Bundle Health Board 24 September 2020
Public Session 10.30am via Webex Conferencing
1 MATERION AGORIADOL A LLYWODRAETHU EFFEITHIOL / OPENING BUSINESS AND EFFECTIVE GOVERNANCE 1.1 10:30 - 20.93 Sylwadau Agoriadol y Cadeirydd / Chair's Introductory Remarks - Mark Polin 1\. To confirm Chair's Action was taken to approve the resetting governance paper following Audit Committee agreement on 28th July 2020 2\. To confirm Chair's Action was taken regarding the appointment of Jo Whitehead to the post of Chief Executive 3. To confirm Chair's Action was taken regarding the remuneration for the former Interim Chief Executive 4\. To confirm Chair's Action to approve the annual report and annual quality statement 5\. To confirm Chair's Action to approve the settlement of a high value claim and instruction of counsel to commence negotiation at a joint settlement meeting 6. To inform the Board that the Minister has agreed an extension to the associate board member position of Director of MHLDS to 6th January 2021 1.2 10:32 - 20.94 Ymddiheuriadau am Absenoldeb / Apologies for Absence 1.3 10:33 - 20.95 Datganiadau o Fuddiant / Declarations of Interest 1.4 10:34 - 20.96 Cofnodion Drafft Cyfarfod y Bwrdd Iechyd a gynhaliwyd yn gyhoeddus ar 23.7.20 er cywirdeb ac adolygu'r Cofnod Cryno o Weithredoedd / Draft Minutes of the Health Board Meeting held in public on 23.7.20 for accuracy and review of Summary Action Log 20.96a Minutes Board 23.7.20 Public V0.03.docx 20.96b Summary Action Log.doc 1.5 10:44 - 20.97 Cofnodion Cyfarfod Ymddiriedolwyr y Bwrdd Iechyd a gynhaliwyd ar 23.1.20 i'w cymeradwyo / Minutes of Health Board Trustees Meeting Held on 23.1.20 for approval 20.97 Minutes Board Trustees 23.1.20 V0.2.docx 1.6 10:46 - 20.98 Mesurau Arbennig / Special Measures - Gill Harris Recommendation: It is recommended that the Board notes this update. 20.98a Special Measures update Board 24.9.20 v2.0.docx 20.98b Special Measures update Appendix_BCUHB improvement framework.pdf 2 10:56 - EITEMAU AR GYFER CYDSYNIAD / ITEMS FOR CONSENT 2.1 20.99 Deddf Iechyd Meddwl 1983 fel y diwygiwyd gan Ddeddf Iechyd Meddwl 2007. Deddf Iechyd Meddwl 1983 Cyfarwyddiadau Clinigwyr Cymeradwy (Cymru) 2008. Diweddaru Cofrestr Meddygon Cymeradwy Adran 12(2) Meddygon i Gymru a Diweddaru Cofrestr Clinigwyr Cymeradwy (Cymru Gyfan) /Mental Health Act 1983 as amended by the Mental Health Act 2007. Mental Health Act 1983 Approved Clinician (Wales) Directions 2008. Update of Register of Section 12(2) Approved Doctors for Wales and Update of Register of Approved Clinicians (All Wales) - David Fearnley Recommendation: The Board is asked to ratify the attached list of additions and removals to the All Wales Register of Section 12(2) Doctors for Wales and the All Wales Register of Approved Clinicians. 20.99 Section 12 _approved by DF.docx 2.2 20.100 Crynodeb Flynyddol o Ymgynghoriadau / Annual Summary of Consultations - Dawn Sharp Recommendation: The Board is asked to note the external consultations responded to by the Health Board and the associated monitoring arrangements. 20.100 Annual Summary of Consultations between April 2019 - March 2020.docx 2.3 20.101 Cylch Busnes Blynyddol y Bwrdd / Annual Board Cycle of Business - Dawn Sharp Recommendation: The Health Board is asked to approve the annual cycle of business 20.101a CoB report.docx 20.101b Board annual cycle of business v2.0.pdf 2.4 20.102 Adroddiad Monitro Blynyddol Gwasanaethau’r Gymraeg 2019-20 / Welsh Language Services Annual Monitoring Report for 2019-20 - Teresa Owen Recommendation: The members of the Board are asked to endorse and approve the attached report, so it can be published and presented to the Welsh Language Commissioner in accordance with the previously agreed timetable (i.e. by the end of September 2020) 20.102a Welsh Language Services Annual Monitoring Report template.docx 20.102b Welsh Language Services Annual Monitoring Report 2019 - 2020 Final.pdf 3 I'W DRAFOD / FOR DISCUSSION 3.1 11:06 - 20.103 Adroddiad Monitro Cynnydd y Cynllun Blynyddol / Annual Plan Monitoring Progress Report - Mark Wilkinson Recommendation: The Board is asked to note the report 20.103a Q2PMR Board - August 2020.docx 20.103b BCU Quarter Two Plan Monitoring Report - August 2020 FINAL v2.0.pdf 3.2 11:16 - 20.104 Adroddiad Ansawdd a Pherfformiad / Quality & Performance Report - Mark Wilkinson Recommendation: The Health Board is asked to scrutinise the report and to consider whether any area needs further escalation to be considered. 20.104a QAP Report Board - August 2020 front cover.docx 20.104b QAP Report Board - August 2020.pdf 3.3 11:31 - 20.105 Adroddiadau Cyllid / Finance Reports - Sue Hill Recommendation: The Board is asked to note the reports 20.105a M04 Finance Report_Board.docx 20.105b M03 Finance Report_Board.docx 3.4 11:46 - 20.106 Adroddiadau Sicrwydd Cadeiryddion y Pwyllgorau a'r Grwpiau Cynghorol / Committee and Advisory Group Chair's Assurance Reports 20.106.1 Audit Committee (Medwyn Hughes) 28.7.20 20.106.2 Quality, Safety & Experience Committee (Lucy Reid) 28.8.20 and 29.7.20 20.106.3 Finance & Performance Committee (Mark Polin) 27.8.20 and 16.7.20 20.106.4 Strategy, Partnerships & Population Health Committee (Lyn Meadows) 13.8.20 20.106.5 Local Partnership Forum (Sue Green) 7.7.20 20.106.1 Chair's Assurance Report Audit 28.07.20 V1.0.docx 20.106.2a Chair's Assurance Report QSE 28.8.20 v1.0.docx 20.106.2b Chair's Assurance Report QSE Jul 20 v1.0.docx 20.106.3a Chair Assurance Report FPC 27.8.20 v1.0.docx 20.106.3b Chair's Assurance Report FPC 16.7.20 v1.0 .docx 20.106.4 Chair Assurance Report SPPHC 13.8..20 v1.0.docx 20.106.5 LPF Advisory Group Report 7.7.20 v1.0.doc 3.5 12:01 - Egwyl / Comfort Break 3.6 12:16 - 20.107 Diweddariad ar yr Uwch Adran Iechyd Meddwl ac Anableddau Dysgu / Mental Health & Learning Disabilities Division Update - David Fearnley/Teresa Owen Recommendation: The Board is asked to: \- Note the report which summarises the recent work on care pathways during the covid\-19 pandemic\, and seek any further assurance; \- Support the efforts to stabilise leadership and management within the Division as a priority; \- Support the MHLD Division to jointly manage external relationships to enable the necessary service changes over the next year of the covid\-19 pandemic \- Support the MHLD Division and management changes within the Mental Health and Learning Disability Division\, as it facilitates partnership work as the next necessary step to achieve wider community resilience \- Support the MHLD Division as it develops and implements evidence based care pathways 20.107 MHLD update_management arrangements and pathways work Final V1.0.doc 3.7 12:31 - 20.108 Adroddiad Diweddaru - achosion COVID-19 Economi Iechyd y Dwyrain / Update report - COVID-19 outbreak East Health Economy - Debra Hickman Recommendation: The Board is requested to note the content of information of this report as an update position for East Health Community. The report details the current situation, background to events, current position and the planned next steps for both the local hospital sites and the wider Health Board. 20.108 Update report - COVID-19 outbreak East Health Economy.docx 3.8 12:41 - 20.109 Rhaglen Frechu Covid-19 / Covid-19 Vaccination Programme - Teresa Owen Recommendation: The Board is asked to receive the briefing and note the work required to deliver a mass COVID-19 vaccination programme if / when a vaccine becomes available. 20.109 COVID-19 Vaccination Programme Planning.docx 4 I'W BENDERFYNU / FOR DECISION 4.1 12:51 - 20.110 Achos Amlinellol Strategol Atgyfnerthu Meddygaeth Niwclear / Nuclear Medicine Consolidation Strategic Outline Case - Adrian Thomas Recommendation: The Board is asked to approve the Business Case for submission to Welsh Government. 20.110a Nuclear Medicine SOC Board Coversheet Sept 20.docx 20.110b DRAFT SOC V0.24 Board Sept 2020.docx 20.110c Appendix F SOC Cost Forms 24.06.2020.xlsx 20.110d Appendix G Revenue v.5.xlsx 20.110e Board Nuclear Medicine SOC Companion Slides v3.pptx 5 12:56 - ER GWYBODAETH / FOR INFORMATION 5.1 20.111 Crynodeb o Fusnes Heb y Cyhoedd y Bwrdd i gael ei adrodd arno'n gyhoeddus / Summary of Private Board business to be reported in public 20.111 Private session items reported in public.docx 5.2 20.112 Adroddiad Blynyddol Arolygiaeth Gofal Iechyd Cymru / Healthcare Inspectorate Wales Annual Report - Debra Hickman 20.112a HIW Report annual report_overview.docx 20.112b HIW Annual Report.pptx 5.3 20.113 Fforwm Cymru Gyfan a Fforymau Eraill / All Wales and Other Forums 5.3.1 20.113.1 Cofnodion Cymeradwy y Fforwm Arwain Cydweithredol 15.1.20 / Collaborative Leadership Forum Approved Minutes 15.1.20 20.113.1 Approved Minutes of CLF 150120 v1.docx 5.3.2 20.113.2 Pwyllgor Gwasanaethau Ambiwlans Brys - Cofnodion wedi'u cadarnhau 14.7.20,12.5.20 Crynodeb o'r Prif Faterion 8.9.20, 14.7.20 / Emergency Ambulance Services Committee Confirmed Minutes 14.7.20, 12.5.20 Summary of Key Matters 8.9.20, 14.7.20 20.113.2a EASC confirmed minutes 14.7.20.doc 20.113.2b EASC confirmed minutes 12 May 2020.doc 20.113.2c EASC Chair's Summary 8.9.20.docx 20.113.2d EASC Chair's Summary from 14 July 2020.docx 5.3.3 20.113.3 Nodiadau Gwybodaeth Cydbwyllgor Gwasanaethau Iechyd Arbenigol Cymru 8.9.20 a 14.7.20 / Welsh Health Specialised Services Committee Joint Briefings 8.9.20 and 14.7.20 20.113.3a WHSCC JC Briefing 8.9.20 v1.0.pdf 20.113.3b WHSCC JC Briefing 14.7.20 v1.0.pdf 5.3.4 20.113.4 Adroddiad Sicrwydd Pwyllgor Partneriaeth Cydwasanaethau / Shared Services Partnership Committee Assurance Report 23.7.20 20.113.4 SSPC Assurance Report 23 July 2020.doc 6 13:01 - MATERION I GLOI / CLOSING BUSINESS 6.1 20.114 Dyddiad y Cyfarfod Nesaf / Date of Next Meeting Joint Board meeting with Community Health Council 10.00am 15th October 2020 BCU Health Board meeting 9.30am 12th November 2020 7 20.115 Heb y Wasg a'r Cyhoedd / Exclusion of Press and Public Resolution to Exclude the Press and Public - ''That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest in accordance with Section 1(2) Public Bodies (Admission to Meetings) Act 1960.''
1.4 20.96 Cofnodion Drafft Cyfarfod y Bwrdd Iechyd a gynhaliwyd yn gyhoeddus ar 23.7.20 er cywirdeb ac adolygu'r Cofnod Cryno o Weithredoedd / Draft Minutes of the Health Board Meeting held in public on 23.7.20 for accuracy and review of Summary Action Log 1 20.96a Minutes Board 23.7.20 Public V0.03.docx
Minutes Health Board 23.7.20 Public V0.03 1
Betsi Cadwaladr University Health Board (BCUHB) Minutes of the Health Board meeting held in public session on 23.7.20 Via WebEx Conferencing (livestreamed) Present: Mark Polin Chair Cheryl Carlisle Independent Member John Cunliffe Independent Member Simon Dean Interim Chief Executive Morwena Edwards Associate Board Member – Director of Social Services David Fearnley Executive Medical Director Sue Green Executive Director of Workforce & Organisational Development (OD) Gill Harris Executive Director of Nursing & Midwifery / Deputy Chief Executive Jackie Hughes Independent Member Medwyn Hughes Independent Member Eifion Jones Independent Member Lyn Meadows Independent Member Teresa Owen Executive Director of Public Health Lucy Reid Vice Chair Dawn Sharp Acting Board Secretary Chris Stockport Executive Director of Primary & Community Services Adrian Thomas Executive Director of Therapies & Health Sciences Helen Wilkinson Independent Member Mark Wilkinson Executive Director of Planning & Performance Ffrancon Williams Chair of Stakeholder Reference Group
In Attendance: Kate Dunn Head of Corporate Affairs (for minutes) Eric Gardiner Finance Director (Provider Services) Michael Rees Vice Chair of Healthcare Professionals Forum Llinos Roberts Executive Business Manager (Chair’s Office) Marian Wyn Jones Board Adviser
Agenda Item Discussed Action By 20.65 Chair's Introductory Remarks
20.65.1 The Chair extended a warm welcome to all attendees and observers of the meeting, highlighting that for the first time the public session was being live streamed. He reported that the current platform did not enable simultaneous translation however he would welcome bilingual contributions from any member.
20.65.2 The Chair went on to extend his personal thanks and appreciation, and that of the Board, to all those members of staff who had been working tirelessly throughout Minutes Health Board 23.7.20 Public V0.03 2 the Covid-19 pandemic. He made reference to the current prevalence of the virus in Wales and to the latest progress and performance in terms of testing.
20.65.3 The Chair informed members that following a recruitment process for the substantive Chief Executive post, three candidates had been shortlisted with interviews scheduled during August. He wished to record his thanks to Simon Dean who continued to support the Health Board on an interim basis.
20.65.4 The Chair then reported on a range of Chair's Actions that had been undertaken. These being: The approval of the awarding of the Llys Meddyg Contract to Dr MB and Dr MT of Corwen House Surgery, Penygroes and to approve the provision of limited financial support to enable the new contractor to take over the contract and merge the provision of GMS services in Penygroes from 1st September 2020 Approval of the draft Q1 plan to support service delivery during the Pandemic Approval of the purchase of 52 Dräger Perseus invasive ventilation machines to meet the anticipated demand of COVID patients requiring ventilation in the event of the anticipated surge based on current predicted modelling
20.66 Apologies for Absence
20.66.1 Noted for Nicky Callow, Gareth Evans (Michael Rees deputising as Healthcare Professionals Forum Vice Chair) and Sue Hill (Eric Gardiner deputising)
20.67 Declarations of Interest
20.67.1 Ffrancon Williams and Eifion Jones both declared an interest in item 20.73 (Test, Trace and Protect Update) in that they had active involvement in the testing unit located at Parc Menai, Bangor.
20.68 Draft Minutes of the Health Board Meeting held in public on 14 May 2020 and 21 May 2020 for accuracy and review of Summary Action Log
20.68.1 The minutes of the two meetings held in public were agreed as an accurate record.
20.68.2 In terms of the summary action log, an update was provided for inclusion against the single open action regarding workforce policies around raising concerns. There were other points raised under matters arising as follows: Action 20/39.4 recovery arrangements – that a paper capturing the learning from CS the pandemic would be shared at a future meeting. Action 20/63.16 vascular services – that the task and finish group had now met twice and had received detailed presentations around antimicrobial prescribing and amputation, with an audit of the latter planned which would include issues of Minutes Health Board 23.7.20 Public V0.03 3
consent. In terms of foot care the Executive Medical Director reported that there were positive examples of professional engagement in developing this pathway.
20.69 Mental Health Act 1983 as amended by the Mental Health Act 2007. Mental Health Act 1983 Approved Clinician (Wales) Directions 2008. Update of Register of Section 12(2) Approved Doctors for Wales and Update of Register of Approved Clinicians (All Wales)
20.69.1 It was resolved that the Board ratify the list of additions and removals to the All Wales Register of Section 12(2) Doctors for Wales and the All Wales Register of Approved Clinicians.
20.70 Documents Signed Under Seal 1.1.20 to 16.7.20
20.70.1 It was resolved that the Board note the information presented.
20.71 Annual Assurance Report on compliance with Nurse Staffing Levels (Wales) Act
20.71.1 The Executive Director of Nursing & Midwifery presented the paper which had also been presented to the Quality, Safety & Experience (QSE) Committee. The paper set out areas for compliance together with those areas where the organisation had not managed to achieve the desired staffing levels which had potential consequences of harm. A range of planned audit work had not been undertaken due to the Covid-19 pandemic, and there were known gaps in staffing levels due to staff being redeployed. The Board were assured that officers were working closely with colleagues and partners and there were some excellent examples of joint initiatives, for example with Bangor University and a positive take up of posts by student nurses. The Executive Director of Therapies and Health Sciences also took the opportunity to acknowledge that therapy and other students had also taken up temporary registration posts to support the pandemic work within the Health Board.
20.71.2 In response to a question from the Chair, it was confirmed that the series of reviews set out in the paper had commenced and learning would be shared in due course. The Chair also made reference to the increase in hospital acquired pressure damage at Ysbyty Glan Clwyd (YGC) and whilst acknowledging this was not thought to be linked to staffing levels, enquired whether the increase was of concern. The Executive Director of Nursing and Midwifery confirmed that every such incident was reviewed with the impact of staffing levels being one of the factors considered. In terms of YGC specifically she indicated that a safety review was being undertaken across the site.
20.71.3 The Chair noted there were separate recommendations within the paper and it was resolved that the Board note the report and support the next steps regarding: Targeted focus of Nurse recruitment including resource to support campaigns both locally and regionally Exploration of a clinical fellowship programme for nurses Minutes Health Board 23.7.20 Public V0.03 4
Ongoing analytics regards leavers and ‘what could we do better?’ Review of implementation of new roles to support the nursing recruitment pipeline Expansion of harm avoidance collaborative to assist in reducing variation Development of a nurse performance dashboard as a further monitoring and assurance tool in real time Further analysis of deviations from previous reporting periods
20.72 Covid-19 Pandemic Update
20.72.1 The Executive Director of Primary & Community Care delivered a presentation, a summary of which was as follows: Overview of the pandemic – highlighted that Covid-19 has been the biggest mobilisation of resources in modern day NHS and will impact on health care and daily life for some time to come Clinical considerations – highlighted that medical knowledge continued to develop particularly around ventilator support, but that testing and diagnostic challenges remained. Work around a vaccination was gaining momentum but a number of uncertainties remained. North Wales data – numbers of tests completed and confirmed cases. The confirmed cases were also displayed by category and did demonstrate a reduction across all Local Authority areas. In-patient activity showed a reduction generally but a recent increase in the Wrexham area which was being managed appropriately. Deaths recorded in line with Office of National Statistics were continually falling in North Wales. Hospital Acquired Infections – this remained an area of challenge within the Health Board. Infection Prevention teams were focused on dealing with outbreaks and ensuring that staff were equipped with Personal Protective Equipment (PPE). Infection reviews were planned and all hospital sites were fully on board with the need to undertake these. Temporary Hospitals – it was pleasing that the additional capacity had not yet been utilised, and revised planning scenarios for their use were now being undertaken. Moving forwards – the organisation needed to ensure a balance between returning to normal activity and being able to react and respond to any upturn in Covid-19 activity The Executive Director of Primary & Community Care concluded that the collaborative work evidenced throughout the pandemic had been very positive, and that public engagement remained very important in terms of everyone following public health guidance and using services appropriately.
20.72.2 A discussion ensued with members raising a range of points. In response to a question whether there should be wider testing for staff and a requirement to wear face coverings, the Executive Director of Primary & Community Care agreed that spare testing capacity should be utilised for asymptomatic staff and that this was in line with the national testing strategy. In terms of face coverings he suggested these would be best targeted on front line areas. The Executive Director of Nursing & Midwifery added that where there were outbreaks on wards, all patients on those wards were tested and additional staff deployed there. The Executive Director of Minutes Health Board 23.7.20 Public V0.03 5
Workforce & OD remarked that maintaining staff confidence was key, particularly those who were returning to work following shielding.
20.72.3 The Chair indicated he had requested a review of hospital transmissions and was concerned about an increase at the Wrexham Maelor site in particular. The Executive Director of Public Health confirmed that the Outbreak Control Team (OCT) were very much aware and involved, with the situation under surveillance and control measures being implemented.
20.72.4 A comment was made that an increased awareness of false negative tests would be helpful, and that the range of symptoms associated with Covid-19 could be unhelpful in terms of prioritising tests. The Executive Director of Primary & Community Services concurred this was a valid point, and noted that clinical teams had to date been broad in their interpretation of those individuals needing a test. In addition a question was asked regarding the Board’s approach to the known impact of Covid-19 on Black Asian & Minority Ethnic (BAME) individuals. The Executive Director of Workforce & OD confirmed that as part of the Board’s equality portfolio appropriate risk assessments were being undertaken in a focused way with BAME colleagues. Impact assessments were being revised based on learning to support those currently shielding in particular.
20.72.5 The point was made that there was an understandable nervousness amongst patients in accessing health services and that the QSE Committee was to receive a paper on essential services on 29th July 2020.
20.72.6 A member enquired what the available data and analysis showed around the nature of the virus in terms of the likelihood of a second wave for North Wales. The Executive Director of Primary & Community Services indicated that a second wave was anticipated and that the current reduction in infection rates was a direct result of lockdown. As lockdown restrictions were lifted and previous ways of life returned to there would undoubtedly be a rise in transmission rates although this may be more sporadic and localised. The role the public had to play in minimising the risk of a second spike was critical, and therefore the Board had a specific area of work underway in terms of engaging with the public.
20.72.7 In response to a question regarding flu vaccination supply and whether the Board was confident it would be able to increase the uptake this year, the Executive Director of Primary & Community Services responded that community vaccination was dependent on the companies having the necessary supply chain. Generally there was additional capacity planned for and he was reasonably confident that the demand could be matched for flu vaccination this year. He reiterated the need to focus on ensuring all those eligible for the flu vaccination were offered it and encouraged to take it up.
20.72.8 The Chair summarised that the collaborative work with partners evident throughout the pandemic was impressive together with how the organisation had responded internally with the flexibility and sensitivity of front line staff being commendable. He felt that the role of the public in following guidance and accessing health services appropriately and safely was vital, and that ensuring winter preparedness was a key focus for the Board. Minutes Health Board 23.7.20 Public V0.03 6
20.73 Test, Trace & Protect (TTP) Update
20.73.1 The Executive Director of Public Health presented the paper, noting that this was the first opportunity to update the Board in public session although TTP updates had been provided at other opportunities and through a line of reporting to the Strategy, Partnerships & Population Health (SPPH) Committee and the Recovery Coordination Group (RCG). She felt this reflected how quickly the programme had needed to be established and the fast moving pace of development.
20.73.2 The Executive Director of Public Health highlighted that the TTP programme would need to continue even if a vaccine for Covid-19 was found and that the “trace” element was likely to develop more as autumn approached. Capacity had increased with up to 1400 tests having been undertaken in the past week, however, turnaround times for results were still proving challenging. It was confirmed that antibody testing was also part of the testing strategy and organisations were learning about immunity as part of that programme.
20.73.3 In terms of contact tracing work it was reported this was done at a local level with the more complex cases being discussed at the regional cell. Performance reporting was improving as was the ability to evidence pace and activity. Overall the numbers of confirmed cases were reducing but the programme currently remained focused on outbreaks associated with local areas eg; Anglesey. The Executive Director of Public Health was pleased to report that funding had been confirmed by Welsh Government (WG) which would allow the Health Board to tailor the TTP to local needs. In summary she concluded the programme was working well and acknowledged the need to protect the most vulnerable, focus on learning, and to build on existing assets.
20.73.4 A discussion ensued with members raising a range of points. In response to a question around the selection process for antibody testing and the level of confidence in this element of the programme, the Executive Director of Public Health confirmed that guidance from the Chief Medical Officer had been followed. She acknowledged that not enough was known about immunity from antibody status which did put limitations on some of the work. The Executive Director of Therapies & Health Sciences added that there had been very close working with all partners in terms of identifying relevant cohorts for antibody testing and that guidance was awaited on the next stage.
20.73.5 An explanation was sought as to why Public Health Wales (PHW) had decided against placing the ‘Starlet’ machine in North Wales. The Executive Director of Public Health apologised that she was not able to provide this explanation and the TO Chair asked that this be sought from PHW. Secondly a question was raised as to the timeframe for the ‘Nimbus’ machine to be operational in Ysbyty Gwynedd (YG) and TO the Executive Director of Public Health would establish this and feed back to the member concerned. Minutes Health Board 23.7.20 Public V0.03 7
20.73.6 In response to a comment around the public perception of turnaround times for testing the Executive Director of Public Health felt that in general the position for testing of in-patients was good, but that there was a need to establish community capacity going forward given the two large incidents. She undertook to write to PHW TO by close of play on the 24th July 2020.
20.73.7 A member enquired as to the level of confidence that the programme was engaging with the right stakeholders and was fully involving the community and business sectors. The Executive Director of Public Health acknowledged that this element had not been the top priority when initially setting up the service and that rapid improvement was now needed. She felt that local signposting within the TTP programme was key together with the role of social prescribing.
20.73.8 General comments were made at how well the TTP programme had been established and that local outbreaks had been managed well with evidence of good partnership working with Local Authorities.
20.73.9 It was resolved that the Board: 1. Reflect on the TTP arrangements across the region 2. Note the update and the formal reporting route through the SPPH Committee.
20.74 Quarter 1 Plan Monitoring Report
20.74.1 The Chair informed members that he had already called for more detail on a number of areas within the paper following discussion at the Finance & Performance (F&P) Committee, these being stroke, eye-care, essential services start-up and pathways.
20.74.2 The Executive Director of Planning & Performance presented the report, reminding members that the Board was now planning on a quarterly basis. He highlighted that the report summarised progress against actions within the plan to the end of Q1 via a self-assessment process by the lead Executive with scores being reviewed by the Executive Team as a whole.
20.74.3 A discussion ensued with members raising a range of points. It was noted that the stroke rehabilitation action was rated as amber and a member was concerned that this had been identified as an essential service for which demand was likely to increase due to Covid-19. The Executive Director of Primary & Community Services responded that the amber rating had been chosen not necessarily because insufficient progress had been made, but as a result of the impact of Covid-19. He was now confident that the teams were all but there in terms of stroke. With regards to harm reduction, the Executive Director of Planning & Performance reported that a risk classification process had been utilised and teams were now looking to see how performance reporting could be developed on a risk based perspective not purely on the numbers of patients waiting. The Executive Director of Nursing & Midwifery added that clinicians were working together to prioritise patients by risk. The Vice Chair noted the importance of having specific and measurable actions. The Executive Minutes Health Board 23.7.20 Public V0.03 8
Director of Planning & Performance felt that the Q2 plan was far more developed in this regard. The Chair noted that whilst the report was a result of an executive self- assessment process, the Board was always able to seek and request more detail on areas of concern.
20.74.4 It was resolved that the Health Board note the report.
20.75 Quality & Performance Report
20.75.1 The Executive Director of Planning & Performance presented the report, noting that it had also been scrutinised by the F&P Committee. He highlighted that the focus and scrutiny of performance had been paused during Covid-19 however the organisational accountability remained the same. RAG performance ratings had not been included within the paper as it would not be meaningful to compare current performance during the pandemic to that of 12 months ago. It was noted that the report included a range of indicators on Covid-19 and it was hoped to be able to develop this area of the report further in terms of the TPP programme and turnaround times. The Executive Director of Planning & Performance indicated that the report included detail on essential services, with planned care delivery being significantly lower than normal as a result of reduced levels of referrals. Waiting times were worsening month on month and there was a clear need to start to return safely to the provision of essential services. In terms of unscheduled care there was a notable increase in demand compared to when lockdown was introduced.
20.75.2 A discussion ensued with members raising a range of points. In response to a question regarding the restarting of some key screening services such as bowel, cervical and breast, it was confirmed these would recommence during Q2. They did not feature specifically in the Q2 plan as they were led by national bodies and it was not the Board’s responsibility to deliver them. There would however be challenges for the organisation’s diagnostic services in terms of responding to the results of those screening programmes. The Executive Director of Public Health added that it was important to note that not all screening had been paused, and she acknowledged it was a core element of maintaining population health.
20.75.3 A member noted reference within the paper to Mental Health Measure outcome data being “problematic” and she enquired as to the timeframe for addressing this. The Executive Director of Planning & Performance undertook to look MW into this outside of the meeting and to feed back.
20.75.4 A conversation took place regarding the correlation between Q2 performance and the associated action plan and the Chair asked whether the construction of the action plan would be in keeping with the concerns that had been identified. The Executive Director of Planning & Performance stated that the performance report focused on the full range of indicators which were based around the quadruple aim. He believed it did align to the action plan but acknowledged the need to test out the level of detail on a case by case basis. Minutes Health Board 23.7.20 Public V0.03 9
[Miss T Owen left the meeting]
20.75.5 In terms of unscheduled care the Chair noted that there had been changes in practice put in place during the pandemic, and asked whether elements would be embedded going forward to manage the increasing numbers of attendances that were now being seen. The Executive Director of Nursing & Midwifery confirmed that opportunities for learning from Covid-19, including the experiences of primary care colleagues, were being utilised. The Unscheduled Care Board would be working with partners and stakeholders in terms of winter preparedness and recent senior appointments would further support the maintenance of performance across secondary and primary care.
20.75.6 In response to a question around diagnostic waiting times the Executive Director of Therapies & Health Sciences reported that access to endoscopy and radiology had been particularly challenging with a reduction in capacity due to social distancing requirements and the redeployment of some staff. He also referred to the potential for insourcing via utilisation of temporary hospitals which would be taken forward however the key barrier would be the associated staffing requirements. The Vice Chair of the Healthcare Professionals Forum made reference to the need for better IT support and equipment provision to provide solutions for clinicians to work remotely.
20.75.7 With regards to planned care and the pausing of some elective services the Executive Director of Nursing & Midwifery confirmed that services had been maintained for high risk patients, including through making use of the Spire Hospital. She added that a number of pathways had now been developed for planned care which were clinically led. A number of clinicians were now travelling to undertake surgery at alternative sites to ensure patients were given an option of travelling to receive the most appropriate treatment. It was highlighted this meant that patients were not necessarily seen in chronological order. The Executive Director of Nursing & Midwifery referred to the prioritisation of urology and that the dashboard had been re-engineered to look more holistically at care.
20.75.8 The Executive Director of Workforce & OD reported that there had been an improvement in June in terms of sickness absence. The staff well-being hubs continued to be maintained and developed as the pandemic moved on and there was an intention to expand the ways in which staff could access the services offered. With regards to working from home she stated that this would continue where appropriate until staff could be safely welcomed back to their workplaces, recognising the need to sustain an agile workforce whilst protecting physical and mental health and wellbeing.
