidic flavour, with the main literary prizes for poetry and prose being awarded in colourful and dramatic ceremonies under the auspices of the Gorsedd of Bards of the Island of Britain, complete with prominent figures in Welsh cultural life dressed in flowing druidic costumes, flower dances, trumpet fanfares and a symbolic Hom of Plenty. However, the Gorsedd is not an ancient institution or a pagan ceremony but rather a romantic creation by Iolo Morganwg in the 1790s, which first became a formal part of the Eisteddfod ceremonial in 1819. Nevertheless, it is taken very seriously, and an award of a crown or a chair for poetry is a great honour. The Chairing and Crowning ceremonies are the highlights of the week, and are presided over by the Archdruid. If no stone circle is there already, one is created out of Gorsedd stones, usually taken from the local area. These stone circles are icons all across Wales and signify the Eisteddfod having visited a community. As a cost-saving measure, the 2005 Eisteddfod was the first to use a temporary "fibre-glass stone" circle for the druidic ceremonies instead of a permanent stone circle.

As well as the main pavilion with the main stage, there are other attractions throughout the week. Some are fixtures every year, hosting gigs (Maes B/Llwyfan y Maes/Caffi Maes B). Other fixtures of the maes are the Pabell Lên (literature pavilion), the Neuadd Ddawns (dance hall), the Pabell Wyddoniaeth a Thechnoleg (science and technology pavilion), Maes D (learners' pavilion), at least one theatre, Y Cwt Drama (the drama hut), Tŷ Gwerin (folk house), Y Lle Celf ("the Art Place") and hundreds of stondinau (stands and booths) where groups, societies, councils, charities and shops exhibit and sell. 7 Work, Train, Live in Mid Wales

The pictures on this page say it all; there is no need for words to describe how beautiful Mid Wales is and what it has to offer. It offers all you need to have that perfect work/life balance.

To find your dream role within one of the three Health Boards in Mid Wales, the Welsh Ambulance Service Trust or the Local Authorities please visit their respective websites or social media pages.

Betsi Cadwaladr University Health Board http://jobs.bcu.wales.nhs.uk/

Hywel Dda University Health Board http://jobs.hywelddauhb.wales.nhs.uk/

Powys Teaching Health Board http://jobs.powysthb.wales.nhs.uk/

Welsh Ambulance Trust http://www.ambulance.wales.nhs.uk/Default.aspx?pageId=73&lan=en

Ceredigion County Council https://careers.ceredigion.gov.uk/

Powys County Council https://recruitment.powys.gov.uk/

Gwynedd Council https://diogel.gwynedd.llyw.cymru/ADNSwyddi/rhestr_swyddi.asp?iaith=en

8