20.75.9 It was resolved that the Board: 1. Note the revised format of the report. 2. Note that performance management had been formally stood down during Covid- 19 and therefore the information provided was management information that had Minutes Health Board 23.7.20 Public V0.03 10 been scrutinised via the Finance & Performance and Quality, Safety & Experience Committees of the Board.
20.76 Finance Report Month 1
20.76.1 It was resolved that the report be noted.
20.77 Finance Report Month 2
20.77.1 The Finance Director (Provider Services) presented the paper which provided a briefing on the financial performance of the Health Board as at May 2020 and which reflected the financial impact of the continuing response to the Covid-19 pandemic. He explained that the original forecast did not take into account the impact of Covid- 19 and as a consequence the Board was reporting a balanced position predicated on the assumption that WG will fund the impact of the pandemic. This was currently being stated as a financial risk as this funding had not yet been formally notified. Members’ attention was drawn to section 3.3 which set out the impact of Covid-19 in terms of expenditure, and it was highlighted there were elective care savings of £2.9m. The Finance Director (Provider Services) went on to explain that in terms of contractual arrangements, the Board had agreed payment for block values even where providers were not currently undertaking activity, and that discussions were now taking place around reintroducing activity. He concluded by assuring members that in terms of financial governance, the respective rules around Covid-19 were being followed.
20.77.2 A discussion ensued with members raising a range of points. The Vice-Chair of the F&P Committee enquired as to what was being done to bridge the savings gap. The Finance Director (Provider Services) accepted that savings performance was low and whilst plans were being developed for consideration by the F&P Committee it was unlikely that the entire gap would be filled. Once clarity was received from WG on the funding of Covid-19 costs the forecast would be adjusted for year-end. In response to a question regarding the additional Information Technology (IT) resources that had been required as a result of Covid-19, the Finance Director (Provider Services) confirmed that this had been factored in in terms of staffing and that any costs for systems and software that were directly attributed to the pandemic should be centrally funded. The Executive Director of Workforce & OD added that as part of the recovery work it was recognised that there were a number of opportunities from the pandemic that should be retained and that one key one was around the use of IT to support accessibility for patients and new ways of working for staff.
20.77.3 The Chair noted that the Interim Chief Executive as the Accountable Officer had written to WG regarding the Board’s expenditure. He enquired whether finance colleagues were monitoring the consideration of future use of temporary hospitals, and it was confirmed that there was finance representation in place to ensure that expenditure was justified and represented value for money. The Executive Director of Workforce & OD reported that the additional expenditure relating to additional staff Minutes Health Board 23.7.20 Public V0.03 11 joining the workforce had been tracked in order to identify what was Covid-19 related and what was not. An ongoing governance review would identify whether alternative solutions could be found on a more sustainable footing.
20.77.4 The Chair asked that the Digital Information & Governance Committee JC/DF examine the capital programme and transformation schemes to ensure that the Board had sufficient resources in terms of finance and people to deliver these, and to highlight any gaps back to the Board.
20.77.5 It was resolved that the report be noted.
20.78 Committee and Advisory Group Chair's Assurance Reports
20.78.1 The Audit Committee Chair presented the report of the meeting held on the 29th June 2020. He highlighted – a discussion around Covid-19 presenting a significant risk to the financial position and the ability to progress business as usual; the approval in principle of a revised Risk Management Strategy; that whilst the internal audit plan had not been completed in full, sufficient audit work had been undertaken to provide an overall opinion of reasonable assurance; progress had again been suspended in terms of clinical audit.
20.78.2 The Quality, Safety & Experience (QSE) Committee Chair presented a combined report for the meetings held on 17th March 2020, 5th May 2020 and 3rd July 2020. She highlighted – that during the height of the pandemic the QSE Committee had continued to meet but with more focused agendas; the reduction in referrals and access to services was a key concern for the Committee; avoidable infections was due to be an agenda item for an additional meeting of the Committee on 29th July 2020.
20.78.3 The Finance & Performance Committee Chair presented the report of the meeting held on 4th June 2020, noting there had been a subsequent meeting on 16th July 2020.
20.78.4 The Remuneration & Terms of Service Committee Chair presented the report of the meeting held on 15th June 2020.
20.78.5 The Strategy, Partnerships & Population Health Committee Chair presented the report of the meeting held on 9th June 2020. She highlighted – that the Committee had requested further reports on emergency preparedness; that Committee involvement in the production of Q1 and Q2 plans had been lighter than usual and that the Committee expected to be more heavily involved from Q3 onwards.
20.78.6 The Charitable Funds Committee Chair presented the report of the meeting held on 25th June 2020. She highlighted – that the fundraising and finance teams had Minutes Health Board 23.7.20 Public V0.03 12 worked exceptionally hard to make funds available during the pandemic; that a staff wellbeing fund had been established around Covid-19 specifically; that any requests for funding had been approved via the required quorum; that a key risk had been identified around proposals to introduce a staff lottery. The Health Board Chair wished to commend the practical support from the Awyr Las charity during the pandemic.
20.78.7 The Digital Information & Governance Committee Chair presented the report of the meeting held on 19th June 2020. He highlighted – that the Committee wished to record its thanks to teams for their rapid response during the pandemic in terms of identifying and applying information governance solutions; that since the last meeting there had been another national system failure in south Wales which raised local concerns around the reliability of national infrastructure.
20.78.8 The Stakeholder Reference Group Chair presented the report of the meeting held on 22nd June 2020. He highlighted – the importance of communication and partnership working; the essential role of the third sector and that the co-ordination of those services was complex with many being stretched in terms of resources as a result of Covid-19.
20.78.9 The Vice Chair of the Healthcare Professionals Forum presented the report of the meeting held on 19th June 2020. He highlighted - the importance of keeping the workforce engaged and up to date; that positive outcomes had been noted from moving away from traditional meetings; the need to ensure health and well-being support was provided to staff on an ongoing basis. The Executive Director of Therapies & Health Sciences apologised that the member report from Professor Michael Rees had not been noted within the report.
20.79 Vascular Services : Update on Independent Review
20.79.1 The Executive Medical Director presented the paper which provided an update on the work undertaken to date by the Vascular Task and Finish Group relating to the external review of the service. He confirmed that the Group had met twice to date and had been well attended. It had been agreed at the first meeting to apply for an external review from the Royal College of Surgeons (RCS) and Chair’s Action had been taken in between meetings to submit this to the RCS with the aim of work being able to commence in the early autumn. Members’ attention was drawn to the scope of the review and that the Group had commenced work relevant to antibiotic prescribing and amputation. The Executive Medical Director felt that overall there was an increasing level of positive engagement, and that regular reporting would take place to the QSE Committee with WG also keen to be kept abreast of progress.
20.79.2 A discussion ensued with members raising a range of points. In response to a question from the Chair regarding patient involvement, the Executive Medical Director stated that the membership of the Group would continue to be reviewed to Minutes Health Board 23.7.20 Public V0.03 13 ensure there was adequate representation. He confirmed that the current representative was very proactive and their contribution to the Group was very positive. In addition a visit by the Community Health Council to the service would shortly take place. With regards to securing vascular pathways the Executive Medical Director responded that this was being prioritised but there would be a need for project management support. The Chair enquired as to the timescale for the independent review and the Executive Medical Director said he would expect to see a desk top review commence in September followed by site visits. In response to a further question he confirmed it would be as comprehensive as possible to also address the antimicrobial issue.
20.79.3 A member acknowledged that there was obviously a lot of work being undertaken but she felt that the report itself was lacking in terms of ensuring timely status updates against the actions. She felt that given the public interest in the review, the Board should take every opportunity to demonstrate progress and give as much assurance to the public and partners as possible. The Executive Medical Director accepted that the report could be improved in order to present progress in a more timely manner. The Chair asked that the Executive Medical Director pick up DF with the Chair of QSE Committee how the independent review was to be commissioned and how the implementation plan would be further developed and monitored, before sharing with full Board.
20.79.4 It was resolved that the Health Board note the progress made by the Vascular Task and Finish Group.
20.80 Healthcare Inspectorate Wales (HIW) : National Review of Maternity Services
20.80.1 The Executive Director of Nursing & Midwifery presented the report which set out the background to the HIW National Review of Maternity Services across Wales and provided the Board with assurance in relation to progress made within BCUHB. She indicated that the report detailed the Board’s approach in terms of both acute and community services and also set out the reporting and assurance mechanisms. She added that the QSE Committee were looking at broader assurance mechanisms around maternity services.
20.80.2 A discussion ensued with members raising a range of points. A member made reference to current issues within maternity services in the Shrewsbury & Telford Hospital NHS Trust and asked how BCUHB could learn from their experiences. The Executive Director of Nursing & Midwifery confirmed that some north Wales residents were affected by this issue, and all relevant reports would be reviewed to ensure any similar gaps were closed in BCUHB, and that a learning opportunity around human factors had recently been identified. She added that with regards to the maternity services in Cwm Taf Morgannwg Health Board, BCUHB had completed its own self-assessment which would be discussed at QSE Committee in August. Minutes Health Board 23.7.20 Public V0.03 14
20.80.3 It was resolved that the Board receive the report for information and to note for assurance: The action progress made by the Health Board in response to inspections undertaken during phase 1 and phase 2 of the review, and that no actions were overdue The arrangements in place for coordination of the Board member interviews in phase 2 The readiness of the Health Board to coordinate the patient engagement and community clinic inspections expected in phase 2
20.81 Quarter 2 Plan
20.81.1 The Executive Director of Planning & Performance presented the paper which described what the Health Board aimed to achieve within Q2 (1st July to 30th September 2020), and which also had been constructed to give an indication of what would also follow in later quarters. He referred to orthopaedics as an example in that Q2 gave a commitment to complete a recovery plan, Q3 would focus around developing a clinical network, and Q4 reviewing and refreshing the business case. The Executive Director of Planning & Performance confirmed that the Q2 Plan had been submitted to WG as required on 3rd July 2020 and feedback was expected within the next week to ten days.
20.81.2 With regards to the specific action planning documents that underpinned the Q2 Plan, the Executive Director of Planning & Performance confirmed that a draft had been shared with Board members as an internal working paper. He confirmed that it had been supported in principle by the Executive Team with some changes to be made around - the reporting of various elements through the Committee structure; clarity of mental health reporting; and the approach for primary care reporting i.e. strategic matters to SPPH Committee, performance and finance matters to F&P Committee and quality and safety matters to QSE Committee. The Executive Director of Planning & Performance confirmed that a refreshed version of the action MW plans would be shared within the public domain.
20.81.3 The Executive Director of Planning & Performance concluded by assuring members that the organisation should be clear on the key areas within the Q2 Plan namely – the ability to maintain an agile response to Covid-19; provision of a safe environment in which to deliver healthcare during Covid-19; the need to reintroduce services safely which would be supported by the TTP programme and risk stratification; progressing the Digital Health Record.
20.81.4 A discussion ensued with members raising a range of points. The Chair stated that the Board needed to have confidence in the plan itself and also be assured around the ability for it to be delivered. He was therefore disappointed to learn that the action plan had not yet been fully signed off by the Executive Team, and he sought assurance that the material content of the action plan could deliver the Q2 plan itself. Furthermore he felt it was unacceptable in terms of good governance that the organisation was still developing an action plan so far into the quarter, and he would be looking to identify some time for the Board to consider the Q3 plan at 22nd Minutes Health Board 23.7.20 Public V0.03 15
September 2020 workshop and therefore some way in advance of Q3 commencing. MW/DS The Executive Director of Planning & Performance assured members that the material content of the action plan was supported by the Executive Team and that the changes were minor and related to presentational aspects before the document could be placed in the public domain. He accepted the point regarding making time to discuss the Q3 plan.
20.81.5 The Vice Chair felt that the plan should make it clearer that demand and capacity was far greater than just hospital beds and needed to be more visible across the whole system. She also felt that the action plan contained very high level actions that weren’t sufficiently specific and measurable - for example those around stroke services and the well-being hubs. Finally she suggested that the mental health actions required updating as they didn’t correlate with recent discussions. The Executive Director of Planning & Performance accepted that the plan could be more integrated and clearer around capacity planning, and he suggested that in terms of stroke and well-being hubs there was more detail in the output column. The Executive Director of Primary & Community Services accepted that the suitability and meaningfulness of the narrative could be improved upon, however, he was content that there was clarity amongst the Executive Team as to what the organisation needed to do. The Executive Medical Director added that a key learning point for the Mental Health & Learning Disabilities Division was to reflect on sustaining safe services, keeping people safe, protecting the most vulnerable and engaging with stakeholders including the CHC, staff and Local Authorities.
20.81.6 The Vice Chair of the HPF was aware of work ongoing around the redesign of accommodation to accommodate social distancing and enquired whether this had been incorporated into the plan in terms of Health & Safety work. The Executive Director of Planning & Performance noted that bed modelling and hospital zoning work would have an impact and would need to be evidenced within the plan as it provided a challenging context within which the Board would need to operate. The Executive Director of Workforce & OD added that the Board had recently communicated that it would continue to advise staff to work from home where they were able to do so, and that reducing footfall on the hospital sites was key.
20.81.7 The Chair asked that the team would need to ensure an appropriate timeline for Q3 planning taking into account the lessons learned from Q2. The Executive Director of Planning & Performance confirmed this was recognised and understood.
20.81.8 It was resolved that the Board: 1. Receive and approve the draft Q2 plan to support service delivery during the pandemic with a caveat that whilst recognising the work that had been undertaken to date and the tight timescales that were being worked to, the Board would not in future entertain receiving a plan that was still being worked upon nor which did not adequately reflect comments that had already been fed in by Independent Members. 2. Provide feedback as to what they would wish to see covered in the Q3 plan through dialogue and comment outside of the meeting.
20.82 Risk Management Strategy Minutes Health Board 23.7.20 Public V0.03 16
20.82.1 The Executive Director of Nursing & Midwifery presented the paper which shared the new Risk Management Strategy and Policy as agreed by the Audit Committee and which proposed a movement from a 5 Tier to 3 Tier risk management model. This had been tested in the East and was well received by teams as being less complicated and easier to understand in terms of escalation. There was an ongoing process to align the divisional teams to the new 3 Tier risk principle and support had been offered from the corporate team. Members’ attention was drawn to the concern of the Audit Committee around the ability to implement the Strategy and Policy by 1st October 2020 due to the impact of Covid-19, and that since the Audit Committee had met a series of Board Workshops had been arranged around the risk agenda.
20.82.2 A discussion ensued with members endorsing the general direction of travel but raising a range of points. A member stated that he had previously raised a concern that a key element of risk was the ability of staff to appropriately define the impact, likelihood and inherent risk but this did not appear to have been documented. The Executive Director of Nursing & Midwifery responded that this would be incorporated within the associated implementation plan which dealt with the education of staff. The Vice Chair felt it was important to note that this was just the beginning of a much wider and important piece of work regarding risk appetite. The Audit Committee Chair suggested that the implementation aspect was key and reiterated the Committee’s concern at the ability to deliver all that was required by October 2020.
20.82.3 It was resolved that the Board 1. Ratify the approval of the revised Risk Management Strategy and Policy by the Audit Committee 2. Note there may be a delay in the 1st October 2020 implementation date from operational teams due to the effect from returning to business as usual following the Health Board’s response to the COVID Pandemic arrangements.
20.83 Documents Circulated to Members
20.83.1 It was noted that a range of Covid related briefings and updates continued to be circulated on a daily basis, together with other documentation as listed.
20.84 Date of Next Meeting
20.84.1 The Annual General Meeting of the Health Board would take place at 9.30am on the 24th September 2020 followed by a Health Board meeting at 10.30am
20.85 Exclusion of Press and Public
20.85.1 It was resolved that representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be Minutes Health Board 23.7.20 Public V0.03 17 prejudicial to the public interest in accordance with Section 1(2) Public Bodies (Admission to Meetings) Act 1960.' 1 20.96b Summary Action Log.doc
HEALTH BOARD SUMMARY ACTION LOG – ARISING FROM MEETINGS HELD IN PUBLIC
Lead Minute Reference and Action Original Update Action to be Executive / Agreed Timescale closed Member Set Actions from Health Board 21.5.20 S Green 20/63.22 Arrange for review and 23.7.20 Timeframe to be confirmed by Executive Director refresh of BCU policies/procedures of Workforce & OD. supporting staff raising concerns 23.7.20 Sue Green concurred that clarity was required as to the process followed when a concern was raised by a staff member. She reported that a proposal was being worked upon with staff and trade union partners with the intention to bring a paper to the RaTS Committee October on the 6th October. Actions previously deferred, now to be addressed as part of a return to Business As Usual C Stockport 20/10.6.1 (meeting held 23.1.20) March Approach GPs to encourage applications and clarity funding/indemnity issues for independent contractors around Section 12(2) work. L Reid 20/12.2.3 (meeting held 23.1.20) February Discussions held and revised IQPR format now in Closed Share with Executive Director of place. Performance and Planning, suggestions for alternative measures within the IQPR that may give a better overview of integrated care. T Owen 20/17.2 (meeting held 23.1.20) November Ensure an appropriate assessment 1 Summary Action Plan – Health Board – arising from meetings held in public around capacity in relation to translating board papers was undertaken and brought back to the Board M Wilkinson 20/23.3.1 (meeting held 23.1.20) February The Priorities and Plans of the Mid Wales Joint Closed Discuss with Mrs S Baxter how to Committee are increasingly being developed in maximise learning and making collaboration with Directors of Planning and connections with the Mid Wales executive colleagues of the member Health Joint Committee Boards, such that there is consistency with the HB corporate planning priorities. The Planning and Delivery Executive Group which supports the Committee is attended regularly by the Assistant Director – Health Strategy and links are made with local North Wales plans e.g. cluster plans, eye care plan, etc and good links with the West Area team in respect of care closer to home. Rural Health and Care Wales, which is also linked to the MW Joint Committee structure, now has good links with the North Wales Research, Improvement & Innovation Hub. Actions from Health Board 23.7.20 C Stockport 20/68.2 Tbc Share a paper capturing the learning from the pandemic at a future meeting. T Owen 20/73.5 6.8.20 17.9.20 Public Health Wales was contacted on Determine why Public Health 27.7.20, response is awaited. Wales had decided against placing the ‘Starlet’ machine in North Wales, together with the timeframe for the ‘Nimbus’ machine to be operational in Ysbyty Gwynedd, and feedback to Cheryl Carlisle.
2 Summary Action Plan – Health Board – arising from meetings held in public T Owen 20/73.6 24.7.20 Write to PHW regarding capacity for community testing M Wilkinson 20/75.3 6.8.20 It has improved however, there are some Closed Follow up and feedback to Cheryl outcomes still outstanding due to the challenges of Carlisle as to the timeframe for remote working. We are attending to it and have addressing the issues referenced more robust systems in place to record in a timely re Mental Health Measure way. We will be looking to clear the backlog for outcome data. October reporting certainly in Central area which was where the main issues lie. D Fearnley 20/77.4 25.9.20 On DIGC agenda for 25.9.20 Closed J Cunliffe Arrange for the Digital Information & Governance Committee examine the capital programme and transformation schemes as set out in the M2 finance paper to ensure that the Board had the sufficient resources in terms of finance and people to deliver these, and to highlight any gaps back to the Board. D Fearnley 20/79.3 6.8.20 2.9.20 The scope of the external invited review of Closed Liaise with the Chair of QSE vascular services has been agreed with the CHC Committee how the independent and the Health Board, and was discussed at QSE review of vascular services was to Committee in August ahead of submission to the be commissioned and how the Royal College of Surgeons. The action plan was implementation plan would be also discussed at QSE, and is being developed further developed and monitored, and implemented by the Vascular Task and Finish before sharing with full Board. Group, M Wilkinson 20/81.2 6.8.20 The Q2 action plan was presented within the public Closed Ensure that a refreshed version of domain at the SPPH committee meeting held on the Q2 action plans be shared 13th August within the public domain.
3 Summary Action Plan – Health Board – arising from meetings held in public M Wilkinson 20/81.4 24.8.20 Last hour of the workshop set aside to deliver this Closed D Sharp identify some time for the Board to consider the Q3 plan at the 22nd September 2020 workshop
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4 Summary Action Plan – Health Board – arising from meetings held in public 1.5 20.97 Cofnodion Cyfarfod Ymddiriedolwyr y Bwrdd Iechyd a gynhaliwyd ar 23.1.20 i'w cymeradwyo / Minutes of Health Board Trustees Meeting Held on 23.1.20 for approval 1 20.97 Minutes Board Trustees 23.1.20 V0.2.docx
Minutes Board Trustees 23.1.20 V0.02 1
Betsi Cadwaladr University Health Board (BCUHB) Draft minutes of the Trustees Health Board meeting held in public on 23.1.20 in Neuadd Reichel, Bangor
Present: Mr M Polin Chair Prof N Callow Independent Member ~ University Cllr C Carlisle Independent Member Mrs M Edwards Associate Member ~ Director of Social Services Mr G Evans Chair of Healthcare Professionals Forum Dr D Fearnley Executive Medical Director Mrs S Green Executive Director of Workforce & Organisational Development Mrs G Harris Executive Director of Nursing & Midwifery / Deputy Chief Executive Mrs S Hill Acting Executive Director of Finance Mrs J Hughes Independent Member Cllr M Hughes Independent Member Mr E Jones Independent Member Mrs L Meadows Independent Member Miss T Owen Executive Director of Public Health Mrs L Reid Vice Chair Mrs L Jones Acting Board Secretary Mrs H Wilkinson Independent Member Mr M Wilkinson Executive Director of Planning & Performance Mr Ff Williams Chair of Stakeholder Reference Group
In Attendance: Mrs D Carter Associate Director of Quality Assurance / Interim Director of Operations Mrs K Dunn Head of Corporate Affairs (for minutes) Mrs K Thomson Head of Fundraising
Translator, members of the public, observers
Agenda Item Discussed Action By 20/1 Annual Report and Accounts
20/1.1 The Charitable Funds Committee Chair wished to record her thanks to the teams within finance and fundraising for their work in developing the accounts and the annual report. She felt that the format and quality of the annual report had much improved over recent years.
20/1.2 The Acting Executive Director of Finance confirmed that the Charitable Funds annual accounts had been scrutinized by the Charitable Funds Committee in line with the required timeframe. She highlighted that the income for 2019-20 was £2m, with an expenditure of £2.2m. There had been gains on investments of £0.4m, giving a net increase in funds of £0.2m which was broadly in line with previous years. The Head of Fundraising suggested that any specific questions on the accounts be received via email.
20/1.3 It was resolved that the Board, as the Corporate Trustee, receive the Charitable Funds Annual Report and Financial Statements for 2018/19.
20/2 Regulatory Update and Charity Guidance
20/2.1 The Head of Fundraising indicated that details of regulatory updates for charity guidance had been provided within the paper. There were no questions forthcoming on this paper
20/2.2 It was resolved that the Board note the report.
20/3 An annual round up of Awyr Las and Third Sector BCUHB supporters’ activity
20/3.1 The Head of Fundraising delivered a presentation which covered: Awyr Las grants – including those over £5k, hearts and minds grants, I CAN grants, staff experience grants and other specific grants Priorities including small grant requests, cancer care, older people, younger people and I CAN Key events and activities including the NHS Big Tea, staff lottery and a 10 year impact report Support for third sector groups across North Wales eg; League of Friends groups. Key objective for 2020 to improve the internal and external profile of Awyr Las
20/3.2 The Charitable Funds Committee Chair invited any board member to attend the Charitable Funds Committee meetings to develop their understanding of charitable issues. This principle was agreed. In addition it was suggested that events of significance for Leagues of Friends and other charities that work with BCUHB should be shared with board members to encourage attendance. This would be administered in liaison with the Chair and Vice-Chair’s office. KT
20/3.3 The Chair made reference to the reduction in income and whether this should be of concern to the Board as Trustees. The Head of Fundraising confirmed that the matter was being addressed through the Charitable Funds Committee and that there was a national trend in terms of a reduction in legacy giving. It was noted that Awyr Las had developed a legacy strategy and was strengthening marketing information. In addition the fund raising team was working with hospital management teams to support better visibility around Awyr Las.
20/3.4 The Head of Fundraising reported that a monthly update would be circulated KT for Board Members. In addition the Chair requested that a mid-year update be provided at a Board meeting on the 4 priority areas for Awyr Las. KT
Page 2 20/4 Forward Look and Questions
The Head of Fundraising confirmed that the Awyr Las Support Team would continue to build on the achievements in-year to help raise awareness of the charity externally as well as internally
Page 3 1.6 20.98 Mesurau Arbennig / Special Measures - Gill Harris 1 20.98a Special Measures update Board 24.9.20 v2.0.docx
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Cyfarfod a dyddiad: Health Board Meeting and date: 24th September 2020 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Special Measures update Report Title: Cyfarwyddwr Cyfrifol: Gill Harris, Acting Chief Executive Responsible Director: Awdur yr Adroddiad Liz Jones, Assistant Director, Corporate Governance Report Author: Craffu blaenorol: Executive Team Prior Scrutiny: Atodiadau Special Measures Improvement Framework (2019) Appendices: Argymhelliad / Recommendation:
It is recommended that the Board notes this update.
Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth x /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation:
This paper presents a position statement update on special measures progress to date.
Cefndir / Background:
The Health Board has been in special measures since 2015. During that time a significant amount of work has focussed upon addressing the specific areas in the three Improvement Framework documents which have been issued by Welsh Government. Progress reports have been submitted to Welsh Government in accordance with the specified milestone reporting requirements.
Asesiad / Assessment & Analysis
In recent months, the work of the Health Board has been dominated by the need to respond to the COVID-19 pandemic. This has been a significant test of governance, leadership, planning and delivery. The response of the Health Board to the pandemic offered a unique opportunity to reflect on the progress made under special measures and consider what was required to address the pandemic, and how effectively the Board responded. Whilst this reflection is not directly linked to specific special measures requirements, it does allow for an overview of organisational effectiveness to be formed. 2
The actions taken by the Health Board and the achievements secured in responding effectively to the pandemic demonstrate significantly improved organisational alignment and capability. These achievements reflect progress made in recent years in critical aspects of organisational effectiveness and align with core elements of the expectations and characteristics which the Health Board is required to demonstrate to meet Part B of the Improvement Framework.
It is reasonable to conclude that over the period of special measures, the Health Board has demonstrated positive progress across a wide range of areas. Leadership and Governance has been considerably enhanced and, as alluded to above, the Board believes it is now in a position to oversee progression against the expectations set out in Part B of the Improvement Framework issued in 2019.
The Health Board’s engagement with staff, partners and the public demonstrates is developing an increasing maturity and effectiveness, which can now support the work to define a long term integrated clinical services strategy and the associated transformation of services.
The Health Board has demonstrated the ability to drive improvement that enables services to be removed from special measures. Maternity services and out of hours services have both achieved this progression and now are subject to the Board’s own ongoing improvement drive. Measures of quality such as responding to concerns and infection prevention and control demonstrate that historical performance issues have been addressed. New initiatives such as the harms dashboard demonstrate a more structured approach to ongoing assurance and improvement. Performance in planned and unscheduled care is however yet to demonstrate sustained improvement.
The Health Board has set out its strategy for primary care services and having appointed an Executive Director of Primary and Community Services, is demonstrating improved sustainability of services supported by innovative models of care. It is acknowledged that further work remains to be done on the strategic direction for mental health, and services and systems to improve governance and quality are developing. Leadership is being strengthened, however absences continue to bring instability. Capacity and capability to transform services is building, with positive partnership working, and there is a clear ambition to make the further improvements required.
Progress has been made with elements of strategic planning, including the Living Healthier, Staying Well strategy and supporting plans. The Health Board is about to embark on the development of a long term integrated clinical services strategy which will build on this and provide the framework against which an Integrated Medium Term Plan can be developed. The achievement of a sustainable financial position must be aligned to this development work and the associated transformation of services.
Whilst noting the many examples of progress that have been covered in greater detail in the previously published milestone reports, the Board is fully cognisant of those areas where further work is needed, in parallel with the necessary re-set in the wake of the initial response to Covid-19. The organisation has a strong grip on the specific actions it needs to take to address improvement framework requirements. These actions have been documented and Welsh Government advised. Critical actions include, for example:
Leadership - demonstrate functioning as an effective, integrated Board setting a clear strategic direction for the organisation, supported by a robust Board Assurance Framework and risk management methodology. 3
Strategic vision and change - development of a long term integrated clinical services strategy, with evidence of strong clinical, stakeholder and public engagement throughout its development. Mental health - strengthening leadership capacity within the Division to enhance stability and resilience Finance - the development of a robust 3 year financial plan to meet its financial duties, as part of the Integrated Medium Term Plan Performance - finalise and implement a revised accountability and performance framework, and deliver improvements in performance, particularly in the acute sector
The Health Board is currently in discussion with Welsh Government regarding the way forward in respect of special measures. Further strategic support has been requested to enable the Health Board to realise its ambition to achieve the lifting of special measures. The Board remains committed to building upon work already done in order to bring about the necessary improvement.
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Betsi Cadwaladr University Health Board Improvement Framework 1. Purpose This framework sets out the Welsh Government expectations Betsi Cadwaladr University Health Board will need to progress to be stepped down from special measures. It also sets out longer term improvement expectations to ensure it sustains and builds on progress to further step down the escalation levels so that it returns to routine arrangements. 2. Background 2.1 NHS Wales Escalation and Intervention Arrangements The NHS Wales escalation and intervention arrangements sets out three types of intervention, each an escalation of the previous. Enhanced Monitoring Targeted Intervention Special Measures Depending on the nature of the issues, the escalation and intervention might be applied to either the NHS body as whole or particular service it provides or in some cases both. The overall aim is to support NHS bodies subject to intervention arrangements to deliver the required improvement and address any issue(s) effectively to step down the levels of intervention so they may return to routine arrangements. 2.2 Betsi Cadwaladr University Health Board Betsi Cadwaladr University Health Board was placed under Special Measures in June 2015. The key areas of concern at the time related to quality (infection control, management of complaints and concerns), leadership and governance, planning and issues in relation to specific services including maternity, mental health and GP out- of-hours. There were also significant concerns about the health board’s connection and engagement with its local population. Since 2015 concerns regarding performance and financial management escalated and in February 2018 these were included under Special Measures arrangements. In the areas of quality and specific services, progress has been made in making the improvements required and meeting the expectations and milestones set out in the previous frameworks. This, resulted in maternity services being de-escalated as a special measures concern in February 2018, and GP out-of-hours services reverting to normal monitoring arrangements in February 2019. Recent tripartite discussions noted the progress and improvements made in adult mental health services and quality measures and the importance of sustaining and building on this. Clarity is now needed on expectations that require immediate improvement in relation to the key outstanding special measures concerns, namely planning,
1 performance issues and financial management, and sustaining progress in mental health services to be considered for step down to targeted intervention. These expectations are set out in PART A of the framework. The health board will need to make tangible progress against the expectations set out in PART A whilst also ensuring improvements in these areas doesn’t impact negatively on other areas of its activity. It is also essential the health board sustains momentum to demonstrate how it is making progress towards showing the characteristics expected of an effective, well- governed organisation. The framework in PART B sets out the expectations for the medium and longer term in order to ensure the health board further steps down the escalation levels to routine arrangements status. The framework focuses on how the health board can assess and demonstrate it is improving and is not a list of actions for ‘ticking off’. It will require the health board to make judgements on progress and what needs to be done to further improve in order to step down the escalation levels. This framework in PART A focuses on the key expectations the health board will need to demonstrate progress to be de-escalated from special measures. PART B focuses on the medium/ longer term expectations to demonstrate progress towards it becoming an effective, well-governed organisation. The expectations are set out under four key areas: Leadership and improvement capability Strategic vision and change Operational performance Finance and use of resources
3. The Framework PART A – expectations the health board as a minimum will need to demonstrate progress to be de-escalated from special measures. Area: Leadership and Improvement Capability
Leaders understand the challenges and ensure relevant expertise and capability across the system are addressing barriers, making tangible impact and delivering improved outcomes.
Area: Strategic Vision and Change
It can evidence it is working with staff and partners to develop a clear and comprehensive picture of how services will look in the future and a realistic credible three year plan has been considered by the Board by April 2020.
Area: Operational Performance
Demonstrable progress being made in planned and unscheduled care performance underpinned by an understanding of demand and capacity;
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Sustained progress in the delivery of quality sustainable mental health services and development of new models of care.
Area: Finance and Use of Resources
Improvements demonstrated in financial planning and in the financial position including delivery on savings/efficiency opportunities.
PART B - expectations and characteristics the health board will need to demonstrate it is sustaining and building on to ensure it steps down to routine arrangements status. Area: Leadership and Improvement Capability Expectations:
A compelling vision for the health board which is understood, recognised and accepted throughout the organisation Visible leadership that is open to challenge, understands the issues and addresses the barriers Demonstrably improved capacity and capability to deliver Positive demonstration of organisational culture and behaviours Good quality of care and outcomes Clear accountability systems Effective use of data and intelligence to support decision making
Demonstrated by:
Leaders are described by staff as increasingly visible, approachable and open to challenge Leaders understand the challenges and can identify and act to address them and use data and intelligence to monitor progress The organisation can evidence it understands and has the relevant capability, expertise and capacity across its system to deliver and invest time and resources in continuous organisational development The organisation has an open and transparent culture and willingness to learn Staff are increasingly aware and understand the accountability framework and systems in place including a clear structure that defines accountabilities Staff survey results demonstrate progress and positivity Evidence of effective mechanisms for raising, reporting and acting on concerns and incidents and taking action in response to internal investigations or external reviews. External stakeholders describe relationships with the health board as positive and there is evidence of improved joint working and ownership across the whole system including the Regional Partnership Board and Public Services Boards
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Area: Strategic Vision and Change Expectations:
The organisation has a clear vision and a credible strategy to deliver high quality sustainable care underpinned by delivery plans Staff, partners and the public are engaged and involved in shaping the vision and strategy New models of care are developed with staff, partners and service users. A culture of high quality care
Demonstrated by:
The board can evidence that the health board has a clear and comprehensive picture of how services will look in the future and a route map is in place to achieve this including quality, performance and financial objectives. The vision and strategy is aligned to the plans of partner organisations and staff and service users are actively involved in its development. The health board can demonstrate visible clinical leadership and how patients, partners and staff have been involved and contributed to its vision and strategy. Plans are realistic in achieving priorities and delivering quality care. Plan delivery is effectively monitored and reviewed by the Board.
Area: Operational Performance Expectations:
Key performance targets set out in its operating plan are met, with demonstrable progress towards meeting national standards Clear and effective processes are in place to manage risks and issues in delivering performance targets. Evidence of delivery is regularly reviewed and internal governance processes constructively challenge performance
Demonstrated by:
A clear plan underpinned by an understanding of demand and capacity Effective internal governance and accountability processes which demonstrate evidence of effective risk management Meeting performance targets set out in the plan and demonstrating improvement towards meeting national standards in planned, unscheduled care and mental health services.
Area: Finance and Use of Resources Expectations:
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The organisation uses its resources effectively and is moving towards a sustainable financial position
Demonstrated by:
Delivery against the annual operating plan deliverables in managing the use of resources including savings/efficiency opportunities. Robust grip and control measures across the system to deliver on plan including managing in-year pressures. Staff members contribute and understand the accountability arrangements in place to deliver the plan.
4. Review The health board will be expected to carry out a self-review of its current position and provide an initial report to Welsh Government by the 13 December. The self-review findings will be considered during the regular tripartite meeting and progress further discussed at a special tri-lateral meeting to be held in spring 2020.
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2.1 20.99 Deddf Iechyd Meddwl 1983 fel y diwygiwyd gan Ddeddf Iechyd Meddwl 2007. Deddf Iechyd Meddwl 1983 Cyfarwyddiadau Clinigwyr Cymeradwy (Cymru) 2008. Diweddaru Cofrestr Meddygon Cymeradwy Adran 12(2) Meddygon i Gymru a Diweddaru Cofrestr Clinigwyr Cymeradwy (Cymru Gyfan) /Mental Health Act 1983 as amended by the Mental Health Act 2007. Mental Health Act 1983 Approved Clinician (Wales) Directions 2008. Update of Register of Section 12(2) Approved Doctors for Wales and Update of Register of Approved Clinicians (All Wales) - David Fearnley 1 20.99 Section 12 _approved by DF.docx
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Cyfarfod a dyddiad: Board Meeting Meeting and date: Thursday 24th September 2020 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Mental Health Act 1983 as amended by the Mental Health Act 2007. Report Title: Mental Health Act 1983 Approved Clinician (Wales) Directions 2018. Update of register of Section 12(2) Approved Doctors for Wales and Update of Register of Approved Clinicians (All Wales) Cyfarwyddwr Cyfrifol: Dr David Fearnley, Executive Medical Director Responsible Director: Awdur yr Adroddiad Mrs Heulwen Hughes, All Wales Approval Manager for Approved Report Author: Clinicians and Section 12(2) Doctors Craffu blaenorol: Dr David Fearnley Prior Scrutiny: Atodiadau Appendix 1: Mental Health Act 1983 as amended by the Mental Appendices: Health Act 2007Mental Health Act 1983 Approved Clinician (Wales) Directions. Update of Register of Approved Clinicians for Wales Appendix 2: Mental Health Act 1983 - Update of Register of Section 12(2) Approved Doctors for Wales
Argymhelliad / Recommendation: The Board is asked to ratify the attached list of additions and removals to the All Wales Register of Section 12(2) Doctors for Wales and the All Wales Register of Approved Clinicians. Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation: Betsi Cadwaladr University Health Board is responsible for the initial approval, re-approval, suspension and termination of approval of Approved Clinicians and Section 12(2) Doctors in Wales.
Cefndir / Background: The change introduced to the Mental Health Act 1983 was the abolishing of Responsible Medical Officers (RMOs) and Community Responsible Medical Officers (CRMOs) and the introduction of Approved/Responsible Clinicians (ACs and RCs) in their place.
The Minister for Health and Social Services agreed that as of the 3rd November 2008, Wrexham Local Health Board (LHB) would act as the Approval Body for Approved Clinicians and section 12(2) Doctors on behalf of the LHBs in Wales. The transfer of function from Wrexham Local Health Board to Betsi Cadwaladr University Health Board took place on 1st October 2009.
Asesiad / Assessment & Analysis 2
Strategy Implications
It is important to ensure the highest standards of governance for approving and re-approving practitioners who are granted these additional responsibilities, which apply when people are mentally disordered.
Options considered
This is a factual report for ratification purposes.
Financial Implications
The Approvals Team receive a ring-fenced budget from Welsh Government to support the monitoring and approvals of Clinicians in Wales.
Risk Analysis
To ensure that all Clinicians are approved and reapproved within the agreed timescales, the All Wales Approval Panel assesses applications according to the Procedural Arrangements agreed with Welsh Government.
Legal and Compliance
The Approval Process meets the legislative requirements of the Mental Health Act 1983 (as amended 2007) and the Mental Health Act 1983 (Approved Clinicians)(Wales) Directions 2018.
Impact Assessment
An impact assessment is considered unnecessary for this update paper. The Approval Process is part of the Legislative process.
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Update of Register of Approved Clinicians and Section 12 (2) Approved Doctors for Wales 30th June 2020 – 2nd September 2020
AC S12 (2) Approvals and Re- 22 9 approvals Removed – Expired 2 1 Approvals suspended 0 0 Approvals re-instated – 1 0 returned to work in Wales Approval Ended 0 0 Retired 0 0 Removed – AC approved NA 1 No longer registered 0 0 Transferred from AC NA 0 register Approval Ended as no 1 2 longer working in Wales Registered without a 0 0 licence to practice 4
APPENDIX 1 Mental Health Act 1983 as amended by the Mental Health Act 2007. Mental Health Act 1983 Approved Clinician (Wales) Directions Update of Register of Approved Clinicians for Wales 30th June 2020 – 2nd September 2020 Approvals and re-approvals – 22 Surname First Name Workplace Expiry Date Shivashankar Somashekara Links Centre CMHT, Block 11 First Floor, Cardiff Royal Infirmary, Glossop 2 July 2025 Road, Cardiff CF24 0SZ Fitch Sarah Hafan Y Coed, University Hospital Llandough, Penlan Road, Penarth, CF64 3 August 2025 2XX Ali Syed Noor Uz Hazels Resource Centre, Temple Street, Llandrindod Wells LD1 5HF 6 July 2025 Zia Rao Sandeep Wepre House, Connah's Quay, Flintshire CH5 4HA 7 July 2025 Kidd Lynne Knight Newton House, 183 Newton Drive, Blackpool, Lancashire FY3 8NU 7 July 2025 Beer Roger William 6 Goldtops, Goldtops, Newport, NP20 4PG 7 July 2025 Grenville Theologos Georgios Ynys Mon CMHT, Cefni Hospital, Llangefni, LL77 7PP 28 May 2024 Rydzewski Michal Neath & Port Talbot Hospital, Ward G, Baglan Way, Port Talbot SA12 7BX 12 July 2025 Cardoza Basil Silas Mental Health and Learning Disability Service, 67A Pembroke Road, Canton, 13 July 2025 Cardiff CF5 1QQ Jurewicz Izabela Pentwyn CMHT, Brynheulog, Pentwyn, Cardiff CF23 7JD 16 July 2025 Glaze Robin Catherine Gladstone House, Hawarden Way, Mancot, Flintshire CH5 2EP 20 July 2025 Christopher John 5
Surname First Name Workplace Expiry Date Lloyd Keith Robert Swansea University Medical School, ILS2, Swansea University, Swansea SA2 23 July 2025 8PP Labinjo Francis Delfryn Lodge Independent Hospital, Argoed Hall Lane, Mold, Flintshire CH7 19 January 2025 Olusegun 6FQ Richings Ceri Ian Alders House, Llanfrechfa Grange, Cwmbran, Torfaen NP44 8YN 28 July 2025 Harding Iorwerth Dyffynog Ward, Bronllys Hospital, Brecon, Powys LD1 0LU 28 July 2025 Norman Bhat Prashant CAMHS Clinic, Royal Alexandra Hospital, Marine Drive, Rhyl LL18 3AS 29 July 2025 Farquhar Fiona Jane Bryn Enfys, Bryn y Neuadd Hospital, Aber Road, Llanfairfechan, Conwy LL33 2 August 2025 0HH Fenton Kristy Melissa Preseli Centre, Withybush Hospital, Fishguard Road, Haverfordwest, 4 August 2025 Pembrokeshire SA61 2PZ Mehrpooya Neda Taith Newydd, Glanrhydd Hospital, Bridgend 6 August 2025 Wilson Andrew Carl Ty Grosvenor, 16 Grosvenor Road, Wrexham LL11 1BU 11 August 2025 Hussain Syed The Hazels, Llandrindod Wells LD1 5HF 31 March 2025 Collings Ian Ronald Gwelfor Unit, Cefn Coed Hospital, 17 August 2025 Cockett, Swansea SA2 0GH
Approvals re-instated – 1 Surname First Name Workplace Expiry Date
Rehman Ijaz-Ur Community Mental Health Team, Fan Gorau, Llanfair Road, Newtown SY16 29 November 2020 2DW
Approvals expired – 2 6
Surname First Name Workplace Expiry Date
Race Julian Hilton The Elms, Grosvenor Road, Wrexham LL11 1EB 26 July 2020
Kele Ildiko Bridgend North CMHT, Maesteg Community Hospital, Neath Road, Maesteg 5 August 2020 CF34 9PW
Approvals Suspended – 0 Surname First Name Workplace Expiry Date
Retired – 0 Surname First Name Workplace Expiry Date
No longer Registered - 0 Surname First Name Workplace Expiry Date
No longer working in Wales – 1 7
Surname First Name Workplace Expiry Date
Bramall Peter Delfryn Lodge Independent Hospital, Argoed Hall Lane, Mold, Flintshire 11 January 2022 CH7 6FQ
Approvals Ended – 0 Surname First Name Workplace Expiry Date 8
APPENDIX 2 Mental Health Act 1983 Update of Register of Section 12(2) Approved Doctors for Wales 30th June 2020 – 2nd September 2020 Approvals and Re-approvals – 9 Date Approval Surname First Name Workplace Expires Walton Catherine c/o Hafod Y Wennol AATU, Pontyclun CF72 8JX 6 July 2025 Doherty Joanne Louise Haydn Ellis Building, Cardiff University, Maindy Road, Cardiff CF24 4HQ 6 July 2025 Lappas Andreas Zone R, Mental Health Wellbeing & Outpatient Centre, Princess of Wales 10 August 2025 Hospital, Bridgend CF31 1RQ Ali Aysha 41 Clos Springfield, Talbot Green, Pontyclun, CF72 8FE 11 August 2025 Roufael Rim Waguih Cefn Coed Hospital, Sketty, Swansea SA2 0GH 12 August 2025 Fares Thomas Catrin Elin Heddfan Unit, Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD 13 August 2025 Khan Mohammad University Hospital Llandough, Penlan Road, Llandough, Penarth CF64 2XX 16 August 2025 moved to 102 Blakesley Centre, Yardley Forward Thinking Birmingham B25 8RN Curatola Antonino St Cadoc's Hospital, Lodge Road, Caerleon, Newport NP18 3XQ 18 August 2025 Gianmaria Sharma Simmi Pendine Community Mental Health Team, 124-126 Cowbridge Road West, 20 August 2025 Cardiff CF5 5BT 9
Removed – Expired - 1 Date Approval Surname First Name Workplace Expires
Saeed Humera Monmouth House, Heath Park, University Hospital of Wales, Cardiff CD14 5 August 2020 4XW
Removed – AC approved – 1 Date Approval Surname First Name Workplace Expires Mehrpooya Neda Rehabilitation Psychiatry, Park Lodge, Whitchurch Hospital, Whitchurch CF14 18 July 2022 7BX
No longer registered – 0 Date Approval Surname First Name Workplace Expires
Transferred from AC Register – 0
Surname First Name Date Approval Expires Workplace
No longer working in Wales – 2 10
Date Approval Surname First Name Workplace Expires
Sadi Hamidreza Felindre Unit, Bronllys Hospital, Brecon, Powys LD3 OLU 28 June 2025
Khan Mohammed University Hospital Llandough, Penlan Road, Llandough, Penarth CF64 2XX 16 August 2025
No longer registered – 0 Date Approval Surname First Name Workplace Expires
Removed – Retired – 0 Date Approval Surname First Name Workplace Expires 2.2 20.100 Crynodeb Flynyddol o Ymgynghoriadau / Annual Summary of Consultations - Dawn Sharp 1 20.100 Annual Summary of Consultations between April 2019 - March 2020.docx
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Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.20 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Annual Summary of Consultations April 2019 – March 2020 Report Title: Cyfarwyddwr Cyfrifol: Dawn Sharp, Acting Board Secretary Responsible Director: Awdur yr Adroddiad Fiona Lewis, Corporate Officer Report Author: Craffu blaenorol: Approved by Acting Board Secretary Prior Scrutiny: Atodiadau Annex 1 – List of Consultations received between April 2019 – March Appendices: 2020 Argymhelliad / Recommendation: The Board is asked to note the external consultations responded to by the Health Board and the associated monitoring arrangements. Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation: The Health Board receives a large number of formal consultations each year and has a system in place to monitor such consultation requests in order to track progress and ensure that they are responded to in a timely manner.
This paper is written to provide the Board with an overview of the consultation documents received by the Health Board between April 2019 and March 2020.
Cefndir / Background: The information contained in Annex 1 provides an overview of the consultations received by the organisation during the period in question. Consultation documents are received into the organisation via the Chief Executive, Board Secretary or the BCU information email. A Lead Executive is then assigned to determine whether a response is required and if so to co-ordinate that response. The monitoring arrangements are overseen by the Office of the Board Secretary. Copies of responses to formal consultations are routinely published by the relevant consultative body but are also available on request via the Office of the Board Secretary.
Asesiad / Assessment & Analysis The Health Board has a robust process in place for logging and tracking consultations. Annex 1 2
Consultation Topic Response submitted
YES NO
April 2019 Setting National Milestones Children (Abolition of Defence of Reasonable Punishment)(Wales) Bill Positron Emissions Tomography (PET) Consultation before applying for planning permission re Registered Care Home St Asaph Business Park Radiofrequency Ablation for Barrett’s Oesophagus in Adults May 2019 Amending the Govt of Wales Act 2006 (Budget Motions & Designated Bodies) Order 2018 Draft AHP Framework for Wales Children & Young People - Mind over Matter Report Children and Young People's Continuing Care Haematopoietic Stem Cell Transplantation Deep Brain Stimulation Paediatric Epilepsy Paediatric Imaging June 2019 Proposed Commissioning Policy for Sterotactic Radiosurgery Intracranial Cochlear implants Environmental Permitting (Eng & Wales) Regs 2016 Health and Social Care (Quality and Engagement) (Wales) Bill CP49 War Veterans - Enhanced Prosthetic Provision and CP89 Prosthetic Provision July 2019 Children Cases in the Family Court – Interim Proposals for Reform Welsh Govt Substance Misuse Plan 2019-2 Changes to freedom of movement after Brexit & implications for Wales Salvage Cryotherapy for Prostate Cancer Policy Position Statement (PP173) Chimeric Antigen Receptor (CAR) T-cell therapy Position Statement (PP185) 3
Emicizumab as prophylaxis in people with congenital haemophilia A without factor VIII inhibitors (PP189 Sickle Cell Disorders, Thalassaemia Disorders and other Rare Hereditary Anaemias CP179 Soft Tissue Sarcoma Service Specification (CP149) Welsh Government Draft Budget Proposals 2020-21
Proposed Changes to the Victims Code - Ministry of Justice Consultation The Welsh Government's consultation on the Together for Mental Health Delivery Plan 2019 - 2022 Food and Nutrition and older people's care homes
Safeguarding Children & Child Sexual Exploitation
Children's rights in Wales Public procurement in the foundational economy Senior clinicians' pensions more flexibility The implementation of the Regulation and Inspection of Social Care (Wales) Act 2016 Transparency in supply chains Health Education and Improvement Wales Social Care Wales Joint Workforce Strategy Wrexham Public Space Protection Order
Follow up to the suicide prevention inquiry
August 2019 Call for Evidence Inquiry into implementation of the Welsh Government’s Stroke Delivery Plan Draft data sharing code of practice The principles and procedures relating to the new powers created by the PSO (Wales) Act 2019 National Development Framework CHC Adult Framework NICE's draft guideline on cannabis-based medicinal products (CBPMs) Paediatric Nephrology Services (CP169) September 2019 Children, Young People & Education Cttee NHS Pension Scheme increased Flexibility Health, Social Care and Sport Committee Inquiry into Sepsis Fee Scales 2020-2021 Economy Infrastructure and Skills Committee inquiry into public procurement in the foundational economy 4
In-patient Child and Adolescent Mental Health Services (CAMHS) Proposed Service Specification for Specialist Oesophageal and Gastric Cancer Services for Welsh Residents Lixwm Community Primary School Statutory Proposal Increased Recycling by Businesses Strategic Equality Objectives 2020-2024 Principles and Procedures relating to the new powers created by the Public Services Ombudsman (Wales) Act 2019 October 2019 Impact of the proposal to change parents' ability to withdraw their child from RD and Relationships & Sexuality Education Eculizumab for Paroxysmal Nocturnal Haemoglobinuria National Health Service (Pharmaceutical Services) (Wales) Regulations 2020 Education at a place other than school (EOTAS) Mid & West Wales Fire & Rescue Srvcs National Health Service (Indemnities) (Wales) Bill Guidance on reducing restrictive practices in childcare education health and social care settings Structure for Welsh apprenticeship frameworks Wrexham Town Public Space Protection Order (PSPO) Community Pharmacy Reimbursement Forms
Developing a Strategic Plan for Tertiary Services Equality, Local Government and Communities Committee's follow-up work into rough sleeping in Wales Letter from the Chair of WIGB re Email use Policy (BCUHB
November 2019 Social Partnership Bill White Paper All-Wales self-Assessment of Current Governance Arrangements A More Equal Wales - Commencing the Socio-economic Duty The Children, Young People and Education Committee's inquiry into perinatal mental health in Wales RCPCH State of Children's Health Trade and the implications for the NHS in Wales The Finance Committee and Economy, Infrastructure and Skills Committee's joint inquiry into retention payments in the construction industry 5
December 2019 Welsh NHS Confed report on Joint Working Paper - A toolkit for industry and NHS Wales Proposed Policy Position Statement for Lutetium (177Lu) Draft Public Audit (Amendment) (Wales) Bill Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene (PP118) Case studies for Community Transport – Making health accessible to all briefing Cleft Lip and or Palate including Non-Cleft Velopharyngeal Dysfunction All Ages (CP186) Children, Young People and Education Committee – Mind Over Matter Report Nusinersen for treating spinal muscular atrophy Policy Position Statement (PP191 January 2020 Managing the transition from Children's to adults' healthcare services Draft Regulations Consultation re Speech, Language & Communication (SLC) Delivery Plan 2020-2021 February 2020 Health, Social Care and Sport Committee inquiry into hospital discharge processes Welsh Youth Parliament - Mental Health & Wellbeing Environmental Permits Cancer Treatment Waiting Times March 2020 Compassionate Leadership Treatment options for Transthyretin Amyloidosis The Welsh Language Standards (No. 8) Regulations for healthcare regulators and the PrSA 2.3 20.101 Cylch Busnes Blynyddol y Bwrdd / Annual Board Cycle of Business - Dawn Sharp 1 20.101a CoB report.docx
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Cyfarfod a dyddiad: Health Board Meeting and date: 24th September 2020 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Annual Board Cycle of Business Report Title: Cyfarwyddwr Cyfrifol: Dawn Sharp, Acting Board Secretary Responsible Director: Awdur yr Adroddiad Kate Dunn, Head of Corporate Affairs Report Author: Craffu blaenorol: None Prior Scrutiny: Atodiadau Board cycle of business Appendices: Argymhelliad / Recommendation:
The Health Board is asked to approve the annual cycle of business
Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation:
The Board is required to agree an annual cycle of business.
Cefndir / Background:
This routine governance paper has been deferred from the March Board agenda due to the need to focus agendas on key priorities during the Covid-19 pandemic.
Asesiad / Assessment & Analysis
As the Board is now returning to some degree of business as usual, the cycle of business is now presented.
Options considered N/A 2
Financial Implications N/A
Risk Analysis Not required for a governance paper of this nature.
Legal and Compliance Standing Orders para 7.2.1 require the Board to agree an annual cycle of business.
Impact Assessment Not required for a governance paper of this nature.
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BOARD CYCLE OF ANNUAL BUSINESS AND FORWARD PLANNER
Part 1 – Annual Recurring Business
Notes Committee May July July Sep Nov Jan Mar Agenda Items AGM All Wales Meetings As required Minutes (EASC, WHSCC and NHS - Wales Health Collaborative) to Annual Accounts A delegate authority to AC Agency & Locum WG requirement Deployment in Wales * WHC2017/042 see note at end Annual Consultations Procedural
Summary Annual Cycle of WG requirement
Business (contained in SOs)
Annual General Meeting minutes to Annual Governance A delegate Statement authority to AC
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Notes Committee May July July Sep Nov Jan Mar Agenda Items AGM WG requirement to Final (as Annual Quality part of ann (detailed within QSE/A delegate Statement MFA) authority to report) AC WG requirement – Annual Report of the has to be A Inc AGS Health Board presented by end and AQS Sept each year WG requirement as Annual Reports of Via AC Chair detailed within Report Board Committees Standing Orders Approved Clinicians WG requirement and Section 12(2) *every other MHAC meeting Doctors Business Cases/Capital Compliance with Developments(as SFIs and WG F&P requirements appropriate) Chair’s Assurance Good practice Reports from All Committees Charitable funds Requirement under Charities Act audited accounts and CFC Via Ch Ass Rep annual report Civil contingency and WG requirement business continuity SPPH update (via SPPH Chair’s report)
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Notes Committee May July July Sep Nov Jan Mar Agenda Items AGM Collaborative Agreed by Board Leadership Forum Secretaries Minutes (All Wales) Corporate Risk & WG requirement A Assurance Framework Director of Public WG requirement SPPH Health Annual Report Documents signed WG requirement as - under seal set out in SOs Engagement Strategy WG requirement SPPH (via SPPH Chair’s Report) Equality & HR Annual WG requirement QSE / report inc Strategic IoS from SPPH SPPH Equality Plan progress Monthly report in Finance report F&P view of deficit Finance WG requirement Strategy/budget and F&P financial framework
HASCAS Investigation and Ockenden QSE Governance Review Progress Reports Health & Care WG requirement via QSE Standards scrutiny AGS
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Notes Committee May July July Sep Nov Jan Mar Agenda Items AGM Health and Safety Statutory Annual Report requirement (HSE QSE regulations)
Health Care WG requirement Inspectorate Wales QSE reports (as appropriate) Infection Prevention WG requirement QSE and Control reports Requirement of Medicines national WAO Management Audit into QSE medicines management Mental Health Progress WG requirement and linked to Reports (via SMIF updates QSE and QSE Chair’ reports) Special Measures Mental Health Strategy WG requirement SPPH Nurse Staffing Act Nurse Staffing QSE requirement Primary Care Contracts Compliance with Sos (new awards) (as required) Advice from All Wales Board QSE Secretaries and Primary Care Updates WG that regular reports should be taken
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Notes Committee May July July Sep Nov Jan Mar Agenda Items AGM Prison Health Annual Report (through QSE QSE Chair’s Report) Putting Things Right WG/Ombudsman Annual Report requirement (incorporating link to QSE Ombudsman Annual Report) Quality & Performance WG requirements QSE/ Report F&P Research & SPPH Development Risk Management WG requirement A Strategy Review of SOs/SFIs WG requirement and Scheme of A Delegation Service Change Agreed at Board
(orthopaedics) 5.4.18 WG requirement Final
Strategy Development SPPH IMTP (3 To include primary (monitoring of AOP) year plan) / community care Safeguarding Updates WG requirement ann (as and when via QSE QSE rep via Chair’s Report plus annual Ch rep
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Notes Committee May July July Sep Nov Jan Mar Agenda Items AGM report also via QSE Chair’s report in March) Seasonal Plan WG requirement SPPH Special Measures WG requirements Progress Reports (via SMIF Chair’s report) Tissue and Organ QSE Via QSE Donation annual report Chair Rep University status of the WG requirement every 3 years (due Health Board in 2019) Wales Audit Office WG/WAO A Annual Audit Report requirement Wales Audit Office WG/WAO A Structured Assessment requirement Well-being of Future WG requirement as part of SPPH corporate Generations Act annual report Welsh Language WL Commissioner strategic/annual requirements SPPH report(s)
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Key: A Audit Committee CFC Charitable Funds Committee F&P Finance and Performance Committee DIG Digital Information and Governance Committee MHAC Mental Health Act Committee PoD Power of Discharge Sub-Committee R&TS Remuneration and Terms of Service Committee SPPH Strategy, Partnerships and Population Health Committee QSE Quality, Safety and Experience Committee
2.4 20.102 Adroddiad Monitro Blynyddol Gwasanaethau’r Gymraeg 2019-20 / Welsh Language Services Annual Monitoring Report for 2019-20 - Teresa Owen 1 20.102a Welsh Language Services Annual Monitoring Report template.docx
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Cyfarfod a dyddiad: Health Board Meeting and date: 24th September 2020 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad BCUHB Welsh Language Services Annual Monitoring Report for Report Title: 2019-20. Cyfarwyddwr Cyfrifol: Teresa Owen (Executive Director of Public Health) Responsible Director: Awdur yr Adroddiad Alaw Griffith (Welsh Language Standards Compliance Officer) Report Author: Craffu blaenorol: Prior scrutiny at Strategy, Partnerships and Population Health Prior Scrutiny: Committee (SPPH) on 3rd August 2020. Atodiadau The final draft of the Welsh Language Services Annual Monitoring Appendices: Report for 2019-20 is attached as Appendix 1.
Argymhelliad / Recommendation: The members of the Board are asked to endorse and approve the attached report, so it can be published and presented to the Welsh Language Commissioner in accordance with the previously agreed timetable (i.e. by the end of September 2020).
Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation: The Health Board is obligated to provide the Welsh Language Commissioner with a Welsh Language Services Monitoring Report on an annual basis.
This report provides an overview of delivery against key performance indicators, relating to the provision of bilingual healthcare services within BCUHB and demonstrates the Health Board’s compliance with the statutory Welsh Language Standards (which the organisation has been subject to since 30th May 2019).
The progress made during the last reporting year (April 2019 – March 2020) is highlighted by referencing the numerous initiatives that have been implemented in order to facilitate the delivery of Welsh-medium healthcare services throughout north Wales.
The Welsh Language Commissioner no longer provides formal written feedback to organisations. However, the Commissioner provided positive and complimentary verbal feedback to the Health Board following last year’s Annual Report, and there were no recommendations or suggested improvements.
Cefndir / Background: 2
Having previously reported on the Health Board’s compliance with its Welsh Language Scheme (in accordance with the Welsh Language Act 1993), this is the first BCUHB Welsh Language Services Annual Monitoring Report that focuses on our delivery in relation to the Welsh Language Standards (which superseded the previous legislation upon their introduction on 30th May 2019).
Asesiad / Assessment & Analysis The successful development and delivery of Welsh-medium healthcare services aligns with most of the seven well-being goals that are set-out in the Wellbeing of Future Generations Act 2015, including the development of a healthier Wales; a more equal Wales; and a Wales of vibrant culture and thriving Welsh language.
At the same time, this report reflects many aspects of the Wellbeing of Future Generations Act’s sustainable development principle by incorporating long-term thinking (but balancing it with short term need); promoting integration and collaboration; and helping to prevent shortcomings relating to Welsh-medium healthcare service provision, by encouraging the prudent and sensible use of resources to stop problems from occurring or getting worse.
Furthermore, the promotion and delivery of bilingual healthcare services also contributes towards the realisation of all of the Health Board’s own Well-being Objectives, namely: To improve physical, emotional and mental health and well-being for all. To target our resources to those with the greatest needs and reduce inequalities. To support children to have the best start in life; To work in partnership to support people – individuals, families, carers, communities - to achieve their own well-being; To improve the safety and quality of all services; To respect people and their dignity; To listen to people and learn from their experiences.
Options considered N/A
Financial Implications If non-compliance is identified, the Commissioner will undertake an investigation, presenting the final conclusions in a written report. If adequate action is not taken to address shortfalls, the Commissioner will be able to impose a civil penalty of up to £5000 on the organisation.
Risk Analysis Noncompliance with the Welsh Language Standards would create inherent legislative risks. Whilst BCUHB continues to lead the way in terms of the availability and development of Welsh- medium healthcare provision, our ongoing efforts to continuously monitor the procedures, initiatives and schemes that we have created in order to facilitate the delivery of our bilingual services help to mitigate the risk of statutory noncompliance. Thus, whilst the Annual Monitoring Report is obviously a platform to highlight successes and best practice, the process of collecting data and information during its preparation also allows us to identify shortcomings (in relation to Welsh-medium provision) and to subsequently arrange for specific actions to be taken in order to resolve any existing or potential deficiencies. ‘Self-policing’ and reporting of this kind also ensures greater accountability and allows potential issues to be identified before they develop into larger problems. 3
Legal and Compliance The Welsh Language (Wales) Measure 2011 gave the Welsh language official status and reinforced the principle that the Welsh language should not be treated less favourably than the English language in Wales. The Measure also created the procedure for placing statutory duties on organisations in the form of Welsh Language Standards. BCUHB has been subject to these benchmarks since 30th May 2019 and this report explains how the organisation has been able to adapt successfully to the new legislative framework and continue to operate in accordance with the relevant statutory requirements (in relation to the Welsh language).
Impact Assessment An impact assessment wasn’t required in connection with the creation of this report. Indeed, the purpose of the report itself is to ensure and confirm that due regard is given to the delivery of Welsh language services and the promotion of equality within BCUHB.
Y:\Board & Committees\Governance\Forms and Templates\Board and Committee Report Template V2.0 July 2020.docx 1 20.102b Welsh Language Services Annual Monitoring Report 2019 - 2020 Final.pdf Content Page
Executive Summary 1
Background and current situation 2
Self-regulation and Governance 3
Welsh Language Standards 6
More than just words 8
Welsh Language Training Developments 10
Welsh Learner of the Year 14
Primary Care Services 15
The Translation Service 17
Service Developments and Key Achievements 19
- Mental Health Project 25
- Cymraeg i Blant 27
- Working with Schools and Colleges 27
Performance Indicators Data 30
Workforce Planning 30
Training to Improve Welsh Language Skills 35
Recruitment 36
Complaints 37
Conclusion and Forward Vision for 2020 - 2021 38
Executive Summary
This is the first report to address the statutory duty of Betsi Cadwaladr University Health Board (the Health Board) to provide an annual account to the Welsh Language Commissioner on compliance with the Welsh Language Standards since the imposition date of 30th May 2019. The Health Board had made progress to prepare the organisation for the implementation date to ensure full compliance with the Standards under the Welsh Language (Wales) Measure 2011.
The report reflects the requirements and content as stated within Standard 120 of the Welsh Language Standards:
Complaints Workforce Planning Recruitment Language Skills Training to improve Welsh language skills
This report also gives an overview of general progress including key achievements and good practice as well as areas for development.
The report reflects work undertaken to progress the Bilingual Skills Strategy, implementation of More than just words and the ‘Active Offer’ principle, meaning the provision of a Welsh medium service without the service user having to request it. A Strategic Plan and associated Work Programme are in place to ensure comprehensive delivery of these requirements. Self-governance and monitoring continue to be key aspects of the work undertaken this year, which has led to tighter performance measures and accountability.
This report builds on the Health Board’s previous annual reports, reflecting improvements and progress made during this reporting year.
At this point, we must also refer to the challenging and unprecedented times faced by the Health Board with the spread of the worldwide pandemic of the Coronavirus (COVID-19). From March 2020 onwards, the Welsh Language Team had adapted to working from home whilst continuing to provide a full support service for staff, although it has not been possible to be proactive in developing further projects at this time. All meetings were cancelled, and with the situation changing on a daily basis, a few staff members were redeployed for two to three days a week to provide support within other sectors. However, every opportunity was taken to emphasise the importance of continuing to provide bilingual services, and a message conveying this was sent to senior staff members. The translation team continued to provide a full service, and continued to be extremely busy translating daily briefings, press releases, and patient letters and information leaflets as the Health Board adapted to the new norm. The Welsh language tutor offered Welsh lessons over Skype and email for the Health Board’s learners and also on the ‘Dysgwyr Betsi’ Facebook and Twitter pages.
Welsh Language Services Annual Monitoring Report 2019-2020 Page 1
Background and the current situation
This report not only reflects the Health Board’s progress against the requirements noted in Standard 120, it also demonstrates how we have planned our services to address the needs of our population.
Understanding our population needs
Understanding population needs is essential to inform our ability to design and deliver services in North Wales. Gwynedd has the highest proportion of Welsh speakers, 65 per cent, although we know that this can be much higher in some areas of the county. Elsewhere in North Wales, 57 per cent of residents on the Isle of Anglesey speak Welsh, 27 per cent in Conwy and 25 per cent in Denbighshire. The proportion of Welsh speakers in Flintshire (13.2 per cent) and Wrexham (12.9 per cent) is lower in comparison, however, the demand for Welsh medium services is prominent, taking into account rural Welsh speaking areas that access services delivered in the east region of North Wales.
In terms of day-to-day usage of the language, the North Wales Population Needs Assessment 1 demonstrates that just over half (53 per cent) of Welsh speakers in North Wales are fluent in the language and 63 per cent speak Welsh on a daily basis. In Gwynedd, 78 per cent of Welsh speaking residents are fluent and 85 per cent speak Welsh every day. The level of Welsh spoken, particularly in the north west of the region, influences the number of people choosing to access services in Welsh. In Gwynedd, 37 per cent of people attempt to use the Welsh language at all times when contacting public services. This information has assisted the Health Board in identifying the need for Welsh medium services and has enabled us to plan based on meeting this demand.
The Welsh Language Services of the Health Board
The Health Board’s Welsh Language Team consists of four services that supports the organisation to both deliver legislative requirements and to address our patients’ needs.
1. Legislative Compliance Ensuring that we support the organisation to deliver its obligations under the Welsh Language (Wales) Measure 2011, facilitated by our Welsh Language Standards Compliance Officer. 2. Promotion and Engagement In line with the operational elements of delivering the More than just words Strategic Framework, our Welsh Language Officers actively support services and initiate projects and schemes that will provide effective customer service. 3. Training Provision Our Welsh Language Tutor and Support Officer ensure organisational
1 https://www.gwynedd.llyw.cymru/en/Council/Documents---Council/Strategies-and-policies/Health- and-Social-Services/North-Wales-Population-Assessment/NW-Population-Assessment-1-April- 2017.pdf
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development in line with our Bilingual Skills Strategy and the wider Welsh language agenda.
4. Translation Services Our senior Translator and five translators ensure that the organisation is able to provide information to patients in their preferred language, and are also providing simultaneous translation to facilitate language preference in clinical and corporate settings.
Self-regulation and Governance
Developing a clear strategy enables us to achieve our objectives and our Welsh Language Strategic Plan, has enabled us to focus through our dimensions of Behavioural Change, Strategic Intervention and Governance & Performance.
Monitoring Monitoring Strategic Workforce Planning and Interveniton Governance Performance Service Delivery
Good Practice ICT Systems
Behavioural Change
Training Corporate Identity
Communication
Our work programme over the past year has been built on these key dimensions and we have seen our services going from strength to strength.
Overall Board Accountability
Our Welsh Language Strategic Forum, chaired by our Executive Director of Public Health, establishes our internal governance arrangements. The Terms of Reference steers our strategic approach, with membership consisting of senior and active leaders who are able to drive requirements forward. The Forum reports to the Health Board’s Strategy, Partnership and Population Health Committee, which is a Committee of the
Welsh Language Services Annual Monitoring Report 2019-2020 Page 3
Board, and chaired by the Vice-Chair. There is a clear scrutiny route as well as arrangements for escalating any issues of significance.
Welsh Language Services Risk Register
It is essential that the Health Board recognises possible areas of risk in relation to the Welsh language and a dedicated Risk Register is in operation. Current potential risks include meeting the demands of the Welsh Language (Wales) Measure 2011, implementing the Active Offer principle in line with Welsh Government’s Strategic Framework More than just words, and delivering the Bilingual Skills Strategy.
All risks have remained the same during 2019-2020, and the risk rating is currently at moderate or minor. Controls have been put in place to mitigate any complex issues and to determine further actions required to achieve target risk score. The current pandemic might escalate the risks with the team’s inability to be proactive during this period. This will be taken into consideration when assessing the risks.
The Welsh Language Services Risk Register is monitored quarterly, and reported upon bi-annually to the Welsh Language Strategic Forum.
Incorporating the Welsh language into wider planning and performance
Ensuring that the Welsh language is fed into the overall wider planning of the organisation is key to achieving our goals and dimensions. The Well-being of Future Generations (Wales) Act 2015 requires us to think more about the long-term, with a focus on a Wales of vibrant culture and thriving Welsh language being one of its seven well-being goals. This drives us to work better with people, communities and other organisations, as well as directing us to adopt a more joined-up approach. As such, Welsh language requirements has been mainstreamed into our strategy for the future, Living Healthier, Staying Well, with short-term goals and commitment having been established in our Three Year Plan. This has allowed us to unite our requirements in delivering the Welsh Language Standards and More than just words, as well as having a clear focus on developing our Bilingual Skills Strategy, leading on delivering a comprehensive Translation Service and facilitating Primary Care developments as part of our cluster planning. The Welsh Language Team provide bi-annual updates to the Planning Directorate on its operational service plan, providing assurance and RAG rating of our compliance and timescales.
Welsh language requirements has been incorporated into the Integrated Quality and Performance report submitted to the Board, reporting on Welsh language data completeness of skills on the Electronic Staff Register. Any breach or failure to achieve targets requires the completion of an exception report, detailing robust actions on achieving compliance for the following quarter.
Welsh language key priorities are also incorporated into the NHS Wales Delivery Framework and bi-annual reports are submitted via our Performance Directorate for submission to Welsh Government. This has ensured that Welsh language is mainstreamed into internal processes and monitoring, securing an organisation wide platform for ownership and delivery.
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Internal Performance Assurance
Bilingual Services Monitoring (Mystery Shopper) Scheme
The Health Board has continued to operate an internal Bilingual Services Monitoring Scheme during 2019-20.
Through a combination of site visits and mystery shopper surveys, this ongoing scheme – which was originally introduced in March 2018 – continues to scrutinize the availability and quality of Welsh-medium services at various BCUHB locations on a quarterly basis.
A number of community hospitals, managed practices and acute (main) hospital departments are included in each round of surveys, which focus on signage (both permanent and temporary) and the provision of reception and telephone services.
After these inspections have been concluded, relevant site / practice / service managers are then provided with bespoke reports (which include a breakdown of the pertinent findings and suggestions for possible / required actions) and are subsequently invited to work alongside members of the BCUHB Welsh Language Team to ensure that any necessary changes and / or improvements can be put in place as quickly as possible.
As managers remain willing and committed to secure improvements, the ongoing implementation of the Bilingual Service Monitoring Scheme has continued to ensure that various shortcomings can be identified and quickly rectified at sites throughout north Wales and this has naturally contributed to the general development and enhancement of the Health Board’s Welsh-medium provision during 2019-20.
Furthermore, as some sites have now been included within the Bilingual Service Monitoring Scheme for a second time, it has recently become possible to gauge whether or not progress is being made at specific community hospitals and managed practices.
Indeed, by comparing newly collected data with initial baseline results (from surveys that were conducted during the summer and autumn of 2018), it has become increasingly clear that the general availability and quality of Welsh-medium service provision has improved at various locations during the past eighteen months.
This is especially true of sites within the Health Board’s East Area, where specific steps have recently been taken to secure progress, after a previous round of Bilingual Service Monitoring Scheme surveys revealed that the standard of Welsh- medium services at one of the region’s managed practices was unsatisfactory.
A little over a year later, the quality of bilingual provision at that particular practice has now improved significantly, whilst similar positive developments have also been recorded at a number of other East Area sites.
Along with evidencing progress, the Bilingual Service Monitoring Scheme also now provides assurance, as recent findings have confirmed that previously recorded high
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standards are being maintained at several locations in the Health Board’s West Area.
Beyond this, the ongoing ‘mystery shopper’ surveys have also continued to uncover numerous examples of existing good practice in relation to the Welsh language: these are all recorded and subsequently shared with other sites / practices / departments, as appropriate.
To ensure increased accountability, general findings are still shared with Area / Hospital Management Teams and BCUHB Welsh Language Strategic Forum members on a quarterly basis.
By doing this, broader trends continue to be identified (and dealt with), alongside more localised issues.
Welsh Language Standards
The Welsh Language Standards have now been in operation since the imposition date of the 30th May 2019. Last year’s report mentioned the internal campaign which was about to be launched to raise awareness of the new legislative requirements with the strapline ‘Are you ready?’. A series of All Users emails were sent over a few weeks prior to the 30th May to engage with staff and raise their awareness of the requirements of the Standards. An email signature was also created and added to the email signature of the Welsh Language Team as well as members of the Welsh Language Strategic Forum, and members of the Welsh Language Standards Project Management Group to ensure wide circulation.
This led to numerous enquiries from staff as well as requests for the Compliance officer to attend meetings to discuss the requirements, which also provided an opportunity for discussions on specific issues with services. Examples of meetings held include a meeting with Speech and Language Therapy team leaders in Wrexham and Flintshire, a Community Mental Health Team in Conwy, Minor Injury Operational Group Meeting, Ysbyty Alltwen. A booklet has also been created to provide information on the Welsh
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Language Standards, and Welsh language Services generally. It also includes information on ‘More than Just Words’, the translation service, learning Welsh, resources available, recruitment as well as a check list for departments.
One of the main focus for the Welsh Language Standards Project Management Group was to conduct a baseline audit of compliance with the Welsh Language Standards within their services. A comprehensive questionnaire was sent to the Hospital Directors and members of the Welsh Language Project Management Group. A fair amount of questionnaires were returned, demonstrating good progress across the Health Board in terms of awareness of the need to provide services bilingually. The analysis of the questionnaires is ongoing, with services required to provide regular updates on progress for the Welsh Language Strategic Forum. Examples of areas where progress has been made include administration services. All frontline posts are advertised with the Welsh language as an essential skill. Signage has been provided for all reception areas to demonstrate the availability of a Welsh language service. The online 10 hour course has also been widely publicised with frontline admin staff. Also, a new switchboard system is in development to ensure that Welsh speakers, via an automated message, can choose to be put through to a Welsh speaking telephonist to deal with their query. This has meant significant investment from the Health Board to improve accessibility to Welsh language services for the public. The new system will be in operation from September/October. The Welsh Language team will be involved in providing support to staff to ensure full compliance with the Welsh Language Standards from the outset.
Another focus for the Welsh Language Standards Project Management Group has been the development of an assessment in accordance with Standard 63 for assessing the need to offer courses through the medium of Welsh. An example of good practice and the Health Board adapting to the new norm during Covid-19 is a bilingual virtual ante-natal session which has been developed. The online resources are fully bilingual and the service is able to provide sessions and advice to parents in both English and Welsh.
A policy on using Welsh with inpatients is awaiting approval and focuses on rolling out the Language Choice Scheme using the orange ‘Working Welsh’ logo in magnet form to identify patients’ preferred language. This scheme Initially piloted on selected wards at Ysbyty Gwynedd, Bangor, in early 2017, has gradually been extended to other wards and hospitals throughout north Wales. Also included in the policy is the work undertaken to mainstream the Welsh language into the Ward Accreditation Scheme
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whereby staff are presented with a set of standards to frame our quality, safety and patient care agenda. The resources for the scheme include bilingual welcome boards, patient safety boards, patient experience boards, and magnetic symbols.
Several sub-groups to the Project Management Group have continued to meet in order to address more local issues and information or good practice is then fed back to the Project Management Group. One example is the group set up within Ysbyty Glan Clwyd, consisting of Administration Managers from across all services. The members have provided guidance to admin staff on dealing with telephone calls, reception services, signage, and promoting Welsh lessons, in particular the 10 hour online course provided by the Centre for Learning Welsh.
More than just words
As March 2019 marked the end of the three-year period covered by the Welsh Government’s follow-on More than just words... strategic framework, a further Action Plan was developed to provide a clear structure for continued progress in relation to the promotion and provision of Welsh language services in health, social services and social care during 2019-20.
BCUHB continues to lead the way in this field and maintaining a broad compliance with the aims and principles advocated by More than just words... remains centrally important, in this regard.
This is clearly exemplified by the continued implementation of the Health Board’s award-winning Language Choice (orange magnet) Scheme, which ensures that the delivery of the ‘Active Offer’ principle (i.e. that a Welsh-medium service can be provided without someone having to ask for it) remains at the heart of service delivery on hospital wards throughout north Wales.
Indeed, during the past twelve months, the Language Choice Scheme has been further expanded to include wards at both Ysbyty Glan Clwyd and Wrexham Maelor Hospital, whilst the instantly recognizable magnets are also now utilised to identify Welsh speaking patients at almost every community hospital within the BCUHB region.
The Health Board’s position at the forefront of Welsh-medium healthcare service provision is further reflected by the fact that some of the latest More than just words... targets had already been implemented within BCUHB for some time, before they first appeared within the Action Plan for 2019-20.
This is true of action 4.1, for example, which calls for ‘support to be given to staff to deliver services in Welsh’ by ‘focusing in particular on encouraging and empowering Welsh speakers to use and develop their Welsh language skills’: through her range of structured courses, the BCUHB Welsh Language Tutor has now been providing such support for Health Board employees over three years.
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4.1 Support to be given to staff to deliver services in Welsh, focusing in particular on encouraging and empowering Welsh speakers to use and develop their Welsh language skills.
Furthermore, BCUHB staff can also attend confidence boosting sessions, which are tailored specifically for individuals who already have some Welsh language skills, but currently lack the self-belief to use the language in the workplace.
Whilst some of the targets within the More than just words... Action Plan for 2019-20 might therefore have been influenced by initiatives that were already in place within BCUHB, the document also includes a number of other objectives, which the Health Board has been required to implement from scratch.
We have acted quickly to contribute towards the regional realisation of action 2.5 (below), for example:
2.5 The Cymraeg Byd Busnes pilots in primary care to be developed to support sharing of best practice. A toolkit for primary care to be produced as part of this work
Having initially provided a number of examples of good practice for inclusion within the proposed toolkit, a member of the BCUHB Welsh Language Team also subsequently worked alongside Cymraeg Byd Busnes and the Welsh Government on a pilot scheme to provide support for seven independent GP practices / surgeries / medical centres within the South Flintshire primary care cluster.
At the same time, another member of the team has been contributing to a similar scheme, which aims to provide basic Welsh-medium assistance and encouragement for primary care providers in Anglesey: this localized project was developed through the Fforwm Iaith Ynys Môn (Anglesey Welsh Language Forum) group and is therefore independent of the official Welsh Government primary care pilot.
Much of BCUHB’s work in relation to More than just words... is either informed, guided or supported by the North Wales More than just words... Forum, which meets on a quarterly basis to facilitate the continued regional implementation of the Welsh Government’s strategic framework for Welsh language services in health, social services and social care.
The Health Board was primarily responsible for the establishment of this multi-agency group, which first met in May 2016 and was subsequently recognised for its positive and influential work with an award in the Innovation category at the Welsh Government’s 2017 More than just words... Showcase Event in Cardiff.
The Forum – which includes representatives from a number of relevant organisations (including all six local authorities, Social Care Wales, the Wales Ambulance Service NHS Trust and Bangor University’s School of Healthcare Sciences) – has continued to thrive during the past twelve months, under the chairmanship of Morwena Edwards (who is the Corporate Director of Social Services at Gwynedd Council and also a BCUHB Associate Board Member).
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It remains a stage for sharing information and examples of good practice and continues to demonstrate the benefits of following a collaborative approach in order to ensure the successful delivery of some More than just words... objectives.
Indeed, in response to the northern Forum’s sustained success, the following action was included within the 2019-20 Action Plan:
6.2 Further support the development of the regional More than just words forums across Wales which draw together representatives from a number of health and care organisations in order to promote joint working, share best practice and support progress on a regional level.
As some other regional More than just words... groups have subsequently been established, members of the BCUHB Welsh Language Team have continued to provide advice and assistance, as required, in order to expedite their initial development.
Welsh Language Training Developments
Welsh language training has been prominent and played a key role in implementing the Welsh Language Standards and our Bilingual strategy. We continue to work strategically to prioritise delivery of Welsh language training for front line staff, including, but not limited to, the following areas: Staff in clinical services which patients / service users in the following categories will access regularly: o Children and young people o Older people o People with learning disabilities o Mental health service users o Dementia services o Stroke services o Speech and language therapy services
The Health Board’s In-house Welsh Language Training Programme
This year, we’ve been working closely with workforce in order to identify posts that are required to be ‘Welsh essential’ according to the Welsh language standards. If staff that are currently not confident or fluent in Welsh are appointed to these posts we work in collaboration with their managers in order to develop a specific Welsh language developing programme for them as part of their PADR and development in their new posts.
In order to implement a Welsh Language Developing Programme for posts advertised as ‘Welsh Essential’ we’ve re-written and revised our Welsh language Skills Matrix in order to offer a clearer guidance on what is deemed as ‘Welsh Essential’ as some
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posts require fluency in both written and verbal skills (Level 5 Welsh Language Skills), whilst other posts require verbal face to face fluency only (Level 3 Welsh Language Skills). Providing a clearer analysis of Welsh Language Skills required for posts allows more clarity for workforce and during the recruitment process. We’re continuing to work strategically, providing in house courses that are specifically developed for different areas within the health sector e.g. medical assessments, care of the elderly, reception and front of house courses, answering and dealing with telephone queries.
This year also we’ve continued to work in collaboration with the Postgraduate Centre at Ysbyty Gwynedd and developed a specific Welsh language taster course online in order to help with the recruitment of F1 and clinical fellow. The purpose of the course is to show how BCUHB can offer support for staff that want to develop their Welsh language skills.
Welsh Language Skills Certificate - Coleg Cymraeg Cenedlaethol
The Health Board is the first and only organisation in Wales other than higher education establishments to pilot this initiative. The Tystysgrif Sgiliau Iaith (Welsh Language Skills Certificate) is a recognised and accredited qualification by the Coleg Cymraeg Cenedlaethol and the Welsh Joint Education Committee developed to enable applicants to acquire a certificate evidencing their Welsh language skills and ability to work through the medium of Welsh. It also aims to boost the ability to communicate confidently and professionally in Welsh, in written and verbal form in order to respond to the needs of the local population and service users.
Following the success of the scheme in 2018/19, the Health Board has been offered to continue its collaborative working with the Coleg Cymraeg Cenedlaethol, extending the agreement further, this year 3 members of staff completed the oral examination but due to the Covid-19 pandemic the written examination has been postponed, we’re awaiting a new date for the written examination.
Working with the Work Welsh programme, National Centre for Learning Welsh
The pilot program began in 2017 with the Work Welsh initiative offering residential courses at Nant Gwrtheyrn and access to the online taster welcome course, before starting to implement a specific scheme for BCUHB in April 2018,that led to the appointment of a dedicated Support Officer to support members of staff registering and completing Work Welsh courses.
Welsh Language Training Support Officer
Exemplar of achievements and accomplishments in learning Welsh With over 650 members of staff accessing Welsh language training over the past reporting year, there are numerous examples of excellent practice and successes. Here are some inspirational examples of individuals and groups who have been learning Welsh over the past 12 months.
The Officer is a great asset and brings the following benefits to BCUHB.
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• Contact for Welsh at Work courses (Online Course, Intensive Courses and Nant Gwrtheyrn Courses)
• Online course - This course has now attracted hundreds of staff to try their hand at learning Welsh, and has led to others joining classes. This is through the officer promoting and marketing the courses and offering drop-in sessions to give staff a boost and a helping hand to continue the course. There has been considerable increase in numbers e.g. in May 2019 there were 189 registered and 18 completed the Health course, however, by October 2019 there were 282 enrolled and 35 completed this course.
• Nant Gwrtheyrn - 145 staff have now attended NG courses. All courses have been full. The officer will join the lessons for a day and act as a link between NG and the Health Board. Following attendance at NG, the Officer will offer 1: 1 support or drop in sessions to past attendees. A chat club, whose core members will be attendees of the October Intermediate Course, will start in January 2020.
• Intensive Courses - The Officer attends the classes on a monthly basis to act as a link for the attendees, as well as having the opportunity to discuss with the tutors. The Officer will also take the class for half an hour to transfer what has already been learned and apply it to the workplace.
• Ffrindiaith - a buddy scheme for fluent speakers and learners
• 1: 1 Sessions - as needed e.g. discuss learning needs, catch up, get up to the standard of intensive, residential courses.
• Learner of the Year - Organize a prestigious event that includes several elements e.g. promotion and marketing, arranging dates and venues, organizing forms and applications, organizing and securing prizes etc.
• Clebran Club (chat and a cuppa) - established in Rhyl for staff of various levels to run fortnightly
• Take beginner classes / taster / bridging Welsh on-line courses.
• Gossip Lunch - once a month in the main hospital restaurants
• Promotion and marketing stands and awareness of what is available for staff to learn Welsh
• Creating leaflets / posters / information documents for staff
• Promotional and marketing walks around community wards / departments / hospitals
• Establish a closed staff-only Facebook page as a place to discuss and voice opinions, and another for the wider public, to share information and good news
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• Write short adverts / articles for inclusion in the Health Board's weekly information bulletin
• Compile and interpret various questionnaires
• Manage BCUHB's learner information database
• First point of contact for staff wishing to learn Welsh and have comprehensive information on the availability of various courses and options available to staff appropriate to their level
Feedback from staff that have attended Nant Gwrtheyrn and other various opportunities to learn Welsh through the Work Welsh initiative
“I feel more confident using Welsh with colleagues and can understand a lot more, which helps me in MDT clinics to be able to follow what is being said if the patient prefers to speak in Welsh with other members of the MDT. I think that being able to use a few words and phrases is appreciated by patients, even if I cannot conduct my consultation in Welsh” “I have received a lot of encouragement from my colleagues to try using my welsh even if it is only a few words. I have found that the patients appreciate me attempting to speak welsh, and they understand I am learning so also encourage me. It has been useful to allow my to communicate with patients in their own language, with certain patient groups. The intensive course has played a huge part in increasing my confidence to use my welsh as before I wouldn't use it at all”
Learners feedback on intensive Work Welsh Weekly Course
Feedback from Nant Gwrtheyrn attendees “Diolch yn fawr iawn am y oppourtunity to go, it was brilliant and had a wonderful time. Very relaxed but also interesting and useful, have learnt a lot and gained a lot of confidence”
“Really great course that I have been recommending to colleagues. Enjoyed mix of class-based learning and being out and about and using Welsh within Nefyn”
Summary Since being a part of the Work Welsh initiative in April 2018 9.4% of the workforce have registered, completed and received Welsh language training whether online, a residential course at Nant Gwrtheyrn, or an intensive course (3 hours per week for a period of 87 hours or more). BCUHB are the first health board to be part of the scheme with Work Welsh in Wales, and following the success of the scheme, we are likely to be part of the scheme again at 2020-21.
Since 2017, 1,223 staff members have received training from the BIPBC tutor from various departments e.g.
- Postgrad and Undergraduate Students - Front line medical and administrative staff - Care of Elderly
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- Children and paediatric staff - Adult Mental Health Services - BCUHB Board Members including the Chief Executive and Chairman.
Welsh Learner of the Year
On the 4th March 2020, the first ever Betsi Cadwaladr University Health Board’s Welsh Learner of the Year Ceremony was held. The award was launched in the autumn during the Welsh Language Week with the aim of recognising significant contribution to learning and using Welsh in the workplace and enthusiasm in promoting the Welsh culture. From this point, and from the initial plans to arrange a small scale competition and ceremony, the developments snowballed. Over 40 nominations were received, exceeding expectations, which gave the independent judges (Nia Parry S4C, Teresa Owen, Executive Member of the Board and Medwyn Hughes, Independent member of the Board) a difficult job to compile a shortlist of 6. We received generous sponsorship for prizes at no cost to the Health Board, including:
A week in Nant Gwrtheyrn, from Nant Gwrtheyrn Two weekend courses, one by Coleg Cambria and the other from Bangor University Book tokens, 5 x £20 from the Welsh Book Council A trophy for the winner, donated by Lowri Gwyn, Lingo Refreshments, donated by Asda.
Before the award ceremony, video clips were filmed for the shortlisted six to be shown on the evening and were also shown on Facebook. The ceremony, which was held at the Optic Centre, St Asaph Business Park, was attended by 90 people, including the Chairman, Mark Polin, Teresa Owen, the Executive Director of Public Health and Medwyn Hughes, Independent member who were also on the judging panel, members of the Welsh language team, and several of the Welsh learners and their friends and family. Invitations were extended also for organisations to set up stalls. Also present was Elin Fflur from the S4C television programme ‘Heno’ who gave substantial coverage to the evening which included interviewes with the candidates. The evening was compared by the third judge, namely Nia Mark Polin, Chairman, addressing the Parry, a television presenter who is also audience and Teresa Owen, Executive a Welsh language tutor, and she Director of Public Health. announced Blair Wallace as the winner.
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Blair is originally from Scotland, and works as a Foundation Year 2 doctor at Ysbyty Gwynedd and had been learning Welsh for 2 years, starting to learn before even moving to Wales. Michelle Matthews, who works as Radiology Administrator at Ysbyty Glan Clwyd came second, with David Hostler who works as a community speech and language therapist across west and central north Wales coming third. The result was also announced on the Geraint Lloyd Radio programme on Radio Cymru, with Blair also being interviewed for the programme. The top three have taken advantage of intensive courses, and the top six have been to Nant Gwrtheyrn as part of the Work Welsh Scheme.
We hope that this competition will create more enthusiasm for learning the Welsh language within the Health Board and to emulate the excellent example of our winners.
Blair Wallace receiving his trophy from Nia Parry with Elin Fflur Lowri Gwyn, Lingo Cyf and Mared Grug from Nant Gwrtheyrn. Primary Care Services
On the 30th May 2019 new Welsh Government Regulations came into force that required all Primary Care contractors to carry out six new duties in relation to the Welsh language. This has allowed the Welsh Language team to continue to be proactive in supporting contractors to carry out these duties as well as further develop the Welsh medium and bilingual provisions they can offer and provide to the service users. To establish a baseline of what the contractors were currently offering a questionnaire was sent out during the summer of 2019 to all BCUHB primary care contractors asking them to give details about their current Welsh medium and bilingual provision.
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The response from GPs was very good, fewer responses came from dentists and opticians and 1. YDY’R SEFYDLIAD a single response from one pharmacy. Geographically the most responses were received YN: IS THE from the west area with the east coming in second ESTABLISHMENT: and less from the central area. The responses to Deintyddfa / Dental practice the questions were very mixed with some providing more Welsh/bilingual services than Feddygfa / General Practitioners others. Some positives include nearly three Fferyllfa / Pharmacy quarters of GPs had bilingual self-service Optegwyr / Opticians machines and only 3% of GPs had English only signs. Half the opticians that answered the survey 16% had bilingual websites and only one noted that 24% they only have English only signage. 2% 58%
The responses to the questionnaire led to the development of an action plan to work with the providers, and to further develop what support and advice they need and what the Health Board can offer. An information sheet was shared with what services can be offered and ways that the Welsh Language team can help e.g. access to some translation work, Welsh language awareness session for staff, resources such as lanyards and badges (denoting a Welsh speaker). This led to the delivery of some Welsh language awareness sessions for GP practise staff, delivering several items such as badges and lanyards and phrase cards to many as well as translating some practice leaflets and registration forms as well as doing some basic Welsh lessons for staff.
This work also coincided with another project with Welsh Government and Menter Iaith Fflint & Wrecsam working with one GP cluster in the area. This was a pilot project (alongside one in the Hywel Dda Health Board area) working with the Welsh for Business officer, BCUHB Welsh language officer and the GP practices in the cluster. The South Flintshire cluster was chosen and work was undertaken with seven different practices within the cluster.
The first part of this project involved a short presentation at one of their monthly cluster meetings as well as introducing the Welsh language team and what we could offer. All the practices were contacted and meetings set up with all apart form one of the practices (one practice felt they couldn’t take part at the time due to unforeseen circumstances).
Welsh for Business had a standard form to go through in each meeting which then helped to create an individual action plan to work on after the meeting. As part of this many resources were given to them such as badges, bilingual door signs and stickers as well as recording some bilingual phone systems for the practices. Also
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we showed them what they have access to via our intranet as well as arrange some translation work for signs etc. for the practices. The project worked well in helping implementing some small changes that will increase their Welsh and bilingual provision.
As a result of the work during the past year with the primary care providers we are currently working on a Primary Care campaign to guide and further support the contractors with the new Regulations.
The Translation Service
The upward trend in demand has continued again this reporting year as shown in the graph below. During the period leading up to imposition day, a 41.4 per cent increase was recorded in the demand for translation during 2018-19. This trend continued during 2019-2020 due to improved staff awareness of their obligations to comply with the Welsh Language Standards.
Number of words received per year
4500000 4000000 3500000 3000000 2500000
2000000 1500000 Numberwords of 1000000 500000 0 2015/16 2016/17 2017/18 2018/19 2019/20 Year
In order to manage the increased demand, we have worked with IT colleagues within the Health Board to develop a bespoke solution to receiving and managing translation requests. In August, our new translation portal was launched. Upon launching the portal from their home screen, staff are directed to the loading screen where their details are loaded automatically.
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From here, staff are requested to upload their document and select a return date. The system is simple and easy to use, and feedback from users has been very positive, with most stating the portal is quicker and simpler than the previous email based system. The system is also able to manage the requests, create work programmes for all translators and create advanced IRIS reports in order to analyse usage and data per department.
We have continued our collaboration with our network of partners from public sector organisations, meeting bi-annually to share learning, identify training needs and address issues such as recruitment. As a group, we have worked with education providers to discuss training needs and created a data base of systems and equipment. During the reporting year, we invested in a simultaneous translation system in order to support departments with simultaneous translation at various forums and meetings. We have regularly attended the Engagement Practitioners Forum facilitated by the Health Board Engagement Team to support with translation so that the meetings are able to be held through the medium of Welsh. We have also seen an increase in demand for simultaneous translation during interviews, with applicants
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taking advantage of the requirement within the Welsh Language Standards to offer Welsh language interviews.
Service Developments and Key Achievements
The Health Board has progressed its services even further this year with a number of developments and activities undertaken across the organisation. This section provides a brief overview of some of the most pioneering initiatives we have seen across north Wales.
BCUHB Welsh Language Week 2019
14th-18th October 2019
Following the success of the initial BCUHB Welsh Language Week in February / March 2018, a second week-long celebration of bilingualism within the healthcare sector was held in October 2019.
Various events were consequently held at a number of locations throughout north Wales, specifically in order to promote the use of the Welsh language within the Health Board and beyond.
Following collaborative work between the BCUHB Welsh Language Team and the Health Board’s Care of the Elderly Service, primary school pupils from Ysgol Gymraeg Gwenffrwd and Ysgol Plas Coch performed selections of popular Welsh language songs for older patients at Holywell Community Hospital and Wrexham Maelor Hospital, respectively.
These two events were very well-received and plans were subsequently made to hold a similar Welsh-medium sing-along for elderly patients at Ysbyty Gwynedd during the Christmas season.
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The Health Board’s younger patients were also catered for during the Welsh Language Week, as Menter Iaith Fflint a Wrecsam brought Magi Ann – a well-known children’s character – to visit the Children’s Unit at the Maelor Hospital.
Shwmae Su’mae Day was celebrated on 15th October, as members of the public and Health Board staff visited the BCUHB Welsh Language Team’s Welsh Language Week stalls at our main hospitals.
Having been provided with information about the range of courses that are provided by the BCUHB Welsh Language Tutor, a number of Health Board employees subsequently signed up to attend lessons.
On the same theme, ‘Cinio Clebran’ events were held at Ysbyty Gwynedd, Ysbyty Glan Clwyd and Wrexham Maelor Hospital: these informal gatherings provided Health Board staff who are already learning Welsh with opportunities to practice their language skills over lunch.
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The BCUHB Welsh Language Team also worked with Cymraeg i Blant to provide an information stall during a prenatal clinic in Ysbyty Gwynedd on 16th October: this allowed prospective parents and Health Board staff to learn more about the benefits of using the Welsh language with babies and young children.
Alongside these aforementioned events, which were primarily arranged for staff and / or patients on BCUHB sites, a series of seminars for secondary school pupils and further education students were also held between 14th and 18th October, in order to highlight the importance of bilingualism as a skill for young people who may be considering careers in health or social care.
Whilst hundreds of year 9 and year 10 pupils attended events at Ysgol Dyffryn Conwy (in Llanrwst), Ysgol Maes Garmon (in Mold) and Ysgol Dyffryn Ogwen (in Bethesda), a similar session was also held for health and social care students on Coleg Cambria’s Yale College site in Wrexham.
After an initial talk about ‘The importance of Welsh-medium healthcare services’ by a member of the BCUHB Welsh Language Team, each seminar also included presentations by representatives from Social Care Wales and the Coleg Cymraeg Cenedlaethol, whilst Sophie Burgess (who is a nurse at Ysbyty Gwynedd) spoke about her personal experiences of working bilingually on Tegid Ward.
Careers Wales also had stalls at some of the seminars, so pupils / students could seek further (informal and bespoke) advice, after the aforementioned presentations.
The BCUHB Welsh Language Team also worked with BBC Radio Cymru, Radio Ysbyty Gwynedd and Radio Glan Clwyd during a successful week, which undoubtedly raised the profile of Welsh-medium service provision within the Health Board.
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It’s therefore hoped that a similar celebration of the Welsh language can be arranged during 2020-21.
Language Choice Scheme
The Health Board’s award-winning Language Choice Scheme facilitates the delivery of the ‘Active Offer’ principle (see the section on More than just words...) on our wards.
Orange magnets – adorned with the instantly recognizable ‘Cymraeg: iaith gwaith’ / ‘Working Welsh’ logo – are placed on white boards above / beside beds and on staffing boards, in order to identify Welsh-speaking patients and employees (and pair them together).
Having initially been piloted on selected wards at Ysbyty Gwynedd in early 2017, the scheme has now been greatly expanded to include numerous other hospitals throughout north Wales.
It was introduced on all 22 wards at Ysbyty Glan Clwyd in June 2019 and evidence (gathered from monthly audit forms) suggests that the scheme’s initial implementation within that hospital has been successful, with many patients deciding to take advantage of its availability.
The table below shows the results of the monthly audit undertaken at several wards/units departments at YG from May 2019 – February 2020
No. of Total no. Number Number of Percentage Number of monthly of of Welsh- of Welsh- Welsh- records patients Welsh- speaking speaking speaking provided on the speaking patients patients staff on the ward patients that opted that opted ward Ward / Unit during the to partake to partake recording in the in the timeframe Language Language Choice Choice (Range) Scheme Scheme
Enfys Ward (NW Cancer Treatment 5 (Oct.) – 11 1 Centre) 2 *36+ 22 19 86.36% (Sep.)
2 (Oct. & Ward 19 (Care of the Dec.) – 5 2 Elderly) 5 119 17 17 100.00% (Jan.)
Emergency 3 Department (ED) 1 52 11 11 100.00% 7 (Oct.)
Surgical Assessment 2 (Dec.) – 3 4 Unit (SAU) 3 86 10 9 90.00% (Oct.)
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5 Ward 8 1 25 8 8 100.00% 1 (Sep.)
2 (Dec.) – 5 6 Ward 12 2 48 4 4 100.00% (Nov.)
0 (Jun. & Jul.) – 2 7 Ward 3 (Vascular) 3 36 4 2 50.00% (May)
Ears, Nose & Throat 8 (ENT) Outpatients 1 17 3 3 100.00% 2 (Sep.)
9 Ward 9 1 25 2 2 100.00% 4 (Oct.)
10 Paediatrics 1 20 2 2 100.00% 4 (Nov.)
Outpatients (Corridor 11 E) 1 14 2 2 100.00% 1 (Sep.)
Day of Surgery Arrival 0 (Nov.) – 2 12 (DOSA) 3 77 2 1 50.00% (Oct.)
Acute Medical Unit 13 (ACU) 1 24 2 0 0.00% 2 (Oct.)
14 Ward 18 1 7 1 1 100.00% 5 (Oct.)
15 Ward 19a 1 13 1 1 100.00% 1 (Sep.)
Outpatients (Ivor 16 Lewis Building) 1 12 1 1 100.00% 3 (Sep.)
Maxillofacial (MaxFax) 17 Outpatients 1 7 1 1 100.00% 2 (Sep.)
Same Day Emergency 18 Care (SDEC) 1 10 1 0 0.00% 2 (Oct.)
Dermatology 19 Outpatients 1 14 0 - - 0 (Sep.)
Intensive Care Unit 20 (ICU) 1 10 0 - - 3 (Oct.)
Gastroenterology Day 21 Unit 1 3 0 - - 2 (Oct.)
Total: 33 655+ 94 84 89.36%
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Data from the Enfys Ward (which is based within the North Wales Cancer Treatment Centre on the Ysbyty Glan Clwyd site), shows that 14 patients opted to partake in the scheme during September 2019, for example, whilst a further 11 individuals also decided to utilise the magnets whilst they were under the Emergency Department’s care the following month.
To further facilitate the delivery of the Language Choice Scheme within Ysbyty Glan Clwyd, the BCUHB Welsh Language Team worked with the Health Board’s Informatics Team to ensure that a digitized version of the orange ‘Cymraeg’ logo could also be displayed beside the names of Welsh-speaking patients on electronic whiteboards (which have recently replaced the traditional magnetic bedside boards on a number of wards within the hospital).
The electronic whiteboards are essentially large (55 inch) television screens, which allow staff to access basic information about patients in a quick and straightforward manner and including details about linguistic preferences (which can be obtained directly from the Welsh Patient Administration System) naturally makes it even easier for staff to identify which patients prefer to communicate through the medium of Welsh.
The screenshot below shows how basic patient details (including information about linguistic preferences) are displayed on the electronic whiteboards:
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Beyond the Language Choice Scheme’s inauguration at Ysbyty Glan Clwyd, the use of the orange magnets was also initiated at a number of other BCUHB sites during 2019 and following their introduction at Llandudno General Hospital, Abergele Hospital and Holywell Community Hospital, the scheme is now operational on wards within all of the hospitals in the Health Board’s Central Area.
Further east, the magnets were also introduced at Chirk Community Hospital (in April 2019), before work was subsequently undertaken to engage matrons and nursing leads at Wrexham Maelor Hospital, in preparation for the expanded implementation of the Language Choice Scheme on the Health Board’s main / acute East Area site.
Following on from this, the orange magnets began to appear on more wards at the Maelor in early 2020.
The continued popularity and success of the scheme is reflected by the fact that positive feedback is still regularly received from service users, their families and Health Board employees alike.
Mental Health Project
A project focusing on strengthening Welsh language provision within the mental health sector, as one of the priority groups as identified by Welsh Government, was conducted during 2019. The aim of the project was to increase the opportunities service users within mental health have to use the Welsh language, to identify and address any shortfalls or barriers to complying with the relevant Welsh language Legislation and to provide a more positive experience for them as a result.
As mental health is identified as one of the four priority groups within the More than Just Words framework, it is relevant and timely to focus on delivering and meeting the needs of mental health service users, as they have a particular need to communicate through the medium of Welsh, and their care or treatment might suffer if it isn’t provided in their first language. Language within this context is seen as a language need, rather than language choice.
The project, which was based at the Hergest Unit in Ysbyty Gwynedd, focused on the Welsh language awareness of staff members, scoping staff members’ Welsh language skills, implementation of the Language Choice Scheme to identify Welsh speaking patients, identifying where there is a lack of Welsh language skills, and targeting these
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areas by providing Welsh language training in order to strengthen staff members’ ability to deliver language appropriate care. Another key deliverable was to engage with service users to learn about their experiences of receiving Welsh medium care, their expectations of Welsh medium care versus the reality in order to inform improved Welsh medium provision.
A short questionnaire was distributed to mental health staff working within the Hergest Unit, following the Welsh language awareness sessions to evaluate their effectiveness and monitor whether they would lead to positive behavioural change with regards to meeting the patients’ linguistic needs, whilst ensuring compliance with the relevant Welsh language legislation.
One of the questions focused on three things the individuals had learnt following the Welsh language awareness session. All of the responses were extremely positive, with the attendees emphasising that they now fully appreciate and understand the importance of the Welsh language within the health sector, whereas before a significant number of the staff hadn’t realised the implications and the consequences of not providing a Welsh language service on patients, as well as on the process of diagnosing, assessing and treating Welsh speaking patients.
Another important aspect highlighted in the section focusing on what the individuals had learnt was the Language Choice Scheme, which is a successful way of delivering the Active Offer. As all clinical staff employed by the Health Board will be involved in delivering the active offer and providing care through the medium of Welsh for patients.
A number of respondents claimed that following the training session they were more aware of the support that is available to them as staff members in terms of the Welsh language internal training programme, the existence of an internal Welsh language Tutor, and the translation team that is available to translate all documents that are public facing. A significant number of the individuals noted that they are aware of the Welsh language Legislation and the More than Just Words Framework as a result of receiving the training session, as the sessions facilitate the process of informing staff members of the Welsh language legislation, what legal requirements and actions are required of all Health Board’s staff, but more importantly what practical steps can be taken to deliver the active offer, and comply with the Welsh language legislation. They also noted that they were more aware of the communication barriers present when using a patient’s second language, and that therefore they recognise it’s a key priority to endeavour to use any Welsh they have especially with the four vulnerable groups identified by Welsh Government; children and young people, older people, people with learning difficulties, and people with mental health problems.
The project created an enhanced understanding and awareness of the Welsh language which is a crucial element of providing care that meets the individuals’ needs, which is patient centred, and means that patients are treated with dignity and respect.
The information gathered from this project will be used to develop a similar project for the Mental Health units in the Central and East areas of the Health Board.
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Cymraeg i Blant / Cymraeg for Kids
After our Welsh language officer in Wrexham met with one of the lead officers and the new field officer for the area we arranged a visit to the Children’s Ward. During the visit they kindly gifted the Children’s Ward a selection of Welsh and bilingual children’s books to keep in the play room on the ward. We also arranged for Cymraeg for Kids to have some display banners and notices up highlighting the advantages of bilingualism, showcasing their work and examples of their community groups for families with young children on the maternity ward and clinic areas in the Wrexham Maelor. The Cymraeg for Kids officers have also been visiting the hospital during clinics to chat to expectant mothers and families about the benefits of bilingualism and some examples of the different groups they hold in the community.
Cymraeg for Kids also took part (as mentioned above) in two of our Welsh Week activities and we continue to work closely with them and meet quarterly as we plan our next collaborative projects.
Working with schools and colleges
Building on the success of previous work, the BCUHB Welsh Language Team continued to collaborate with schools and further education institutions, in order to promote the benefits of bilingual skills, during 2019-20.
Events and seminars for secondary school pupils / further education students
A number of seminars were held at locations throughout north Wales during the Health Board’s annual Welsh Language Week (in October 2019): whilst around four hundred year 9 and year 10 pupils attended events at Ysgol Dyffryn Conwy (in Llanrwst), Ysgol Maes Garmon (Mold) and Ysgol Dyffryn Ogwen (Bethesda), a further session was also held for health and social care students on Coleg Cambria’s Yale College site in Wrexham.
All of these seminars were arranged in conjunction with Social Care Wales, the Coleg Cymraeg Cenedlaethol and Careers Wales and further details about their delivery and content can be found in the section that focuses specifically on the BCUHB Welsh Language Week.
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Beyond this, the Welsh Language Team has also continued to contribute to a number of careers events arranged by external organisations: a member of the team gave a presentation entitled ‘The Welsh language: an all-important skill for the workplace’ during Grŵp Llandrillo Menai’s Health and Social Care Conference at the end of November 2019, for example.
This one-day event was held at Bangor University and also included a careers fair, which was attended by a large number of Grŵp Llandrillo Menai students.
Many of those present took the opportunity to discuss their future aspirations and career plans with a member of the BCUHB Welsh Language Team and subsequently received further advice about the advantages of having bilingual skills (in the context of healthcare service provision).
Likewise, the Welsh Language Team also contributed to a number of Careers Wales events during 2019-20.
Having participated in a ‘Welsh Language in the Workplace’ seminar for year 10 pupils at Rhyl High School in November 2019, the team also subsequently contributed to similar sessions at the Maelor School (in Penley, near Wrexham) and Ysgol Aberconwy.
As all of these events were held at English-medium schools, they afforded opportunities to promote the importance of Welsh-medium healthcare services to audiences of primarily non-Welsh speaking pupils and / or learners, who might not have previously been encouraged to consider the advantages of bilingualism.
A member of the Welsh Language Team was also present at a Careers Wales- arranged ‘Cymraeg yn y Gweithle’ / ‘Welsh in the Workplace’ event at Eirias Park in Colwyn Bay, on 2nd October 2019.
Pupils from several local secondary schools attended this careers fair, which also featured a number of other prominent employers from the north Wales region.
On the same day, around fifty health and social care students from Coleg Menai, Bangor, attended a session about the ‘Importance of Welsh-medium healthcare service provision’ during a visit to Ysbyty Gwynedd.
After an introductory presentation, a member of staff from the hospital’s pharmacy spoke about his use of Welsh within the workplace, before the students were subsequently taken on a tour of selected wards, where they learned more about the importance of the ‘Active Offer’ principle (which is a central facet of the Welsh Government’s More than just words... strategic framework for Welsh Language Services in Health, Social Services and Social Care).
A member of the BCUHB Welsh Language Team also contributed to a World of Work event at Wrexham’s Ysgol Morgan Llwyd in February 2020.
Careers Wales webinars
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Additionally, two Health Board representatives also participated in a Welsh-medium webinar for Careers Wales in October 2019.
The session’s primary aim was to provide year 9 pupils with information about careers within the healthcare sector and a recorded version has subsequently been made available as an online resource to all secondary schools in Wales (via YouTube).
Work with primary schools
The BCUHB Welsh Language Team also contributed to three Career Wales ‘Welsh in the workplace’ events for primary school pupils during the spring and early summer of 2019.
These speed-networking events – which also featured a number of other leading employers from north-east Wales – were held at Ysgol y Grango, in Rhosllanerchrugog (on 8th April 2019) and Ysgol Rhiwabon (on 23rd May and 6th June) and were designed to help year 6 pupils to develop their communication skills and confidence, whilst learning about the use of Welsh within various workplaces.
Prompted by a series of prearranged questions, the Welsh Language Team’s representative provided hundreds of pupils from a number of local schools (including Ysgol I. D. Hooson, Ysgol Maes y Mynydd, Ysgol yr Hafod and Penycae Community Primary School) with pertinent information about the importance of Welsh-medium healthcare services and the benefits of bilingualism.
Work with universities
The BCUHB Welsh Language Team contributed to two Bangor University modules in March 2020: students on the ‘O’r Senedd i’r Swyddfa’ (‘From the Parliament to the Office’) and ‘Cymdeithas, Iaith a Phrotest' (‘Society, Language and Protest’) courses were provided with a PowerPoint presentation, which included information about bilingual healthcare service provision and how the use of the Welsh language is promoted within BCUHB.
The visual presentation was accompanied by a full Welsh-medium audio track to facilitate the students’ learning.
In an innovative development, the BCUHB Welsh Language Team also recently worked with Wrexham’s Glyndŵr University to provide basic Welsh language training for Occupational Therapy and Physiotherapy students.
A total of seventy students attended three lessons and consequently learned simple Welsh-medium phrases and sayings, including greetings, numbers, parts of the body and some other words they might see around the hospital.
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The Welsh Language Team also recently agreed to support Bangor University’s ARFer project, which looks at linguistic practices and aims to promote and facilitate the use of the Welsh language within workplaces.
Initial talks were held with representatives from Canolfan Bedwyr (the university’s Centre for Welsh Language Services, Research and Technology) about the possibility of introducing the project within selected GP practices in Anglesey, before the proposed venture was temporarily halted due to the ongoing Covid-19 pandemic.
Performance Indicators Data
The data requirements differ this year in accordance with the new Welsh Language Standards. The data included below are in accordance with Standard 120 of the Welsh Language Standards (Welsh Language (Wales) Measure 2011).
Workforce Planning
During the reporting year, an Internal Audit was undertaken to establish whether there is a robust control environment in place within the Health Board to action the requirements of the Bilingual Skills Strategy and ensure compliance with the Welsh Language Measure (Wales) 2011. The approach to this review was to identify and evaluate controls in place and highlight potential weaknesses.
The review focussed on the following: Management and administration of vacant posts deemed Welsh language Essential; Vacancy justification; Supporting policies and guidance notes; and Accuracy and consistency of reporting.
The report received was based upon the information provided, responses during discussions and on documents provided.
To support compliance with the Welsh Language (Wales) Measure 2011, the Health Board has developed a Bilingual Skills Strategy which is underpinned by relevant Health Board Workforce policies. The Strategy is designed to, “enable effective workforce planning and recruitment to ensure the delivery of bilingual services through the medium of Welsh and English, according to individual choice and the needs of the population in the area”.
The Strategy states that the aim of the skills strategy is: “…to ensure that BCUHB has the sufficient number of staff with the appropriate Welsh language skills, to provide a healthcare service to the public bilingually, according to the needs of the local community.”
As part of the requirements, the Strategy mandates certain Health Board posts as Welsh language essential. The following posts are deemed as such: Switchboard Staff, Patient Booking Centres / Call Centre Staff and Receptionists.
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This review focused solely on the management and administration of Welsh essential posts, and compliance with Section 5 of the Bilingual Skills Strategy, WP1 BCUHB Policy for Safe Recruitment Selection Practices, and WP1a BCUHB Safe Recruitment Selection Practices Guidelines.
Whilst the Health Board has robust policies, guidance document, and reporting in place to support adherence to the Welsh Language (Wales) Measure 2011, some issues and limitations were noted, including the Bilingual Skills Strategy requirements not explicitly stated in the policy documentation, and some lack of awareness of the Bilingual Skills Strategy.
There were three recommendations included within the report
Management should review current practice and put in place controls to ensure that essential post requirements are either met or that training is undertaken allow successful applicants to meet the requirements. Management should review current practice and put in place controls to ensure that the requirements of the Bilingual Skills Strategy are met. Consider whether current practice meets the requirements of the Bilingual Skills Strategy.
In light of this report, the Bilingual Skills Strategy has been updated and strengthened and is awaiting final approval. The Workforce team has taken the recommendations on board and has tightened processes to ensure it fully meets the requirements of the Welsh Language Standards.
2019 / 2020 Data:
89 per cent of the entire workforce had recorded their Welsh language skills on ESR
2018 / 2019 Data:
88.5 per cent of the entire workforce had recorded their Welsh language skills on ESR
2017 / 2018 Data:
83.77 per cent of the entire workforce had recorded their Welsh language skills on ESR
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Number and percentage of the organisation’s employees: - whose Welsh language skills have been assessed; - that has Welsh language skills (per skill level)
Across the organisation
Count of Employee Number 2017/18 2018/19 2019/20
Individual Proficiency Level Total % Total % Total % 0 - No Skills / Dim Sgiliau 7165 38.57 7954 43 8031 42.4% 1 - Entry/ Mynediad 2336 12.57 2366 13 2443 13% 2 - Foundation / Sylfaen 1171 6.30 1185 6 1227 6.5% 3 - Intermediate / Canolradd 1203 6.48 1243 6.5 1254 6.6% 4 - Higher / Uwch 1546 8.32 1502 8 1525 8.1% 5 - Proficiency / Hyfedredd 2141 11.53 2217 12 2338 12.4%
Total 15,562 83.77% 16,467 88.5% 16,818 89% Total number of staff 18,577 18,624 18,922
Number and percentage of employees working in the following priority group services, whose Welsh language skills have been assessed, per skill level:
Paediatrics School nursing Health visiting Elderly care medicine Speech and Language Therapy Learning Disabilities Mental health services: - Child and Adolescent - Adult - Community - Older People
Paediatrics Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 230 40 127 33.2% 1 - Entry/ Mynediad 69 12 52 13.6% 2 - Foundation / Sylfaen 33 6 22 5.7% 3 - Intermediate / Canolradd 36 6 24 6.3% 4 - Higher / Uwch 32 6 19 5% 5 - Proficiency / Hyfedredd 85 15 66 17.2
Total 485 85% 310 81% Total number of staff 571 383
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School Nursing Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 54 41 58 45 1 - Entry/ Mynediad 22 17 17 13.2 2 - Foundation / Sylfaen 2 2 1 0.8 3 – Intermediate / Canolradd 4 3 3 2.3 4 - Higher / Uwch 17 13 18 13.9 5 - Proficiency / Hyfedredd 26 20 26 20.1
Total 123 92.5% 123 95.3% Total number of staff 133 129
Health Visiting Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 105 34 123 38.4 1 - Entry/ Mynediad 47 15 53 16.6 2 - Foundation / Sylfaen 20 6 17 5.3 3 - Intermediate / Canolradd 24 8 26 8.1 4 - Higher / Uwch 36 12 34 10.6 5 - Proficiency / Hyfedredd 48 16 52 16.3
Total 280 91% 305 95.3 Total number of staff 308 320
Elderly Care Medicine Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 74 30.5 67 28.1 1 - Entry/ Mynediad 23 9 18 7.6 2 - Foundation / Sylfaen 19 8 20 8.4 3 - Intermediate / Canolradd 14 6 18 7.6 4 - Higher / Uwch 44 18 47 19.7 5 - Proficiency / Hyfedredd 31 13 26 10.9
Total 205 84.5% 196 82.3 Total number of staff 243 238
Speech and Language Therapy Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 66 40 69 40.6 1 - Entry/ Mynediad 15 9 14 8.3 2 - Foundation / Sylfaen 7 4 9 5.3 3 - Intermediate / Canolradd 19 11 18 10.6 4 - Higher / Uwch 22 13 23 13.6 5 - Proficiency / Hyfedredd 36 22 35 20.6
Total 165 99% 168 99% Total number of staff 166 170
Welsh Language Services Annual Monitoring Report 2019-2020 Page 33
Learning Disabilities Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 126 33.5 119 32.4 1 - Entry/ Mynediad 66 17.5 64 17.4 2 - Foundation / Sylfaen 39 10 41 11.2 3 - Intermediate / Canolradd 36 10 35 9.5 4 - Higher / Uwch 47 13 47 12.8 5 - Proficiency / Hyfedredd 54 14 51 13.9
Total 368 98% 357 97.2 Total Number of staff 376 367
Mental Health Services - overall Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 784 40 777 39.4 1 - Entry/ Mynediad 307 16 311 15.8 2 - Foundation / Sylfaen 153 8 161 8.2 3 - Intermediate / Canolradd 190 10 182 9.2 4 - Higher / Uwch 156 8 170 8.5 5 - Proficiency / Hyfedredd 234 12 236 11.9
Total 1824 94% 1837 93% Total number of staff 1946 1974
Mental Health Services - CAMHS Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 117 51 115 50.4 1 - Entry/ Mynediad 30 13 38 16.7 2 - Foundation / Sylfaen 16 7 15 6.6 3 - Intermediate / Canolradd 14 6 15 6.6 4 - Higher / Uwch 10 4 11 4.8 5 - Proficiency / Hyfedredd 15 7 15 6.6
Total 202 88% 209 91.7 Total number of staff 230 228
Mental Health Services - Community Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 158 38 144 35.8 1 - Entry/ Mynediad 79 19 68 16.9 2 - Foundation / Sylfaen 32 8 38 9.5 3 - Intermediate / Canolradd 45 11 48 11.9 4 - Higher / Uwch 22 5 23 5.7 5 - Proficiency / Hyfedredd 55 13 57 14.2
Total 391 94% 378 94% Total number of staff 418 402
Welsh Language Services Annual Monitoring Report 2019-2020 Page 34
Mental Health Services - Adult Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 233 43 260 42.6 1 - Entry/ Mynediad 66 12 90 14.8 2 - Foundation / Sylfaen 47 9 57 9.3 3 - Intermediate / Canolradd 57 10 55 9 4 - Higher / Uwch 33 6 40 6.5 5 - Proficiency / Hyfedredd 85 16 84 13.8
Total 521 96% 586 96% Total number of staff 543 610
Mental Health Services - Elderly Count of Employee Number 2018/19 2019/20 Individual Proficiency Level Total % Total % 0 - No Skills / Dim Sgiliau 91 40 82 41 1 - Entry/ Mynediad 46 20 40 20 2 - Foundation / Sylfaen 10 4 7 3.5 3 - Intermediate / Canolradd 22 10 19 9.5 4 - Higher / Uwch 20 9 20 10 5 - Proficiency / Hyfedredd 24 11 22 11
Total 213 94% 190 95% Total number of staff 226 200
Training to Improve Welsh Language Skills
As already outlined within the report, we have seen considerable progress in Welsh language training provision within the Health Board. The following data demonstrates significant increase in the number of staff accessing training, reflecting the positive outcomes of this innovative role within the health sector.
Work Welsh Courses
Online Courses 893 Residential Courses at Nant Gwrtheyrn 61 Intensive Courses (3 hours a week) 34 Total 988
BCUHB Courses 2020-21
Beginners – Level 0-1 72 Foundation – Level 2 73 Intermediate – Level 3 12 Advance – Level 4 6 Gain More Confidence Courses 6 Postgraduates YG course 42 Undergraduates YG Course 60 Total 271
Welsh Language Services Annual Monitoring Report 2019-2020 Page 35
All numbers : 1259
Number and percentage of the organisation’s workforce that received training to improve their Welsh skills to a specific qualification level
2019 / 2020 Data:
Number of the organisation’s workforce that have accessed training to improve their Welsh skills to a specific qualification: 1259
This total equates to 6.6 per cent of the Health Board’s current workforce
2018 / 2019 Data:
Number of the organisation’s workforce that have accessed training to improve their Welsh skills to a specific qualification: 837
This total equates to 5.1 per cent of the Health Board’s current workforce
Recruitment
Number and percentage of new and vacant posts advertised with the requirement that:
2019 / 2020 Data:
- Welsh language skills are essential - 200 (6.2 per cent) - Welsh language skills are desirable - 3006 (93.7 per cent) - Welsh language skills to be learnt - 4 (0.1 per cent) - Total number of posts advertised - 3210
2018 / 2019 Data:
- Welsh language skills are essential - 59 (2 per cent) - Welsh language skills are desirable - 2790 (98 per cent) - Welsh language skills not required - N/A
Welsh Language Services Annual Monitoring Report 2019-2020 Page 36
2017 / 2018 Data:
- Welsh language skills are essential - 53 (1.9 per cent) - Welsh language skills are desirable - 2845 (98.3 per cent) - Welsh language skills not required - N/A -
Welsh language skills requirements continue to be assessed as part of the Health Board’s recruitment processes in line with the Bilingual Skills Strategy. The number of posts advertised as Welsh essential has increased by 6% this year, following another drive to ensure Welsh language requirements are considered as a skill when advertising. Also, as previously mentioned, an Internal Audit was conducted during 2019 by Shared Services to establish whether there is a robust control environment in place within the Health Board to action the requirements of the Bilingual Skills Strategy which has contributed to this increase.
All posts advertised require either Welsh language as an essential skill, Welsh language as a desirable skill or Welsh language skills to be learnt. The Health Board undertook the innovative decision to ensure no post was advertised stating that Welsh language skills are not required. Should there be a requirement to amend the Welsh Language level of a post, this can only be changed through a full assessment with the WOD Bilingual Skills Lead.
A ‘Welsh Language Requirements’ section is included in the Personal Specification, ensuring Welsh language skills, whether essential or desirable for a post, are noted prominently.
Complaints
Number of complaints received about the implementation of the Welsh Language Scheme
From the 30th May 2019, any complaints received were in relation to compliance with the new Welsh Language Standards. The Health Board received five complaints during the year in relation to compliance with the new Welsh Language Standards, which were fully addressed under the Putting Things Right Regulations. Three complaints moved on to the investigation stage by the Welsh Language Commissioner. Although two investigations were responded to prior to the coronavirus outbreak, the Welsh Language Commissioner decided that no additional pressure would be put on the NHS and therefore they would delay making decisions about investigating any new complaints until the emergency is over. Similarly, they also delayed investigations that had already been opened where there was a need for contact with the Health Board and would not ask for evidence of the implementation of enforcement action imposed by previous investigations.
Welsh Language Services Annual Monitoring Report 2019-2020 Page 37
Conclusion and Forward Vision for 2020 - 2021
Through its strategic planning, the Health Board has a clear vision for the next three years with its key focus on further developing the following service areas:
Continuing to deliver the Welsh Language Standards across the organisation Planning the workforce through the implementation of the Bilingual Skills Strategy Promoting and implementing the ‘Active Offer’ principle in line with Welsh Government’s Strategic Framework More than just words Develop and strengthen bilingual primary care services Provide a comprehensive translation service for the whole of the organisation
Partnership working will continue to be a focus for the Health Board with links already established to progress the Cymraeg for Kids project supporting the Welsh Government’s Welsh language strategy Cymraeg 2050: A million Welsh speakers. We will see further developments with partners as we support wider integrated working with local authorities.
Having identified the need to raise awareness amongst young people of the Welsh language being an employment skill, and seeing the success of our visits to local schools and colleges, the Health Board will endeavour to continue to engage with both Welsh and English medium secondary schools although this may not be possible to the same degree as previous years because of the pandemic.
Work has been ongoing with the primary care sector as demonstrated within this report, and this work will be further developed as part of the Standards and proposed duties on contractors as well as a campaign to promote the services offered by the Welsh Language Team to support the primary care sector in developing their capacity to provide bilingual healthcare for Welsh-speaking patients.
We will also be expanding a project with our Mental Health Division to scope our current provision in other areas within the Health Board and through service user engagement, we will work together to identify areas and type of support required. These actions feed into the Health Board’s wider planning and will be a continuous programme of work, monitoring and governance.
This is the Health Board’s first report on the implementation of the Welsh Language Standards, and although the report is in a similar format to previous reports, all the work undertaken by the Welsh Language Team as demonstrated in the report, contribute to Health Board’s compliance with the Standards.
Significant progress has been made in: Improving the quality of care we provide through the language of choice Increasing compliance with legal and statutory requirements Identifying initiatives that have been implemented and rolled out to respond to language need as an integral element of care
Welsh Language Services Annual Monitoring Report 2019-2020 Page 38
Improving organisational development in terms of how we are able to support the workforce to be able to deliver services through the medium of Welsh
We are now eager to progress our work further in delivering statutory obligations so we can further improve our services for our Welsh-speaking patients in their language of choice, and endeavouring to change the way some of our work is undertaken within digital platforms with the current constraints placed on the healthcare sector.
Welsh Language Services Annual Monitoring Report 2019-2020 Page 39
3.1 20.103 Adroddiad Monitro Cynnydd y Cynllun Blynyddol / Annual Plan Monitoring Progress Report - Mark Wilkinson 1 20.103a Q2PMR Board - August 2020.docx
1
Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.20
Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Quarter Two Plan monitoring report Report Title: Cyfarwyddwr Cyfrifol: Mark Wilkinson Executive Director of Planning & Performance Responsible Director: Awdur yr Adroddiad Jill Newman, Director of Performance Report Author: Craffu blaenorol: This paper has been scrutinised and approved by the Executive Prior Scrutiny: Team and the Executive Director of Planning and Performance.
Atodiadau None Appendices: Argymhelliad / Recommendation: The Board is asked to note the report.
Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation:
This report provides a self-assessment by the executive leads of the progress being made in delivering the key actions contained in the 2020/21 Operational Plan for Quarter 2.
Cefndir / Background:
The operational plan has a number of key actions required to be delivered during Quarter 2 of 2020/21. The Executive lead reviews on a monthly basis progress against their areas for action and RAG-rates progress. Where an action is complete this is RAG rated purple, where on course to deliver Quarter end position the rating is green. Amber and red ratings are used for actions where there are risks to manage to secure delivery or where delivery is no longer likely to be achieved. For Red rated actions a short narrative is provided.
Asesiad / Assessment & Analysis 2
Strategy Implications Delivery of the operational plan actions is key to implementation of the Boards strategy
Options considered N/A
Financial Implications Delivery of the operational plan within the budget set by the Health Board is part of ensuring resources are well-managed and care effectively provided within the allocated resources.
Risk Analysis The RAG-rating reflects the risk to delivery of key actions
Legal and Compliance
The Report will be made public once published with papers and Agenda for Health Board
Impact Assessment The operational plan has been Equality Impact Assessed.
Y:\Board & Committees\Governance\Forms and Templates\Board and Committee Report Template V2.0 July 2020.docx 1 20.103b BCU Quarter Two Plan Monitoring Report - August 2020 FINAL v2.0.pdf Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate
Quarter 2 2020/21Plan Monitoring Report
August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate Overview and Purpose of this Report
• The Quarter 2 Plan of the Health Board has been agreed by the Board • The Plan recognises that the disruptive nature of the pandemic has shortened planning horizons, resulting in plans being time limited to quarterly plans for 2020-21 • The Quarter 2 plan relates to the need to maintain essential non Covid-19 services to minimise risk of harm for life-saving or life-impacting treatments. • This report is a self-assessment by the Executive Director responsible for each of the work streams of likelihood to deliver the actions set out in the plan by the 30th September 2020, with supporting narrative where the risk to delivery is rated as red, i.e. unlikely to be achieved. This report provides an update from each Executive Director for the end of July 2020 actual position. The entire report is the reviewed and approved by the Executive Team. • Work is underway in developing the plan for Q3 and Q4 which will also reflect the shift in phasing of response to the pandemic from mobilisation towards parallel running of the pandemic and re-activation of some business as usual activities where it is safe to do so. This will reflect transition to sustainable service delivery phase of the plan. In the plan for Q3 and Q4 plan actions incomplete at the end of Q2 2019/20 will be included with revised timescales to deliver, where these actions are still relevant for delivery. By end of RAG Every month end Actions depending on RAG rating given Quarter Off track, serious risk of, Where RAG given is Red: - Please provide some short bullet points explaining Red Not achieved or will not be achieved why and what is being done to get back on track Some risks being Amber N/A Where RAG is Amber: No additional Information required managed On track, no real Green Achieved Where RAG is Green: No additional Information required concerns Purple Achieved N/A Where RAG is Purple: No additional Information required
BCU Quarter 2 2020/21 2 Plan Monitoring Report August2020 Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate Table of contents
Front Cover 1 About this Report 2 Chapter 7: Acute Care – Implementation of our Table of Contents 3 Acute Operational Model across North Wales 18 to 23 Pages 1 - 6
Chapter 1: Improving Quality Outcomes 4 Chapter 8: Planned Care 24 & 25
Chapter 2: Test, Trace & Protect 4 Chapter 9: Unscheduled Care 26
Chapter 3: Promoting Health & Well-being 5 Chapter 10: Workforce Pages 1 -3 27 to 29
Chapter 4: Primary Care Pages 1 -7 6 to 13 Chapter 11: Digital Health/ IM&T 30 & 31
Chapter 5: Community Care Pages 1 - 3 14 to 16 Chapter 12: Capital 32 Chapter 6: Mental Health & Learning Disabilities 17 Further Information 33
BCU Quarter 2 2020/21 3 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 1: Improving Quality Outcomes Planning & Performance Directorate
QP 01 Improving Quality Outcomes RAG Rating Scrutinising likelihood of End of End of Action 2019/20 Action Lead Target Date Board delivery by July August Number AP Ref. Committee 30.9.20 2020 2020 Publish revised year 3 of Quality Executive Director Nursing & AN1.1 30.09.2020 AP 040 QSE Improvement Strategy Midwifery G G G
Chapter 2: Test, Trace, and Protect
QP 02 Test, Trace, and Protect RAG Rating Scrutinising likelihood of End of End of Action 2019/20 Action Lead Target Date Board delivery by July August Number AP Ref. Committee 30.9.20 2020 2020 Establish a timely testing programme Executive Director Of Public AN2.1 30.09.2020 N/A SPPH for antibodies and antigens Health G G G Lead the development of a 12/24, 7/7 Executive Director Of Public AN2.2 30.09.2020 N/A SPPH comprehensive tracing programme Health G G G
Executive Director Of Public AN2.3 Establish ‘Protect’ programme 30.09.2020 N/A SPPH Health G G G
Executive Director Of Public AN2.4 Develop Test, Trace, and Protect 30.09.2020 N/A SPPH Health G G G
BCU Quarter 2 2020/21 4 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 3: Promoting Health & Well-being Planning & Performance Directorate
QP 03: Promoting Health & Well-being RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Review of Healthy Weight Services for Executive Director of Primary & AN3.1 31.07.2020 AP 002 SPPH children Community Care A R R
AN3.1: Review of Healthy Weight Services for Children Business case and options appraisal complete. Funding for preferred option has been confirmed as recurrent via BAHW monies. Recruitment to posts can now commence Sept/Oct 2020.
BCU Quarter 2 2020/21 5 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 4: Primary Care Page 1 of 7 Planning & Performance Directorate
QP 04: Achieve compliance with the Primary Care Operating Framework RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Use the World Health Organisation framework for essential healthcare services as a schema to ensure we Executive Director Primary & AN4.1 31.07.2020 N/A SPPH are delivering the breadth of essential Community Care G A G services in primary care during COVID- 19 Align with the national Strategic Programme to undertake a review of Executive Director Primary & AN4.2 30.09.2020 N/A SPPH Betsi Cadwaladr commissioned Community Care A A A Enhanced Services during Q2. Development of Locality 2020/21 Executive Director Primary & AN4.3 30.09.2020 N/A SPPH Plans Community Care A A A Identify actions for primary care for Q3 Executive Director Primary & AN4.4 and Q4, with a focus on Winter 11.09.2020 N/A SPPH Community Care A A G planning
BCU Quarter 2 2020/21 6 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 4: Primary Care Page 2 of 7 Planning & Performance Directorate
QP 05: Capture and embed proven technologies in primary care RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Capture good practice /legacy actions from use of technology and different Executive Director Primary & AN5.1 working practices during first phase of 30.09.2020 N/A SPPH Community Care G A A COVID-19, and share these across primary care Build on the initial implementation of Executive Director Primary & AN5.2 virtual attendances in General Medical 30.09.2020 N/A SPPH Community Care G G G Services. Build on the initial implementation of Executive Director Primary & AN5.3 the e-Consult web-based self-triage 30.09.2020 N/A SPPH Community Care G G G platform in General Medical Services.
Ensure patients know how to access primary care services and are Executive Director Primary & AN5.4 30.09.2020 N/A SPPH confident about new ways of working Community Care G G G (virtual or if appropriate, face-to-face). Increase use of primary care Executive Director Primary & AN5.5 technology within care home settings 30.09.2020 N/A SPPH Community Care A A A as requested by care homes
BCU Quarter 2 2020/21 7 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 4: Primary Care Page 3 of 7 Planning & Performance Directorate
QP 06: Efficient and effective immunisation activities RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Develop locality level flu immunisation Executive Director Primary & AN6.1 delivery plans for 2021 31.08.2020 N/A SPPH Community Care G A G Linked to Action 3.5 & 6.3 In partnership with Public Health and Welsh Government colleagues, prepare rolling plans for the delivery in Executive Director Primary & AN6.2 14.09.2020 N/A SPPH Primary Care of Covid-19 vaccination Community Care G A A programme that can be enacted as soon as a vaccine is available. Review uptake of childhood immunisations and implement catch Executive Director Primary & AN6.3 30.09.2020 N/A F&P up programmes as required Linked Community Care A A G to Action 3.5 & 6.1
BCU Quarter 2 2020/21 8 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 4: Primary Care Page 4 of 7 Planning & Performance Directorate
QP 07: Develop the Primary Care & Community Academy RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Further develop the Advanced Executive Director Primary & AN7.1 Paramedic Practitioner Pacesetter 30.09.2020 N/A SPPH Community Care G A G Project Develop our version of Scottish Project Joy scheme for the Executive Director Primary & AN7.2 30.09.2020 N/A SPPH recruitment of general practitioners & Community Care A R R senior primary care clinicians Develop business case for Education Executive Director Primary & AN7.3 and Training Local Enhanced 30.09.2020 N/A F&P Community Care G A A Services
Progress support programme for General Practitioner practices in Executive Director Primary & AN7.4 30.09.2020 N/A SPPH partnership with Royal College of Community Care G A A General Practitioners
Further develop the Academy website and social media marketing and Executive Director Primary & AN7.5 promotional material to capitalise 30.09.2020 N/A SPPH Community Care G A G upon positive recruitment interest that the initiative has brought.
BCU Quarter 2 2020/21 9 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 4: Primary Care Page 5 of 7 Planning & Performance Directorate
QP 08: Implement General Medical Services Recovery Plan RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Agree changes to local covid-19 assessment centres with each Locality Executive Director Primary & AN8.1 that allow step up/ down as 30.09.2020 N/A SPPH Community Care G G G appropriate according to prevailing incidence. Commission revised care homes Executive Director Primary & AN8.2 31.07.2020 N/A F&P Directed Enhanced Service contract. Community Care G G G Support General Practitioner practices with its readiness for recovery including provision of dedicated Executive Director Primary & AN8.3 31.07.2020 N/A SPPH protected education time session and Community Care G G G a recovery plan toolkit alongside Welsh Government Operational Guide Prescribing plan to reduce foot-fall and Executive Director Primary & AN8.4 workload associated with repeat 31.08.2020 N/A SPPH Community Care A A A prescribing
BCU Quarter 2 2020/21 10 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 4: Primary Care Page 6 of 7 Planning & Performance Directorate
QP 09: Implement Dental Services Recovery Plan RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Implement Welsh Government Dental Executive Director Primary & AN9.1 30.09.2020 N/A SPPH Recovery Plan Community Care G G G Continuation & strengthening of Urgent Designated Dental Centres provision Executive Director Primary & AN9.2 30.09.2020 N/A SPPH for those requiring aerosol generating Community Care G G G procedures Implement the national ‘buddy’ system Executive Director Primary & AN9.3 30.09.2020 N/A SPPH to inform contract reform Community Care R R R
QP 10: Implement Community Pharmacy Recovery Plan RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Implement Welsh Government Executive Director Primary & AN10.1 30.09.2020 N/A SPPH Community Pharmacy Recovery Plan Community Care G G G Improve rapid access to palliative care Executive Director Primary & AN10.2 31.07.2020 N/A SPPH drug Community Care A R A
BCU Quarter 2 2020/21 11 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 4: Primary Care Page 7 of 7 Planning & Performance Directorate
QP 011: Implement Community Optometry Recovery Plan RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Implement Welsh Government Executive Director Primary & AN11.1 30.09.2020 N/A SPPH Optometry Recovery Plan Community Care G G G Support the delivery of reinstated secondary care pathways e.g. Executive Director Primary & AN11.2 Glaucoma, Wet Age-Related Macular 30.09.2020 N/A F&P Community Care A R A Degeneration, Optometric Diagnostic and Treatment Centres Address backlog of activity arising Executive Director Primary & AN11.3 30.09.2020 N/A F&P due to Covid. Community Care G G G Reinstate full access to urgent care Executive Director Primary & AN11.4 30.09.2020 N/A F&P pathway Community Care G G G
QP 12: Develop primary care out of hours services and NHS 111 RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Implement agreed management Executive Director Primary & AN12.1 31.07.2020 N/A SPPH structure for Out of Hours Community Care A A A Prepare for implementation of new Executive Director Primary & AN12.2 clinical system and implementation of 30.09.2020 N/A SPPH Community Care A A A 111
BCU Quarter 2 2020/21 12 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 5: Primary Care Narratives Planning & Performance Directorate
AN7.2: Develop our version of Scottish Project Joy scheme for the recruitment of general practitioners & senior primary care clinicians It is proposed that this action is deferred until Q4 and into 2020/21, this will require additional funding to be secured for which the business case is currently being developed.
AN9.3: Implement the national ‘buddy’ system to inform contract reform The Contract Reform programme is currently on hold during the amber phase of the COVID response. Where required practices are buddied with Contract Reform practices to provide support and guidance.
BCU Quarter 2 2020/21 13 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 5: Community Care Page 1 of 3 Planning & Performance Directorate
QP 13: Deliver safe Community Hospital services RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Consolidation of Home First / Step Executive Director Primary & AN13.1 31.07.2020 N/A QSE Down pathways Community Care G G G
Consolidation of covid related Executive Director Primary & AN13.2 31.07.2020 N/A QSE protocols in Community Hospitals Community Care G G G
Maximising stroke rehabilitation Executive Director Primary & AN13.3 services 30.09.2020 N/A QSE Community Care A R R
Linked to Action 28.5
AN13.3: Maximising stroke rehabilitation services Progress will be made in September to utilise video consultations where appropriate to increase capacity and support for stroke rehabilitation services.
BCU Quarter 2 2020/21 14 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 5: Community Care Page 2 of 3 Planning & Performance Directorate
QP 14: Support Care Homes and reintroduce CHC RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Capture good practice and legacy Executive Director Primary & AN14.1 actions internally and share across 30.09.2020 N/A SPPH Community Care G A G partners. Ensure BCU wide approach to care home support and escalation to Executive Director Primary & AN14.2 ensure sustainability and business 30.09.2020 N/A SPPH Community Care G A A continuity (Care Home Directed Enhanced Service, Escalation Levels) Executive Director Primary & AN14.3 Care home testing 30.09.2020 N/A SPPH Community Care G G G Executive Director Primary & AN14.4 Community Health Care Framework 30.09.2020 N/A SPPH Community Care G A A Complete the governance and Executive Director Primary & AN14.5 reporting arrangements for the Care 30.09.2020 N/A SPPH Community Care G A G Home Group
BCU Quarter 2 2020/21 15 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 5: Community Care Page 3 of 3 Planning & Performance Directorate
QP 16: Transform Community Services RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Community Transformation Executive Director Primary & AN16.1 30.09.2020 N/A SPPH Programme Community Care G A A Community Response Team working Executive Director Primary & AN16.2 30.09.2020 N/A SPPH inclusive of third sector Community Care A A A Feasibility study for inclusion of Community Geriatrician within Executive Director Primary & AN16.3 30.09.2020 N/A F&P Community Response Team model of Community Care A R A care
QP 17: Develop Community Resilience RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Complete baseline evidence Executive Director Primary & AN17.1 collation for Right sizing Community 30.09.2020 N/A SPPH Community Care A A A Services Progress implementation of Phase 2 Executive Director Primary & AN17.2 30.09.2020 N/A SPPH of the Digital Communities initiative Community Care R R A
BCU Quarter 2 2020/21 16 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 6: Mental Health & Learning Disabilities Page 1 of 2 Planning & Performance Directorate
QP 18: Mental Health / Learning Disabilities (Part 1 of 2) RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Commence implementation of the AN18.5 Executive Medical Director 01.09.2020 N/A SPPH Primary Care Programme at pace. G A A
QP 18: Mental Health / Learning Disabilities (Part 2) RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Implementation of recommendations AN18.6 from the Psychological Therapies Executive Medical Director 01.09.2020 N/A SPPH R R R Review Re-establish the Rehabilitation AN18.7 Executive Medical Director 01.09.2020 N/A SPPH Programme of work A G G Begin roll out of Attend Anywhere AN18.8 virtual consultation platform across the Executive Medical Director 01.09.2020 N/A F&P G G G division Implementing division wider QI training AN18.9 Executive Medical Director 01.09.2020 N/A SPPH plan G G G AN18.6 - Implementation of recommendations from the Psychological Therapies Review Progression of the Psychological Therapies has been paused for the moment pending the series of engagement sessions that have taken place with the Psychologists. Further meetings planned between the Executive Director for mental health during September 2020 and a substantive leadership structure is being implemented across psychological therapies BCU Quarter 2 2020/21 17 Plan Monitoring Report August 2020 Chapter 7: Acute Care: Implementation of our Acute Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate Operational Model across North Wales Page 1 of 6
QP 19: Maximise Capacity within Each Site RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Review current process for booking and allocation to ensure it is fit for Executive Director Nursing & AN19.1 30.09.2020 N/A F&P purpose and consistently applied Midwifery A A A across North Wales. Executive Director Nursing & AN19.2 Delivery of OPD programme 30.07.2020 N/A F&P Midwifery A A A Utilisation of workforce dashboard to Executive Director of Workforce AN19.3 30.07.2020 N/A F&P N/A identify staffing resource and OD R A
BCU Quarter 2 2020/21 18 Plan Monitoring Report August 2020 Chapter 7: Acute Care: Implementation of our Acute Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate Operational Model across North Wales Page 2 of 6
QP 20: Develop a single risk stratification approach across the pathway of care RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Stage 1 Outpatient transformation project Executive Director Nursing & AN20.1 focused upon delivering virtual 30.09.2020 N/A F&P Midwifery A R A appointments wherever possible and only face to face where necessary Stage 4 Specialty specific risk stratification Executive Director Nursing & AN20.2 30.07.2020 N/A F&P using P1-P4 categorisation as per Midwifery G A A essential services framework
Create specialty multi-disciplinary teams to review cases and ensure Executive Director Nursing & AN20.3 30.07.2020 N/A QSE clinical handover if surgical team Midwifery G A G listing patient is not able to operate
Review current performance measures to ensure they reflect necessary quality metrics including Executive Director Nursing & AN20.4 31.08.2020 N/A QSE reviewing and strengthening current Midwifery G A A reporting structure to ensure patient allocation can be monitored
BCU Quarter 2 2020/21 19 Plan Monitoring Report August 2020 Chapter 7: Acute Care: Implementation of our Acute Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate Operational Model across North Wales Page 3 of 6
QP 21: Identification of highest priority services with risk based capacity shortfalls RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020
Identify specialties where local resource does not meet needs for P1- P2 demand and implement pan BCU Executive Director Nursing & AN21.1 approach including identify specialties 31.07.2020 N/A F&P Midwifery G A G with significant variance in waiting times to implement pan BCU approach
QP 22: Identification of areas for service review RAG Rating likelihood of End of 2019/20 Board End of Ref Action Lead Target Date delivery by August AP Ref. Committee July 2020 30.9.20 2020 Review and refresh priority business AN22.1 cases e.g. Ophthalmology, G A A Orthopaedics, Urology & Stroke Executive Director Nursing & 31.08.2020 N/A SPPH Review of specialties identified where Midwifery a pan BCU risk stratification approach AN22.2 may not on its own provide the G A A necessary impact.
BCU Quarter 2 2020/21 20 Plan Monitoring Report August 2020 Chapter 7: Acute Care: Implementation of our Acute Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate Operational Model across North Wales Page 4 of 6
QP 23: Identify the required metrics to monitor performance RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 a. Quality Outcome Measures of clinical pathways identified G R A AN23.1 b. Pan BCU service metrics Executive Medical Director 30.09.2020 N/A QSE developed G R A c. Effectiveness of implementation plans monitored & reviewed G R A
BCU Quarter 2 2020/21 21 Plan Monitoring Report August 2020 Chapter 7: Acute Care: Implementation of our Acute Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate Operational Model across North Wales Page 5 of 6
QP 24: Improve quality outcomes and patient experience RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Identify clinical pathways requiring AN24.1 Executive Medical Director 30.07.2020 N/A QSE review or development G G A Coordinate with Clinical Advisory AN24.2 Group a programme and timetable for Executive Medical Director 30.07.2020 N/A QSE G G G pathway development and review Develop pathways in line with the AN24.3 digitally enabled clinical services Executive Medical Director 30.07.2021 N/A QSE G G G strategy Establish the Eye Care Digital Programme Board to lead the AN24.3b implementation of the Digital Eye Executive Medical Director 30.07.2020 N/A QSE A G G Care programme funded by Welsh Government Ensure quality outcome measures are AN24.4 Executive Medical Director 30.07.2020 N/A QSE referenced and measurable A G A Ensure Patient Reported Outcome Measures and Patient Reported AN24.5 Experience Measures are included Executive Medical Director 31.08.2020 N/A QSE A G A and measured in pathway development
BCU Quarter 2 2020/21 22 Plan Monitoring Report August 2020 Chapter 7: Acute Care: Implementation of our Acute Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate Operational Model across North Wales Page 6 of 6 QP 25: Provide care closer to home RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Provide virtual appointments wherever Executive Director Nursing & AN25.1 30.09.2020 N/A F&P possible Midwifery G A A Support outpatient transformation to identify community facilities where face to face consultations could be Executive Director Nursing & AN25.2 30.09.2020 N/A F&P offered and deliver appointments and Midwifery G R A treatments as local as possible where there is equity of access Primary Care Optometric Diagnostic and Treatment Centres undertaking Executive Director Nursing & AN25.3 training with Consultants as part of skill Midwifery G A A development to provide shared care for Glaucoma patients
QP 26: Reduce health inequalities RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Ensure that patients are prioritised using an agreed risk stratification tool Executive Director Nursing & AN26.1 30.07.2020 N/A QSE and offered the soonest appointment Midwifery G A A based on their clinical needs
BCU Quarter 2 2020/21 23 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 8: Planned Care Planning & Performance Directorate
QP 27: Planned Care RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Develop preferred service model for Executive Director Nursing & AN27.1 30.09.2020 AP 021 F&P acute urology services Midwifery R R A
Transform eye care pathway to deliver Executive Director Nursing & AN27.6 more care closer to home delivered in AP 023 F&P Midwifery R R R partnership with local optometrists Systematic review and plans developed to address service Executive Director Nursing & AN27.7 AP 025 F&P sustainability for all planned care Midwifery A R R specialties (RTT). Implement year one plans for Executive Director of Therapies AN27.8 30.07.2020 AP 025 F&P Endoscopy & Health Sciences G G G Systematic review and plans Executive Director of Therapies AN27.9 developed to address diagnostic 30.09.2020 AP 025 F&P & Health Sciences G G G service sustainability
BCU Quarter 2 2020/21 August 2020 24 Plan Monitoring Report Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 8: Planned Care Narrative Planning & Performance Directorate
AN27.1 – Develop preferred service model for acute urology services Urology services is part of option 5, and elements of the business case are being aligned to this service transformation
AN27.6 – Transform eye care pathway to deliver more care closer to home delivered in partnership with local optometrists Optometry practices have moved from red phase to amber and during August amber 2 phase. This means that the majority of practices have re- opened however are prioritising their activities to meet social distancing requirements. The national training for glaucoma higher certificate has been delayed until March 2020 and the EPR implementation, now approved by the Minister is also delayed. Both of these are required to develop the shared care model. However the urgent eye care pathway is in place, optometrists have also worked to clinically prioritise the cataract waiting list and we have an agreed pathway for diabetic retinopathy which will go-live from October 2020. Placements for the 6 appointed primary care optometrists are aiming to start in October to build clinical relationships and learning for glaucoma ahead of the formal training programme.
AN27.7 – Systematic review and plans developed to address service sustainability for all planned care specialties (RTT). This work was paused due to the Covid-19 pandemic but is being re-instigated within the Q3/4 plans
BCU Quarter 2 2020/21 August 2020 25 Plan Monitoring Report Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 9: Unscheduled Care Planning & Performance Directorate
QP 28: Unscheduled Care RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Demand: Workforce shift to improve Executive Director Nursing & AN28.1 care closer to home (key priority for 30.09.2020 AP 031 F&P Midwifery R R R 2020/2021) Flow: Emergency Medical Model (key Executive Director Nursing & AN28.2 30.09.2020 AP 034 F&P priority for 2020/2021) Midwifery A A A
Flow: Management of Outliers (key Executive Director Nursing & AN28.3 30.09.2020 AP 034 F&P priority for 2020/2021) Midwifery G G G Discharge: Integrated health and Executive Director Nursing & AN28.4 social care (key priority for 30.09.2020 AP 038 F&P Midwifery A G G 2020/2021) Stroke Services Executive Director Primary & AN28.5 30.09.2020 AP 039 F&P Community Care A R R Linked to Action 13.03 AN28.1 - Demand: Workforce shift to improve care closer to home (key priority for 2020/2021) There have been some delays in progressing this at the pace intended due to COVID unfortunately, this is currently being reviewed in light of recent changes and learning as a result.
AN28.5 – Stroke Services (Linked to Action AN13.3) Progress will be made in September to utilise video consultations where appropriate to increase capacity and support for stroke rehabilitation services.
BCU Quarter 2 2020/21 26 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 10: Workforce Page 1 of 3 Planning & Performance Directorate
QP029: Workforce & Organisational Development RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Review the previous Workforce Improvement Group structure and Executive Director, Workforce AN29.1 establish a revised structure at 30.09.2020 N/A SPPH & Organisational Development G A A Strategic, Tactical and Operational Levels Ensure effective social partnership working as a key enabler for Executive Director, Workforce AN29.2 organisational development and 30.09.2020 N/A SPPH & Organisational Development G A A transformation. Review the operation and management of social partnership Provide ‘one stop shop’ workforce enabling services to support surge Executive Director, Workforce AN29.3 requirements; new developments and 30.09.2020 N/A F&P & Organisational Development G A A reconfiguration or workforce re-design linked to key priorities of the Health
BCU Quarter 2 2020/21 27 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 10: Workforce Page 2 of 3 Planning & Performance Directorate
QP 30: Workforce Planning and Optimisation RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Ensure a robust integrated workforce model is in place with Local Authority partners for specific projects, to Executive Director, Workforce AN30.1 30.09.2020 N/A SPPH support the development of a health & Organisational Development G A A and Social Care model across the wider health community Ensure workforce optimisation plans are in place to support the delivery of safe care and mitigate the impact of Executive Director, Workforce AN30.2 COVID-19, the Test, Trace, Protect 30.09.2020 N/A F&P & Organisational Development G A A programme on staff and they support the Health Boards adjusted surge capacity plans for Q2. Ensure all key workforce indicators are in place and monitored robustly to Executive Director, Workforce AN30.3 30.09.2020 N/A F&P support all surge and essential & Organisational Development G A A services delivery Ensure agile and new ways of working deployed in order to maintain safety Executive Director, Workforce AN30.4 for staff and patients because of 30.09.2020 N/A QSE & Organisational Development G A A COVID-19 are optimised and embedded. Deliver Workforce Optimisation / Efficiency Plan - reducing waste and avoidable variable /premium rate pay Executive Director, Workforce AN30.5 30.09.2020 N/A F&P expenditure. Demonstrating value for & Organisational Development A A R money and responsible use of public funds BCU Quarter 2 2020/21 28 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 10: Workforce Page 3 of 3 Planning & Performance Directorate
QP 31: Occupational Health Safety and Equality RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Implement Year 2 of the Health & Safety Improvement Plan is implemented to staff are proactively protected, supported and safe, Executive Director, Workforce AN31.1 including black, Asian, and minority 30.09.2020 N/A QSE & Organisational Development G A A ethnic, older people, co-morbidities and pregnant workers and that all environmental and social impacts are monitored and complied with Effective infrastructure in place to Executive Director, Workforce AN30.2 ensure wellbeing and psychological 30.09.2020 N/A QSE & Organisational Development G A A support is accessible to all staff Ensure ongoing effective management Executive Director, Workforce AN30.3 of training, equipment and supplies in 30.09.2020 N/A QSE & Organisational Development A R A line with emergency guidance Implement the Strategic Equality Plan revised year 1 actions to help ensure that equality is properly considered Executive Director, Workforce AN30.4 30.09.2020 N/A SPPH within the organisation and influences & Organisational Development A A A decision making at all levels across the organisation
BCU Quarter 2 2020/21 29 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 10: Workforce Narratives Planning & Performance Directorate
AN30.5 - Deliver Workforce Optimisation / Efficiency Plan - reducing waste and avoidable variable /premium rate pay expenditure. Demonstrating value for money and responsible use of public funds Initial revised plan was submitted but Covid-19 related issues have consumed the capacity to move this action forward, most notably the Wrexham Outbreak that has been a major draw on Workforce resource over the period. Nevertheless, efficiency principles have been built-in to our work plans as part of preparation for quarters three and four.
BCU Quarter 2 2020/21 30 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 11: Digital Health Planning & Performance Directorate
QP 32: Digital Health / IM&T RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Seek approval for funding for Welsh AN32.2 Executive Medical Director 30.09.2020 N/A F&P Emergency Department System R R R Development of the digital health AN32.3 Executive Medical Director 30.09.2020 N/A DIGC record G G G Implementation of Digital dictation AN32.5 Executive Medical Director 31.08.2020 N/A DIGC project G G G AN32.7 Scale up Implementation of Office 365 Executive Medical Director 31.12.2020 N/A DIGC G R A Implement COVID-19 hardware AN32.8 Executive Medical Director 31.01.2021 N/A DIGC response A R R Delivery of digital infrastructure rolling AN32.11 Executive Medical Director AP 058 DIGC programme G G G
Further review Provision of infrastructure and access with Area teams/ AN32.12 Executive Medical Director AP 059 DIGC to support care closer to home dependent on G G G Office 365 AN32.2: Seek approval for funding for Welsh Emergency Department System Draft business case awaiting review by the HBRT – source of funding yet to be identified and recent national data centre issues has caused uncertainty for timescale and costs. AN32.8: Implement COVID-19 hardware response Confirmation of WG funding in place but yet to receive funding. In addition Covid-19 related hardware demand continued continues to increase. Detailed proposals will be presented to the next meeting of the DIGC BCU Quarter 2 2020/21 31 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Chapter 12: Capital Planning & Performance Directorate
QP 33: Estates & Capital RAG Rating likelihood of End of Action 2019/20 Board End of Action Lead Target Date delivery by August Number AP Ref. Committee July 2020 30.9.20 2020 Executive Director of Planning AN33.1 Well-being hubs 30.09.2020 AP 064 SPPH and Performance G G A
Complete reviews to initiate the following programmes: G G G - Health economy programme G G G business case Executive Director of Planning AN33.8 30.09.2020 N/A SPPH and Performance - Relocation of services from Abergele G G G
- Rationalisation of Bryn y Neuadd G G G
BCU Quarter 2 2020/21 32 Plan Monitoring Report August 2020 Cyfarwyddiaeth Cynllunio & Perfformiad Planning & Performance Directorate Further Information
Further information is available from the office of the Director of Performance which includes:
• tolerances for red, amber and green
Further information on our performance can be found online at:
• Our website www.pbc.cymru.nhs.uk www.bcu.wales.nhs.uk • Stats Wales www.statswales.wales.gov.uk
We also post regular updates on what we are doing to improve healthcare services for patients on social media:
follow @bcuhb http://www.facebook.com/bcuhealthboard
BCU Quarter 2 2020/21 33 Plan Monitoring Report August 2020 3.2 20.104 Adroddiad Ansawdd a Pherfformiad / Quality & Performance Report - Mark Wilkinson 1 20.104a QAP Report Board - August 2020 front cover.docx
1
Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.2020 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Quality and Performance Report Report Title: Cyfarwyddwr Cyfrifol: Mr Mark Wilkinson, Executive Director of Planning & Performance Responsible Director: Awdur yr Adroddiad Dr Jill Newman, Director of Performance Report Author: Craffu blaenorol: The data and information in this report has been scrutinised by the Prior Scrutiny: Quality, Safety & Experience Committee and the Finance & Performance Committee, both held in August 2020 Atodiadau None Appendices: Argymhelliad / Recommendation: The Health Board is asked to scrutinise the report and to consider whether any area needs further escalation to be considered. Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation: It is important to note that performance reporting of many of the national indicators has been stood down to enable the health board to focus on the mobilisation phase of the pandemic. Staff time has been released to manage the pandemic and therefore the data included in this report has not been subject to the full level of validation and quality control as would normally be included in performance reports.
This report includes available indicators from the National Delivery Framework, together with a section on Covid-19 and Essential Services Delivery.
Cefndir / Background: Our report outlines the key performance and quality issues that are of priority for the Health Board. The summary of the report is now included within the Executive Summary pages of the QAP and demonstrates the work related to Covid-19, essential service delivery as well as the key measures contained within the 2020-21 National Delivery Framework. This framework has been revised to provide performance measures under the Quadruple Aims set out in A Healthier Wales.
Asesiad / Assessment & Analysis 2
Strategy Implications The performance measures within the report are aligned with the National Delivery Framework.
Options considered
Not Applicable
Financial Implications The delivery of the performance indicators contained within our annual plan will have direct and indirect impact on the financial recovery plan of the Board.
Risk Analysis The present pandemic has produced a number of risks to the delivery of care across the healthcare system. The paper highlights the risks arising directly from Covid-19 and the need to maintain essential non-Covid-19 services. The impact of Covid-19 on non-Covid-19 planned care is reported together with the interdependencies between ensuring safe re-start of elective care and balancing the risk of covid-19 for patients, staff and system capacity.
Legal and Compliance This report will be available to the public once published for the Health Board
Impact Assessment
The Report has not been Equality Impact Assessed Y:\Board & Committees\Governance\Forms and Templates\Board and Committee Report Template V2.0 July 2020.docx 1 20.104b QAP Report Board - August 2020.pdf Quality & Performance Report
Health Board August 2020 Put patients first Work together Value and respect each other Learn and innovate Communicate openly and honestly1 About this Report
Covid-19 Pandemic It should be noted that all services have been impacted by the Covid-19 Pandemic, and/or the measures put in place to combat the spread of Covid-19. Although it is important that we continue to monitor and manage performance, it is recommended that the performance reported is not compared as ‘like-for-like’ to previous months/ years performance. It is also important to note that national reporting and performance management arrangements have been suspended at this time. In order to release staff time to manage the mobilisation of the pandemic response normal validation and sign off processes have been reduced, so caution needs to be applied to data quality presented in the report.
This report is the first presentation to the Health Board using the Key Performance Indicators agreed by executives as the key indicators of performance aligned to the Board’s operational plan and risks reportable to Welsh Government under the NHS Wales Delivery Framework scrutinised by the Finance & Performance Committee and the Quality, Safety & Experience Committee.
The format of the report reflects the published National Delivery Framework for 2020-21 which aligns to the Quadruple aims contained within the statutory framework of A Healthier Wales. Sections are added to reflect Covid-19 key performance indicators and the work on maintaining essential services. The report is structured so that measures complementary to one another are grouped together. Narratives on the ‘group’ of measures are provided as opposed to looking at measures in isolation.
The operational planning for 2020-21 has been impacted by the pandemic with planning cycles re-defined into quarterly plans. The Quarter 2 operational plan was submitted to Welsh Government in July 2020. The progress against the actions contained within this plan are reported in the accompanying Q2 Operational Plan monitoring report.
As a consequence of the changes in the planning cycle for 2020-21 and the uncertainty around the future levels of Covid-19 the ability to produce month on month profiles to monitor performance against is severely limited. Therefore the report contains factual information on performance indicators.
Where monthly data is provided this is submitted as of 31st July 2020 position. This data has been scrutinised by the relevant Committee of the Board. Information relating to subsequent months will be reviewed at the next meeting of these Board Committees and reflected in future board reports. Where data is not reported monthly the information in this report relates to the latest available information that has been scrutinised by a committee of the Board.
Performance has improved since last reported Performance has got worse since last reported Performance remains the same as last reported
Quality & Performance Report 2 Health Board Key Messages
Unscheduled Care Covid-19 continues to demands are Essential services circulate and bed increasing resulting in largely maintained, occupancy is starting high levels of bed however activity to increase occupancy on Acute significantly reduced Sites
Table of Contents Page Page
Cover 1 Quadruple Aim 2: Mental Health 19 & 20
About this Report 2 Quadruple Aim 3: Workforce 21 to 23 Key Points Key Points and Table of Contents 3 Quadruple Aim 4: Mortality & Sepsis 24 & 25 Executive Summary 4 & 5 Additional Information
Covid-19 6 & 7 Quadruple Aim 2: Infection Prevention 26
Essential Services 8 Quadruple Aim 2: Unscheduled Care 27 & 28
Quadruple Aim 1: 9 Quadruple Aim 2: Planned Care 29 to 33
Quadruple Aim 2: Key Messages 10 Quadruple Aim 2: Mental Health 34
Number of Social Planned Care Quadruple Aim 2: Infection Prevention 11 & 12 Quadruple Aim 3: Workforce 35 cancer Distancing is being referrals and Safe IPC clinically Quadruple Aim 2: Unscheduled Care 13 & 14 Quadruple Aim 4: Agency Spend 36 returned to measures prioritised to Quadruple Aim 2: Planned Care 15 to 18 Further Information 37 pre-Covid-19 remain reduce risk of levels priority Harm Quality & Performance Report 3 Health Board Executive Summary page 1
Covid-19. The levels of Covid-19 have reduced compared to those seen during Quarter1 of 2020-21. North Wales is continuing to use intelligence to manage Covid-19 response whilst re-starting non-Covid-19 elective activity. The number of cases and deaths has reduced since the peak in North Wales, although recently there has been an upturn in Wrexham following a local outbreak. Containing Covid-19 and keeping the number of cases low requires a sustained focus on ensuring all possible measures are taken to prevent the spread of infection. In North Wales this has included martialling a partnership response to three localised (and largely isolated) outbreaks – the 2 Sisters Plant on Anglesey, Rowan Foods in Wrexham, and more recently Wrexham Maelor Hospital. Outbreak Control Teams were established for all three in line with all Wales Outbreak Plan procedures, as updated in the Communicable Disease Outbreak Plan for Wales (July 2020.) The Health Board and Local Authority partners have worked together on has developed a local Covid-19 dashboard and this, together on the Local Covid-19 prevention and response plan. This has been submitted to Welsh Government and contains detail of the key actions for primary, secondary and tertiary prevention together with confirmation of the provision for antigen and antibody testing. The outbreak in Wrexham Maelor Hospital is now under control. The covid-19 intelligence indicates the need to work with a high degree of uncertainty and plan in are relatively short cycles. We recognise the need for agility and flexibility to ensure we can respond to continuously changing situations appropriately. We need to ensure we minimise the risk of harm both from the direct impact of Covid-19 and the indirect consequences for our population by maintaining responsive services to meet the needs arising from Unscheduled Care, Essential Planned Care services across primary, community, secondary, tertiary and mental health. At the same time we are taking opportunities to use our reduced capacity to re-commence non-essential services, where it is deemed safe to do so, using a clinically risk stratified approach to prioritise care. Essential Services. The Health Board have reviewed compliance with the Essential Service Framework on a monthly basis. The data for the July review is included in this report . The latest report demonstrates the majority of essential services are being maintained and actions have been implemented to address shortfalls. The Committee is reminded that Essential Services are those services that need to continue throughout Covid-19 to avoid the risk of harm arising from life-threatening and life-changing treatments. The framework applies to services across the whole of the healthcare system. The August compliance levels have been returned and are being assessed. Initial assessment shows continuing compliance and move to expand on non-essential services as we re-start services. Phlebotomy compliance remains challenged and additional staff and space is being sourced to address this area.
Quality & Performance Report 4 Health Board Executive Summary page 2
Unscheduled Care During the peak of Covid-19 unscheduled care performance improved considerably on all national reported measures. This was primarily due to the reduction in non- Covid-19 emergency demand. Some of this demand reduction was expected as fewer activities were taking place, however there was a concern that some patients were not presenting due to the fear of Covid-19. Attendances at our Emergency Departments (ED) have steadily increased returning towards pre-Covid-19 levels of attendance. Bed occupancy is high across acute and community sites and flow restricted. Therefore performance although generally better than in July 2019 is deteriorating and delays for patients re-emerging. The Unscheduled Care improvement group has re-convened and work has been agreed with Welsh Ambulance Service NHS Trust (WAST) to address conveyance and hand over. The ED quality and effectiveness framework actions are being refreshed and a deep-dive is underway at YGC to support improvement ahead of the winter period. Winter planning and Surge planning has commenced and will be completed during September for inclusion in the Q3/4 operational plan. This is taking a whole system view to ensure we are prepared to respond to covid-19, seasonal unscheduled care, essential services and planned care requirements and understand the potential requirements for surge capacity during this period. Planned Care Re-starts As Essential Services are being sustained and the level of Covid-19 within our hospitals and communities has passed the initial peak work is progressing to recommence planned care services. This entails risk stratifying our existing waiting lists, risk assessing our facilities, and pathways to support safe restart of services with capacity used for patients with greatest clinical need. This work is complex requiring new ways of working and considerable agility and effective communication to build patient confidence.
We are using the risk stratification for surgery issued by the Royal College of surgeons which provides priority levels for surgery across surgical specialties. This approach is being adopted across Wales and the present patient administration systems are being re-designed to capture this information. While this is progressing we have developed an internal process to capture the P value of clinical assessments. This carries a risk and is not sufficient to fully address the new ways of working and so has been added to the risk register. Primary Care: GP practices across North Wales are reporting their escalation status into a new national reporting system. This is continuing to show the majority of practices are not under significant increased pressure at this time with 100 of the 103 practices at level 1 (green –no or steady pressure) and 3 practices amber ( moderate pressure) as of 17th August. Optometry practices have moved from red to amber phase of the pandemic and the majority have re-opened their practices and managing patients on basis of clinical need within socially distanced environments. The 15 emergency eye care hubs have therefore been stood down. The Welsh Eye Care Service is providing a safety net for patients where practices have not been able to re-open. The active recall of patients is being encouraged from the beginning of August.
Quality & Performance Report 5 Health Board Key Messages
Good social Covid-19 Initial Peak of distancing and forecasting is Covid-19 has infection being past, however prevention is considered to Covid-19 risk is still essential to sustain inform plan for present lower levels of Covid-19 Q3/4
Measures
Measure at 4th September 2020
Total number of tests for Covid-19 90,952
Number of results: Positive 4,856
Number of results: Negative 86,096
% Prevelance of Positive Tests 5.3% Continuing Test Treat Intelligence social and Protect indicates distancing is important potential for Number of Deaths - Confirmed Covid-19 419
important in programme future spikes Source: Public Health Wales coronavirus Dashboard, accessed 4th September 2020 prevention of to reduce and localised future peaks transmission areas of risk Quality & Performance Report 6 Health Board Covid-19 Test Information Previously Test Turnaround within 24 Hours 89% 54% Source: IRIS Covid-19 Dashboard – Early Warning Page – Accessed at 16:00 1st September 2020 Covid-19
Quality & Performance Report 7 Health Board July 2020 Key Messages
Essential Services are those elements of Essential services service required to covers a wide Majority of mitigate harm of life- range of Primary, Essential threatening or life- Community and changing conditions Services Secondary and continuing that must be Tertiary care maintained throughout Covid-19 Pathways
Average Number comparison: Pre Covid-19 Post Covid-19
Referrals into Secondary Care 4,846 3,443 (average per week) w/e 2nd August Referrals Urgent, suspected Cancer 539 410 (average per week) w/e 2nd August Essential New Outpatient Attendances (Average per week includes Virtual) w/e 2nd August 88,479 45,631 Follow Up Outpatient Attendances 183,614 101,803 Services (Average per week includes Virtual) w/e 2nd August Diagnostic 8 Weeks Breaches 2,061 13,312 (Per Month) - July 2020 Maintaining Essential Patients over 62 Days open on Urgent, suspected essential BCU monitors services form 113 305 service compliance cancer pathway (at 31st August) a small activity is key with Essential proportion of Elective Inpatient/ Daycase Procedures for patients Services specialties (Year to Date campared to same period 2019) to 10,998 3,505 with life- Framework normal 31st July 2020 threatening monthly business conditions Quality & Performance Report 8 Health Board Quadruple Aim 1
Key Messages
Cover report for Childhood Extended crisis Screening services Quadruple Aim 1: People in Wales have vaccinations at support provided for suspended under March 2020 families and young improved health and well-being and better Covid-19 restarted showed good levels people during lock- prevention and self management in August 2020 of take-up of down programmes
Measures Committee Period Measure Target Actual Trend
Percentage of children who received 3 doses of QSE Q4 19/20 >= 95% 96.70% the hexavalent ‘6 in 1’ vaccine by age 1
Percentage of children who received 2 doses of QSE Q4 19/20 >= 95% 94.80% the MMR vaccine by age 5
Percentage of adult smokers who make a quit QSE Q4 19/20 >= 5% 4.04% attempt via smoking cessation services
Percentage of those smokers who are CO- QSE Q4 19/20 >= 40% 33.91% People will take more responsibility, not only for their own health and well- validated as quit at 4 weeks being but also for their family and for the people they care for, perhaps even for their friends and neighbours. There will be a whole system On 8th September 2020, Welsh Government announced that the measure ‘Percentage approach to health and social care, in which services are only one smokers CO-validated as quit’ has been discontinued in light of safety concerns in element of supporting people to have better health and well-being carrying out the test due to Covid-19. Work is underway to develop a new, safer testing throughout their whole lies, It will be a 'wellness' system, which aims to process. support and anticipate health needs, to prevent illness, and to reduce the Quality & Performance Report impact of poor health. Health Board 9 Quadruple Aim 2
Key Messages
Planned Care Unscheduled Care delivery will require Performance while Bed Occupancy on Quadruple Aim 2: People in a new approach to lower than June acute sites is Wales have better quality address clinical risk 2020 remains relatively high and more accessible health and service better than in July and social care services, capacity 2019 enabled by digital and supported by engagement. Top 5 Measures (based on movement up or down) Period Measure Target Actual Trend Percentage of patients who spend less than 4 hours in all major and minor July 20 emergency care (i.e. A&E) facilities from >95% 79.71% There will be an equitable system, which achieves equal health outcomes for arrival until admission, transfer or everyone in Wales. It will improve the physical and mental well-being of all throughout their lives, from birth to a dignified end. Services will be seamless discharge and delivered as close to home as possible. Hospital services will be designed Number of patients who spend 12 hours to reduce the time spent in hospital, and to speed up recovery. The shift in or more in all hospital major and minor resources to the community will mean that when hospital based care is July 20 0 704 needed, it can be accessed more quickly. care facilities from arrival until admission, transfer or discharge Diagnostic Planned Care waits Number of Ambulance Handovers over 1 July 20 0 348 Unscheduled system increasing as Hour Care demand switching service is starting to from RTT to Number of patients waiting more than 36 capacity is July 20 0 30,167 increase clinically risk constrained to weeks for treatment stratified care ensure safe Quality & Performance Report provision Health Board 10 Quadruple Aim 2 Measures: Infection Prevention
Committee Period Measure Target Actual Trend QSE July 20 Cumulative numberof MRSA cases 0 1 QSE July 20 Cummulative number of C.difficile cases 0 59 Trend is compared to the same period of 2019/20
• Normal fluctuations in Infection numbers are to be expected month on month. The year to date figures in terms of performance to trajectory are important in relation to improvement. All Welsh Health Boards have seen increases in both Pseudomonas and Clostridium Difficle Infections (CDI).
• Meticillin Resistant Staphylococcus Aureus (MRSA) remains again at zero across the Health Board for July. This is the same as last month. BCU have had 1 MRSA Blood Stream Infection (BSI) year to date 2020/21. In comparison to last year to date (July 2020) BCU has 80% fewer infections. BCU are in 3rd position out of the 7 Health Boards including Powys and Velindre.
• Clostridium Difficile Infections remain under mean, however we have 1 more case than June (CO) with more infections CO overall. BCU is less than all Wales per 100K population and is in 3rd position. There are currently audits being completed in relation to an increase in CDI potentially due to treatment for Covid-19.
Quality & Performance Report 11 Health Board Quadruple Aim 2 Measures: Unscheduled Care Committee Period Measure Target Actual Trend
Percentage of emergency responses to red calls F&P July 20 >= 65% 69.53% arriving within (up to and including) 8 minutes F&P July 20 Number of Ambulance Handovers over 1 Hour 0 348 Percentage of patients who spend less than 4 hours in all major and minor emergency care (i.e. F&P July 20 >95% 79.71% A&E) facilities from arrival until admission, transfer or discharge
Number of patients who spend 12 hours or more F&P July 20 in all hospital major and minor care facilities from 0 704 arrival until admission, transfer or discharge
Percentage of patients who are diagnosed with a F&P July 20 stroke who have a direct admission to a stroke >= 50% 43.90% unit within 4 hours of the patient's clock start time.
Quality & Performance Report 12 Health Board Quadruple Aim 2: Narrative - Unscheduled Care
Emergency Department (ED) Performance Stroke Care Performance Delayed Transfers of Care Performance
Performance against the 4 hour wait target has seen a The number of confirmed strokes reported each The number of non Mental Health Patients delayed for slight deterioration in July to 79.7%, compared to recent month has returned to the levels seen before Covid- discharge is low and significantly reduced compared to months during the first wave of Covid-19 pandemic 19 and is now comparable with 2019 levels; pre-Covid-19 levels. when performance was 87% in April. The latest Stroke Sentinel Audit report shows a The health board has moved to discharge to assess There has been a month on month increase in the deterioration in performance and this deterioration, pathways and CHC assessment panels and processes number of attendances across the 3 sites and the particularly in therapy and rehabilitation continued have been changed. MHLD are reviewing the reasons number of patients waiting over 12 hours and during Covid-19. Some therapy staff were why the reduction in non-mental health delays has not ambulance handover delays have also increased. redeployed to support Covid-19 areas. The been replicated in their services. rehabilitation service in Central has been re- The increase in attendances has impacted on the ED established. Weekly non Mental Health discharge pathways are performance for 4 hour, 12 hour and ambulance reported and variance with the 5 pathways investigated handover delays although they remain improved However the recent national mapping of therapy with a view to embedding these as part of normal compared to the same period last year. resource confirms the shortfall in provision of practice. therapists for rehabilitation. This shortfall is reflected As unscheduled care pressures are indicating a return in the stroke business case. Findings from the to usual demand there remains an anticipation that this mapping exercise are being developed into an will continue to reflect performance levels pre Covid-19. action plan by the end of August. Focus is being given to refreshing the unscheduled care improvement programme of work reflecting on lessons learned from Covid-19.
The Unscheduled Care Improvement Group has reformed and met early in August 2020. We are working jointly with WAST on conveyance and handover improvements. A deep dive is underway at YGC and the EDQEF actions are being refreshed to improve performance. The Q3/4 winter and surge plans are being produced during August and September 2020. Quality & Performance Report 13 Health Board Quadruple Aim 2 Measures: Planned Care Committee Period Measure Target Actual Trend Percentage of patients starting first definitive cancer treatment F&P July 20 TBA 82.30% within 62 days from point of suspicion Number of patients waiting more than 8 weeks for a specified F&P July 20 0 13,312 diagnostic Number of patients waiting more than 14 weeks for a specified F&P July 20 0 4,003 therapy Percentage of ophthalmology R1 patients who are waiting F&P July 20 within their clinical target date or within 25% in excess of their >= 95% 41.60% clinical target date for their care or treatments F&P July 20 Number of patients waiting more than 36 weeks for treatment 0 30,167 Percentage of children and young people waiting less than 26 QSE July 20 >= 80% 26.49% weeks for neurodevelopment assessment Number of patients waiting for a follow-up outpatient F&P July 20 34,721* 63,198 appointment who are delayed by over 100% Quality & Performance Report 14 Health Board Quadruple Aim 2: Narrative - Planned Care (page 1)
Referral to Treatment (RTT) Performance Referral to treatment was established as the mechanism to manage waiting times in Wales from 2009. The Covid-19 pandemic has resulted in low levels of routine referrals to secondary care together with the postponement of routine elective outpatient , diagnostic and Inpatient and Day-case procedures. In part this national decision was to release resource to address the pandemic and in part to ensure patients not requiring urgent treatment could be safely separated from sites were covid-19 was present, protecting patients and in-part to protect the staff from exposure to Covid-19.
The consequences of the postponement of routine appointments has had a marked impact on RTT activity and waits. During the first quarter of 2020-21 only essential services activity was undertaken. Through July 2020 surgical services have been adopting a risk stratification approach in line with national and Royal College guidance to identify patients who are in priority 1a –surgery within 24 hours, priority 1b –surgery within 72 hours, priority 2 –surgery within 1 month, priority 3 –surgery within 3 months and P4 surgery beyond 3 months. This risk stratification of our waiting lists enables a pan-BCU waiting list to be developed with available capacity allocated to those with highest priority.
This is an important but radical change in approach, requiring new data capture, IT system development and booking and scheduling processes to be established. Work is moving rapidly locally and nationally to address this for inpatient and day-cases and is commencing to apply 3 risk tiers based on clinical condition to outpatient appointments.
During July specialties commenced the re-set process including assessment of the environment, staffing, infection prevention measures needed to recommence routine surgery and face to face consultations. The pre-operative pathway was put in place requiring patients to self-isolate for 14 days prior to surgery and to be swabbed for Covid-19 72 hours prior to surgery. The consequence of the necessary precautions is to reduce the flexibility of elective services, as short notice appointments can no longer be used to maximise capacity arising from cancellations etc. Productivity is significantly reduced due to the environmental and social distancing measures in place. Patient confidence and willingness to proceed with routine appointments at the present time is also reduced, with some patients on our waiting lists wishing to defer appointments or treatment.
Overall impact has been a slight increase in the volume of the waiting list but a significant increase in the length of routine waits and a significant reduction in elective activity. This change is being seen throughout Wales and across the wider NHS.
Going forward the planned care services will need to be agile, to increase capacity at times of low Covid-19 and Unscheduled Care pressures and reduce activity as Covid-19 and unscheduled care pressures indicate. We also need to ensure available capacity is allocated to patients with highest clinical priority pan-BCU and were possible virtual consultations are used to maximise clinical provision to patients and reduce risk.
Quality & Performance Report 15 Health Board Quadruple Aim 2: Narrative - Planned Care (Page 2)
Cancer Performance Cancer services form part of the Essential Services framework. These have been maintained throughout the Covid-19 period in line with national guidance. However this does not mean that the services have been able to work as normal or that activity levels reflect previous pre-Covid-19 levels. Initially referrals for Urgent Suspected Cancer fell significantly. These have recovered during July to closer to pre-Covid-19 levels, however concern continues that some patients may not have presented . Early analysis suggests this may be the case with those currently being diagnosed being generally at later stages in their disease.
Initially advice resulted in a number of treatment regimes being altered for reasons of staff and patient safety. This has resulted in a higher proportion of patients proceeding to radiotherapy or chemotherapy for their first definitive treatment and fewer patients being directed to surgery. Guidance has continually been refreshed and therefore some patients who were initially not able to proceed to surgery, have been re-reviewed and progressed to surgery. Conversion to surgery has now returned to pre-Covid-19 levels.
Diagnostic capacity has been reduced, priority has been given to suspected cancer patients and work undertaken to equalise cancer access times between sites for services such as endoscopy. This has entailed patients being offered appointments based on service capacity as opposed to clinical location. Diagnostic capacity remains constrained both in terms of workforce availability, and equipment time. Many of our diagnostic departments are not designed to easily accommodate 2 metre social distancing and so appointment scheduling has needed to be revised to support patients and staff well-being. Additional cleaning of all equipment between patients has added to the length of procedures further reducing imaging time available for patients. Some additional capacity has been provided via Spire and tendering is underway for additional capacity. An additional CT scanner has been obtained which will be placed on the YG site.
The number of patients waiting over 62 days from referral increased during the first quarter as a consequence of the above factors. July has seen improvement in the numbers over 62 days, largely due to improvements in diagnostic access. However with screening services recommencing and referrals returning to pre-Covid-19 levels it is highly likely that the demand on cancer services will continue to increase. This will require creation of additional capacity to enable this improving position to continue and to eliminate the backlog of patients that current exists. BCU continued to use Spire Yale for elective surgery during July as well as schedule patients in accordance with their clinically determined priority.
Diagnostics Performance The impact on diagnostic services was covered under the cancer section of this report and applies equally to routine elective waits for diagnostics. Plans to increase capacity include the appointment of our regular diagnostic agency to increase imaging capacity for CT and MRI to seven days throughout BCU. We have secured an additional CT Scanner via the national programme and this will be on site during August and expected to be operational in September. MRI mobile capacity will be required to replace the estimated 35% loss of internal activity. Work is taking place to determine the value of creating a diagnostic and treatment centre in North Wales. Once this is completed the outcome of the analysis will be reported and any potential business case developed.
Quality & Performance Report 16 Health Board Quadruple Aim 2: Narrative - Planned Care (Page 2)
Narrative for Follow-up Backlog Performance Narrative for Ophthalmology Performance The levels of follow up activity have fallen during the covid-19 period in part due to Ophthalmology services operate a risk stratified waiting list via the introduction of the postponement of routine activity. Virtual consultations, primarily by telephone Eye Care Measures in 2019. However the service entered Covid-19 with a large are continuing where suitable for management of on-going patient care. volume of patients at highest risk of harm being overdue their target date to be seen. AttendAnywhere, a video platform for virtual consultation was piloted and roll out commenced during July 2020, initially with 72 professional areas expressing an During Covid-19 the clinicians have further risk stratified patients through a table interest in using this technology with their patients. top process and also conducted telephone consultations. The a high proportion of patients virtual appointments are not suitable as the diagnostics are required to be BCU has also been instrumental in developing the Patient Initiated Follow Up able to detect changes in the eye overtime. Unfortunately some eye diseases such process for patients with long term conditions and the See on Symptoms process as glaucoma can progress unknown to the patient and therefore regular clinical to enable patients to be discharged with a view to returning within the next few monitoring is required. months should they find they are unable to self-manage their condition. New pathways were introduced to support both emergency and urgent eye care to be delivered. The emergency pathway has been effective with 2911 episodes The self-management project for prostate surveillance is progressing with staff recorded through the work of the primary care hubs. Only 13% of these patients recruited expected to be in post in the next 2 months and the tender for this needed onward referral to the Hospital Eye Service. The urgent care pathway has software having closed. Discussion is underway with Welsh Government due to not been fully utilised and reasons for this are being further investigated. The the move towards a once for Wales approach to procurement of this digital cataract pathway has been redesigned for patients who are classified as Risk 2 product. and sites have tested this and will be implementing the restart of surgery from August. Overall the reduction in elective activity has reduced the rate of the additions to the follow up waiting list and so the size of the list has not significantly increased. Overall the risk to R1 patients remains high and is increasing, with the volume However the increased use of virtual follow up is not suitable for all patients. The overdue the target increased to 17,277 and only 41.6% now within the national take up of this is not sufficient at this time to overcome the loss of face to face target. Work is continuing to re-establish community ODTCs to provide additional activity and therefore the volume of patients overdue their follow up continues to capacity. increase.
The outpatient improvement programme has developed action plans and a trajectory for improvement to deliver year end targets
Quality & Performance Report 17 Health Board Quadruple Aim 2 Measures: Mental Health Committee Period Measure Target Actual Trend
Percentage of mental health (Adult) assessments QSE July 20 >= 80% 76.50% undertaken within 28 days
Percentage of therapeutic interventions (Adult) within 28 QSE July 20 >= 80% 90.20% days
Percentage of patients (Adult) waiting less than 26 weeks QSE July 20 >= 80% 30.95% to start a psychological therapy
Total Number of Mental Health Delayed Transfers of Care QSE July 20 Reduction 16 (DToC)
Percentage of health board residents in receipt of QSE July 20 secondary mental health services who have a valid Care 90% 95.77% and Treatment Plan (aged under 18 years)
Percentage of health board residents in receipt of QSE July 20 secondary mental health services who have a valid Care 90% 88.43% and Treatment Plan (aged 18 years & over) Quality & Performance Report 18 Health Board Quadruple Aim 2: Narrative – Mental Health
CAMHS Adult Mental Health • Reset plans for routine appointments for all teams submitted to BCUHB Clinical Continue to deliver Mental Health Measures of Assessments and therapeutic Advisory Group for consideration interventions within 28 days above national target rate. However there has been an increase in Delayed Transfers of Care which is covered in the next section. • Plans allow for reconfiguration of services should Covid-19 pandemic re-escalate
• Flexibility in provision of service with the use of telephone appointments and Delayed Transfers of Care (DToC) Attend Anywhere where clinically appropriate Overall the volume and bed days affected by patients being delayed on discharge has improved with the changes in process implemented. The discharge to assess • Facilitation of home working for staff where possible to increase capacity in pathways are being used and reported on twice weekly. These predominantly apply bases to adult non-mental health pathways.
• Increase in referrals in June however remains significantly lower than previous Mental Health DTOC has not seen the same improvement. Current numbers of years’ trends DToC patients in MHLD is 14 patients, equating to 1,339 bed days. Dates for discharge have been identified for 2 patients w/c 17.8.20. • Anticipation of significant increase in referrals in September/October on schools reopening. Early Intervention in Psychosis (EIPs) services to be reinstated to Appropriate placements identified for 9 patients, and being progressed and dates provide support for discharge being confirmed.
• Recruitment of Family Wellbeing Practitioner posts to support clusters well Awaiting costings for 3 patients, being presented at CHC panel, w/c 17.8.20. underway in all teams with some commenced in role Discrepancies identified between numbers reported within the Division and those on • Reduced demand in recent months allowed for focus on assessment waiting list DToC/Iris system. Action taken - Senior Leads for each area cross referencing to with considerable improvement ensure accuracy of information.
• Further Improvement in Part 1a position in June to 74% DToC Exceptions Forms will be completed for all areas.
Quality & Performance Report 19 Health Board Quadruple Aim 3
Quadruple Aim 3: Key Messages The health and social care Staff have At 8%, filling of Staff health and workforce in Wales responded well substantive well-being is a to the demands posts better than is motivated and key priority for the placed upon target rate of sustainable health board them 7.8%
Measures
Committee Period Measure Target Actual Trend
New models of care will involve a broad multi-disciplinary team approach F&P July 20 Sickness Absence Rate < 5% 4.60% where well-trained people work effectively together to meet the needs and preferences of individuals. Joint workforce planning will be in place with an Personal Appraisal and F&P July 20 >= 85% 66.90% emphasis on staff expanding generalist skills and working across Development Review (PADR) professional boundaries. Strategic partnerships will support this with education providers and learning academies focussed on professional capability and leadership. F&P July 20 Mandatory Training >= 85% 84.10% Despite Sickness Challenges Agency Spend as % of Absence PADR of Covid-19, F&P July 20 Reduce 4.80% Rates best rates Mandatory overall Staff budget in Wales at increasing training 4.60% rates remain high Quality & Performance Report Health Board 20 Quadruple Aim 3: Workforce
Sickness Absence PADR Mandatory Training Non-Covid related sickness absence has reduced PADR Compliance has increased from 65.7% in June to Level 1 MT has fallen slightly this month to 84.1% as in the last 4 months. The July 2020 figure of 4.6% 66.9% in July. Out of 22 divisions 14 have increased in Covid continues to impact both in terms of is a significant improvement from the same time compliance since June ranging from 0.34% to 9.11% managerial focus and reduced face to face training. last year (5.2% July 2019). Covid related sickness increase. 2 have stayed the same at 33.33% and 30.77% In line with Safe and Agile working, Subject Matter has fallen from a high of 2% in May to 0.5% in July and 6 divisions seeing a decrease of between 0.23% to Experts delivering mandatory training are being 2020. 2.4%. The 6 divisions that have seen decreases have supported to develop a variety of training delivery been contacted to share their detailed reports for action. methodologies ranging from workbooks for those Sickness Rates are being addressed across BCU YGC made the biggest increase of 9.11%. Other actions with difficulty accessing IT facilities, videos of via the Workforce Wellbeing Group and the 3 taken place during July include:- sessions hosted on the Intranet and delivery of live regional Staff Wellbeing Support Service hubs. virtual training sessions. Access to appropriate • OD team working with HR colleagues to identify the virtual platforms is key to ensure quality virtual Workforce & OD teams including HR managers areas and Senior Managers to target and provide delivery. and Occupational Health professionals continue to support to improve compliance within their divisions offer focussed support to hotspot areas and to • Shared guidance on planning and conducting virtual Delivering training in a variety of ways to ensure complex cases. PADRs ensuring the staff and managers not able to ease of access for staff has created challenges in conduct face to face PADRs can become more terms of ensuring the accurate recording of confident in working in a different way compliance. These issues are being worked through • Re-emphasis on qualitative conversations and allowing and should be resolved during August. a less formal process. To facilitate this revised guidance and forms have been developed. Prior to Focussed work continues to support the 2 areas of release there will be an exercise to consult with staff lowest compliance which are Estates & Facilities and managers for feedback on this draft guidance. staff and Medical & Dental staff.
Quality & Performance Report 21 Health Board Quadruple Aim 4: Agency Spend
Agency Spend as % of Total Spend
Key points are: Non core spend has reduced from £8,584,000 in June to £8,292,000 in July 2020. Agency as a percentage of total spend has improved month on month and year on year currently 4.8%, July 2020 (June 2020 = 4.9%, July 2019 = 5.2%). There has been increases in N&M Agency spend this fiscal year with it now representing 5.8% of total N&M spend, this is up month on month and the same as at this point last year (despite increased N&M establishment and demand).
Actions to address: a) Filling substantive vacancies – BCU overall vacancy rate is better than the 8% target at 7.8%, however there are still shortages in key staff groups. The overall M&D vacancy rate is at 9.9%. Actions have ben taken to speed recruitment and the average working days taken from vacancy creation to staff in post for all M&D posts in BCU has been reduced from 110.9 days in the three months to May to 96.5 days in the three months to August. An action plan to further speed up M&D recruitment process and to give focus to high cost vacancies is in place. N&M vacancy percentage is at 13.6% after rises due to increased establishment (whilst we have only 9 fewer N&M staff in post than this time last year the N&M establishment has increased by 134 FTE over the same period). b) Reducing sickness absence – Non-Covid related sickness absence has reduced in the last 4 months. The July 2020 figure of 4.6% is a significant improvement from the same time last year (5.2% July 2019). Covid related sickness has fallen from a high of 2% in May to 0.5% in July 2020. Sickness Rates are being addressed across BCU via the Workforce Wellbeing Group and the 3 regional Staff Wellbeing Support Service hubs. Workforce & OD teams including HR managers and Occupational Health professionals continue to offer focussed support to hotspot areas and to complex cases. c) Increasing supply of internal temporary staff– Particularly in nursing and medical & dental staff groups to provide a more cost effective alternative to Agency. N&M - Focussed recruitment of N&M staff has seen large increase in ‘bank only’ workers with 424 ‘bank only’ N&M registered staff now registered to internal bank, up from 307 in March. In July 2020 16,160 hours of N&M registered bank work was delivered compared to 12,724 hours in the same period last year. M&D - Medical Staff Bank (MSB) - Recruitment to MSB has seen large increase in ‘bank only’ workers with 228 ‘bank only’ Medical Staff Bank registered staff, up from 138 in March. In July 2020 13,857 hours of MSB registered bank work was delivered (MSB was only started in November 2019).
Quality & Performance Report 22 Health Board Quadruple Aim 4
Key Messages
Quadruple Aim 4: Continued increase Increased system Wales has a higher Fracture Neck of in Mortality Rate, working to link value health and social Femur collaborative up from 0.74% to Health and Social developed care system that has 0.85% in 12 months Care Data demonstrated rapid improvement and innovation enabled by data and focussed on Measures outcomes. Delivering higher value in health and social care will focus on outcomes that Committee Period Measure Target Actual Trend matter to the individual and making our services safe, effective, people centred, Crude hospital mortality rate timely, efficient and equitable. This will bring individuals to the fore and consider QSE July 20 Reduction 1.17% the relative value of different care and treatment options, in line with Prudent (74 years of age or less) Health. Research, innovation and improvement activity will be brought together Emergency Department across regions - working with RPBs, universities, industries and other partners. QSE July 20 'Sepsis Six' within one hour Improve 55.50% Alignment of funding streams and integrated performance management and accountability across the whole system will be in place to accelerate of positive screening transformation through a combination of national support, incentives, regulation, benchmarking and transparency.
Sepsis and New data HAT data Fractured flows Neck of established capture Femur KPI and suspended reporting in dashboards during place in place for Covid-19 Covid-19 Quality & Performance Report 23 Health Board Quadruple Aim 4: Narrative
Mortality Sepsis in Emergency Departments
• Medical Examiners will be coming in to post from September 2020 following • A further sepsis collaborative is to take place on October 14th 2020 successful recruitment to the North Wales posts. • Reporting of Sepsis compliance to Welsh Government did cease during • Medical Examiners will be taking over part one of the DATIX Mortality tool which Coronavirus but this has now recommenced with all sites from July 2020. is agreed on all Wales basis Reporting ceased on an All Wales basis
• Stage 2 Mortality reviews using DATIX module have now gone live in YGC • DRIPS* meetings have been re-established with all Emergency departments • Events have been held with secondary care to review learning from deaths and following easing of them to allow focus on Coronavirus moving mortality reviews forward *Data, Review the cases, Improvements, Plot the dots, Share and celebrate • Further event with primary care to review learning from deaths and moving mortality reviews forward will be completed before the end of this calendar year in readiness for Medical examiners reviewing deaths
• Update and finalise Learning from deaths policy with robust dissemination plan for launch.
• Continue the work in the Emergency Departments on driving improvements in Sepsis management on arrival to support further reductions in Sepsis mortality.
• All acute hospital sites are reviewing mortality review processes ahead of medical examiner introduction to ensure all parts of the reviews are streamlined and areas where problems are identified in the process are improved.
Quality & Performance Report 24 Health Board Quadruple Aim 2: Charts Infection Control page 1
Quality & Performance Report 25 Health Board Quadruple Aim 2: Charts Unscheduled Care
BCU Level - Emergency Department (inc MIU) 4 Hour Waits: BCU Level - Ambulance Handovers over 1 Hour: July 2020 July 2020 100% 1,250 90% 80% 1,000 70% 60% 750 50% 40% 500 30% 20% 250 10%
0% 0
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May-20 May-19 Actual Target Control Line Upper Control Limit Lower Control Limit Actual Target Control Line Upper Control Limit Lower Control Limit
BCU Level - Emergency Department 12 Hour Waits: BCU Level - Stroke Care - Admissions within 4 Hours: July 2020 3,000 July 2020 2,750 100% 2,500 90% 2,250 80% 2,000 70% 1,750 60% 1,500 50% 1,250 40% 1,000 750 30% 500 20% 250 10%
0 0%
Jul-18 Jul-19 Jul-20
Jul-18 Jul-19 Jul-20
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Oct-18 Apr-19 Apr-20 Oct-19
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May-19 May-20 Actual Target Control Line Upper Control Limit Lower Control Limit Actual Target Control Line Upper Control Limit Lower Control Limit
Quality & Performance Report 26 Health Board Quadruple Aim 2: Unscheduled Care: Attendances
Add ED&MIU 4 Hour Attendance chart here and reformat accordingly
Quality & Performance Report 27 Health Board 1st September 2020 Quadruple Aim 2: Charts Planned Care page 1
BCU Level - RTT Waits % <= 26 Weeks: July 2020 BCU Level - RTT Waits Number > 52 Weeks: July 2020 100% 15,000 90% 80% 12,500 70% 10,000 60% 50% 7,500 40% 30% 5,000 20% 2,500 10%
0% 0
Jul-19 Jul-18 Jul-19 Jul-20 Jul-18 Jul-20
Oct-18 Apr-19 Apr-20 Oct-18 Apr-20 Oct-19 Apr-19 Oct-19
Jan-19 Jan-20 Jan-19 Jun-19 Jun-19 Jun-20 Jan-20 Jun-20
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May-19 May-20 May-20 May-19 RTT 26W % Target Control Line Upper Control Limit Lower Control Limit RTT Over 52W Target Control Line Upper Control Limit Lower Control Limit
BCU Level - RTT Waits Number > 36 Weeks: July 2020 BCU Level - Total Waiting List cohort with Number of patients 35,000 over 100% overdue their follow up - July 2020 225,000 64,000 30,000 200,000 62,000 25,000 175,000 60,000 150,000 58,000 20,000 125,000 56,000 15,000 100,000 75,000 54,000 10,000 50,000 52,000 5,000 25,000 50,000 0 48,000
0
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May-19 May-20 RTT Over 36W Target Control Line Upper Control Limit Lower Control Limit Total Waiting List Cohort Over 100% overdue
Quality & Performance Report 28 Health Board Quadruple Aim 2: Charts Planned Care page 2
BCU Level - Cancer Waiting Times - 31 Day - June 2020 100.00% 98.00% 96.00% 94.00% 92.00% 90.00% 88.00% 86.00% BCU Level - Diagnostic Waits Number of Breaches: 84.00% July 2020 82.00% 16,000 80.00% 14,000
12,000
Jul-18 Jul-19
Oct-18 Apr-19 Oct-19 Apr-20
Jun-18 Jan-19 Jun-19 Jan-20 Jun-20
Mar-19 Mar-20
Feb-19 Feb-20
Aug-18 Dec-18 Aug-19 Sep-19 Dec-19 Sep-18 Nov-18 Nov-19 May-20 May-19 10,000 Actual Target Control Line Upper Control Limit Lower Control Limit 8,000 6,000 4,000 BCU Level - Cancer Waiting Times - 62 Day from Receipt of 2,000 Referral - June 2020 100.00% 0
90.00%
Jul-19 Jul-18 Jul-20
Oct-18 Apr-20 Apr-19 Oct-19
Jan-19 Jun-19 Jan-20 Jun-20
Mar-19 Mar-20
Feb-19 Feb-20
Sep-18 Nov-19 Dec-19 Aug-18 Nov-18 Dec-18 Aug-19 Sep-19
May-20 May-19 80.00% Actual Target Control Line Upper Control Limit Lower Control Limit
70.00%
60.00%
50.00%
Jul-18 Jul-19
Oct-18 Oct-19
Apr-19 Apr-20
Jun-18 Jan-19 Jun-19 Jan-20 Jun-20
Mar-19 Mar-20
Feb-19 Feb-20
Aug-18 Dec-18 Aug-19 Sep-19 Dec-19 Sep-18 Nov-18 Nov-19
May-19 May-20 Actual Target Control Line Upper Control Limit Lower Control Limit
Quality & Performance Report 29 Health Board Covid-19 Impact on Planned Care Referrals and Out Patient Activity
Core Outpatient Activity
30 Covid-19 Impact on Planned Activity
Activity v Plan Comparison 2019-20 OUTTURN Pro-rata Quarterly delivery Q1 Actual % of previous activity delivered other Elective other Elective NEW Other Elective NEW other Elective Provider NEW OPD FU OPD OPD IPDC NEW OPD FU OPD OPD IPDC OPD FU OPD OPD IPDC OPD FU OPD OPD IPDC COCH 6596 13429 9001 4993 1649 3357 2250 1248 685 1876 602 443 42% 56% 27% 35% RJAH 6717 15361 1854 2638 1679 3840 464 660 305 1776 49 95 18% 46% 11% 14% BCU 268488 533301 1961 47429 67122 133325 490 11857 31194 71519 117 4421 46% 54% 24% 37% NB -RJAH activity for IPDC in Q1 includes trauma activity . Actual split is 55 elective IPDC and 40 Trauma pathway IPDC
31 Covid-19 Impact on Waiting Lists
32 Quadruple Aim 2: Charts Mental Health and CAMHS
Percentage Mental Health Assessments (Adult) within 28 days of Percentage Mental Health Assessments (CAMHS) within 28 days of Referral Referral April 2019/20 vs April 2020/21 April 2019/20 vs April 2020/21 100.00% 100.00%
80.00% 80.00%
60.00% 60.00%
40.00% 40.00%
20.00% 20.00%
0.00% 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2019/20 2020/21 Target 2019/20 2020/21 Target
Percentage Mental Health Theraputic Interventions (Adult) within 28 Percentage Mental Health Theraputic Interventions (CAMHS) within days of Assessment 28 days of Assessment April 2019/20 vs April 2020/21 April 2019/20 vs April 2020/21 100.00% 100.00% 90.00% 80.00% 80.00% 70.00% 60.00% 60.00% 50.00% 40.00% 40.00% 30.00% 20.00% 20.00% 10.00% 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2019/20 2020/21 Target
2019/20 2020/21 Target Quality & Performance Report 33 Health Board Quadruple Aim 3: Charts Workforce Sickness absence Rates
Core Mandatory Training Rate
PADR
Quality & Performance Report Health Board 34 Quadruple Aim 4: Charts Agency and Locum Spend
Quality & Performance Report 35 Health Board Information
Further Information
Further information is available from the office of the Director of Performance which includes:
• performance reference tables • tolerances for red, amber and green • the Welsh benchmark information which we have presented
Further information on our performance can be found online at: • Our website www.pbc.cymru.nhs.uk www.bcu.wales.nhs.uk • Stats Wales www.statswales.wales.gov.uk
We also post regular updates on what we are doing to improve healthcare services for patients on social media:
follow @bcuhb http://www.facebook.com/bcuhealthboard
Quality & Performance Report 36 Health Board 3.3 20.105 Adroddiadau Cyllid / Finance Reports - Sue Hill 1 20.105a M04 Finance Report_Board.docx
Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.20 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Finance Report Month 4 2020/21 Report Title: Cyfarwyddwr Cyfrifol: Sue Hill, Acting Executive Director of Finance Responsible Director: Awdur yr Adroddiad Eric Gardiner, Finance Director - Provider Services Report Author: Craffu blaenorol: Acting Executive Director of Finance Prior Scrutiny: Finance and Performance Committee Atodiadau Appendix 1: Summary of Position by Division Appendices: Appendix 2: COVID-19 Expenditure & Income Appendix 3: Savings Appendix 4: Expenditure Appendix 5: Financial Risks and Opportunities
Argymhelliad / Recommendation: It is asked that the report is noted. Please tick one as appropriate (note the Chair of the meeting will review and may determine the document should be viewed under a different category) Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation: The purpose of this report is to provide a briefing on the financial performance of the Health Board as at 31 July 2020 and reflects the financial impact of the continuing response to the COVID-19 pandemic.
Cefndir / Background: The financial plan for 2020/21, approved by the Board, was to deliver a deficit of £40m, based on achieving savings of £45m. The plan did not take into account the impact of COVID-19, and therefore it will change throughout the year; the Health Board has also submitted plans for both Q1 and Q2 to Welsh Government which incorporate the impact of Covid-19 and we are currently developing a consolidated plan for the second half of the financial year.
In the first four months of the year, expenditure has been considerably higher than planned due to the pandemic response and we have already seen that savings delivery has been significantly impacted, as the Health Board prioritised the clinical and operational response to the pandemic. The uncertainty about the potential resurgence of COVID-19 and the essential infection prevention measures that have been implemented means that the forecast expenditure is much higher than planned and savings delivery will be significantly reduced for the remainder of the year.
Due to the uncertainty around the costs related to COVID-19 and the number of unknown variables, forecasting a position for 2020/21 will be extremely difficult. The Health Board is currently anticipating that the plan of a £40m deficit will be achieved. This is based on the assumption that all COVID-19
1 costs will be funded by Welsh Government although this remains a significant risk to the financial plan and Appendix 2 includes a new table which clearly splits the anticipated income between allocated, received and assumed.
Asesiad / Assessment: 1.0 Strategy Implications This paper aligns to the strategic goal of attaining financial balance and is linked to the well-being objective of targeting our resources to those with the greatest need.
2.0 Options considered Not applicable – report is for assurance only.
3.0 Financial Implications 3.1 Summary
Current Month Year to Date Full Year Forecast
Plan £3.3m Deficit Plan £13.3m Deficit Plan £40.0m Deficit
Actual £3.3m Deficit Actual £13.3m Deficit Forecast £40.0m Deficit
Variance Balanced Variance Balanced Variance Balanced
Achievement Against Key Targets Revenue Resource Limit Public Sector Payment Policy (PSPP) Savings & Recovery Plans Revenue Cash Balance Capital Resource Limit Medium Term Plan
Key points for the month:
The Health Board’s balanced position is based on the assumption that Welsh Government will provide funding to neutralise the impact of COVID-19. This assumption is under review. Progress on savings schemes has been limited and it is forecast that there will be a shortfall of £30.8m against the target. This is currently included as a cost of COVID-19. Excluding COVID-19 impacts, Prescribing over spends are the most significant area of concern, with month on month increasing spend and a £2.9m over spend.
3.2 Revenue Position
Actual Cumulative M01 M02 M03 M04 Budget Actual Variance
£m £m £m £m £m £m £m Revenue Resource Limit (154.7) (128.5) (133.2) (140.1) (556.5) (556.5) 0.0 Miscellaneous Income (9.7) (9.8) (9.3) (9.6) (44.2) (38.4) 5.8 Health Board Pay Expenditure 65.0 66.1 68.1 67.3 269.2 266.5 (2.7) Non-Pay Expenditure 102.8 75.5 77.7 85.7 344.8 341.7 (3.1) Total 3.4 3.3 3.3 3.3 13.3 13.3 (0.0)
Overview (Appendix 1): The £3.3m in-month deficit, £13.3m year to date deficit, is in line with the plan for Month 4. This position assumes that all COVID-19 costs incurred by the Health Board are 2 fully funded. The value of Welsh Government funding available for COVID-19 has not yet been confirmed and this is therefore a significant risk to the financial position. Following discussions with Welsh Government, the Health Board is reviewing its income assumptions around anticipated COVID-19 funding, with a view to effecting any amendments in Month 5.
Impact of COVID-19 (Appendix 2): The overall net cost of COVID-19 on the year to date position is £52.6m. Some specific funding sources have been redirected to COVID-19 to provide funding of £2.4m. £17.5m of Welsh Government income has been received to cover year to date costs and a further £32.7m of Welsh Government funding anticipated, giving a nil overall impact on the position.
M01 M02 M03 M04 YTD £m £m £m £m £m COVID-19 spend (incl. Field Hospitals) 28.8 3.7 7.3 7.1 46.9 Lost income 1.2 1.4 1.2 1.6 5.4 Non delivery of savings 3.7 3.6 2.0 2.7 12.0 Elective underspend (2.4) (2.8) (2.2) (2.6) (10.0) Slippage on planned investments (0.2) (0.1) (0.5) (0.5) (1.3) Cluster funding 0.0 0.0 (0.3) (0.1) (0.4) ICF Funding (0.3) (0.7) 0.0 1.0 0.0 Total COVID-19 costs 30.8 5.1 7.5 9.2 52.6 Funding: Optimise Flow & Outcomes (ICF) 0.0 0.0 0.0 (1.6) (1.6) Mental Health Improvement Fund 0.0 0.0 0.0 (0.7) (0.7) GMS (DES) 0.0 0.0 0.0 (0.1) (0.1) WG - anticpated & received (30.8) (5.1) (7.5) (6.8) (50.2) Impact on position 0.0 0.0 0.0 0.0 0.0
WG funding received (17.5) WG funding anticipated (32.7) Total (50.2)
In Month 4, actual expenditure was £7.1m. Offsetting underspends are seen in Elective Care, where activity has significantly reduced as part of the pandemic response, with limited planned activity in July leading to cost reductions of £2.6m. In addition, there has been £0.5m slippage against some investments planned for 2020/21 and the use of £0.1m of Cluster funding. This gives a total cost of COVID-19 for July of £8.2m.
Forecast: The Health Board is anticipating that it will achieve the £40.0m deficit, as per the financial plan, at the end of the year, on the basis that all COVID-19 costs are fully funded by Welsh Government. Any changes to income assumptions for anticipated Welsh Government COVID-19 funding will impact on this forecast.
Savings (Appendix 3): The identification of savings plans and the delivery of plans already identified has been severely impacted by COVID-19. Savings are currently forecast to under deliver by £30.8m against the £45.0m target.
Income: Most of the Health Board’s funding is from the Welsh Government allocation through the Revenue Resource Limit (RRL). Confirmed allocations to date are £1,545.9m, with further anticipated allocations in year of £136.1m, a total forecast Revenue Resource Limit (RRL) of £1,682.0m for the year. Miscellaneous income is showing a year to date shortfall of £5.8m, of which £5.4m is due to the impact of the pandemic on some of the Health Board’s income streams. This has been included as a cost of COVID-19.
3 Total Loss of Income to Month 4 £m Dental Patient Charge Revenue 2.3 Non-contracted activity (NCAs) 2.4 Other 0.7 Total Income 5.4
Further details on expenditure are included in Appendix 4.
3.3 Balance Sheet
Cash: The closing cash balance for July was £3.1m, which included £2.5m cash held for capital projects. The revenue cash balance of £0.6m was within the internal target set by the Health Board. The cash flow forecast is currently reporting a shortfall of £38.7m at the end of the year. The Health Board will consider all possible actions to minimise the level of Strategic Cash Assistance required, with current forecasts indicating that £32.7m will be required from Welsh Government to support payments.
Capital: The Capital Resource Limit (CRL) for 2020/21 is £23.9m. Actual expenditure to the end of July was £5.4m, which was in line with the plan.
PSPP: The Health Board achieved the PSPP target to pay 95% of non-NHS invoices within 30 days.
4.0 Risk Analysis (Appendix 5) There are currently four identified risks to the financial position and one opportunity.
5.0 Legal And Compliance Not applicable.
6.0 Impact Assessment Not applicable.
4 Appendix 1 – Summary of Position by Division
M01 M02 M03 M04 Cumulative Actual Actual Actual Actual Budget Actual Variance £000 £000 £000 £000 £000 £000 £000 WG RESOURCE ALLOCATION (154,715) (128,474) (133,260) (140,076) (556,524) (556,524) 0 AREA TEAMS West Area 13,969 13,417 13,666 14,796 54,746 55,073 327 Central Area 18,101 17,247 18,204 18,507 70,419 71,319 899 East Area 19,908 19,137 19,730 21,713 78,648 79,598 950 Other North Wales 364 2,706 3,017 3,022 10,618 11,461 842 Field Hospitals 25,037 (539) 1,043 735 26,280 26,280 0 Commissioner Contracts 17,951 17,816 16,890 17,659 72,225 70,316 (1,910) Provider Income (1,170) (1,252) (1,195) (1,211) (7,238) (4,827) 2,410 Total Area Teams 94,160 68,532 71,354 75,222 305,698 309,218 3,520 SECONDARY CARE Ysbyty Gwynedd 8,248 8,076 8,561 8,942 33,550 33,820 270 Ysbyty Glan Clwyd 10,151 10,259 10,480 10,557 41,556 41,445 (111) Ysbyty Maelor Wrexham 9,054 8,930 9,199 9,185 35,721 36,214 492 North Wales Hospital Services 8,520 8,074 8,807 8,826 33,790 34,227 436 Womens 3,404 3,514 3,264 3,516 13,387 13,697 310 Total Secondary Care 39,377 38,853 40,310 41,026 158,004 159,402 1,397 Total Mental Health & LDS 10,920 10,773 11,349 11,295 44,128 44,337 209 CORPORATE Chief Executive 213 209 225 257 689 904 214 Chief Operating Officer 0 0 233 164 831 873 42 Estates & Facilities 4,729 4,564 4,631 4,610 17,923 18,533 610 Utilities & Rates 1,508 1,409 1,482 1,414 5,500 5,812 312 Executive Director of Finance 739 761 750 734 2,955 2,984 29 Executive Director of Nursing & Midwifery 1,074 1,041 973 952 3,924 3,837 (86) Executive Medical Director 1,760 1,839 1,725 1,748 6,851 7,097 246 Executive Director of Workforce & OD 1,068 1,157 1,619 1,218 4,235 5,063 828 Director of Planning & Performance 159 229 200 203 859 804 (55) Executive Director of Public Health 135 88 67 93 462 383 (79) Director of Corporate Services 0 0 0 0 0 0 (0) Office to the Board 162 98 93 61 375 341 (34) Director of Therapies 54 28 30 19 124 105 (19) Executive Director of Primary Care & Comm Services 66 64 74 74 338 277 (61) Director of Turnaround 98 98 110 8 492 315 (178) Total Corporate 11,765 11,585 12,211 11,555 45,558 47,328 1,770 Total Other Budgets incl. Reserves 1,897 2,059 1,352 4,316 16,469 9,624 (6,845) 5 TOTAL 3,404 3,329 3,317 3,338 13,333 13,383 50 Appendix 2 – COVID-19 Expenditure and Breakdown of Income
Significant additional expenditure has been incurred as a result of COVID-19, including pay costs, spend on the establishment of the Field Hospitals, beds, equipment and consumable items (medical, surgical, cleaning, etc.). Total spend in July was £7.1m, £46.9m for the year to date.
M01 M02 M03 M04 Total Type £000 £000 £000 £000 £000 Other Income (30) 30 0 0 0 Total Income (30) 30 0 0 0 M01 M02 M03 M04 Total Additional Clinical Services 170 357 683 532 1,742 Type Administrative & Clerical 166 427 417 374 1,384 £000 £000 £000 £000 £000 Allied Health Professionals 22 50 57 116 245 Field Hospitals 25,041 (539) 1,043 735 26,280 Estates & Ancillary (15) 36 166 148 335 Area Teams 607 947 1,852 2,228 5,635 Healthcare Scientists 10 34 15 10 69 Secondary Care 2,133 2,033 2,811 2,940 9,917 Medical and Dental 437 648 1,255 1,523 3,863 Mental Health 289 427 788 641 2,145 Nursing and Midwifery Registered 313 383 1,729 1,592 4,018 Professional Scientific & Technical 0 18 43 73 134 Corporate 728 868 759 441 2,796 Total Pay 1,103 1,953 4,365 4,368 11,789 Other Budgets 0 0 1 79 80 Primary Care (10) 21 42 395 448 Total 28,798 3,737 7,254 7,064 46,853 Primary Care Drugs 0 0 0 0 0 Secondary Care Drugs 129 61 38 89 318 Clinical Services & Supplies 1,129 580 387 120 2,216 General Services & Supplies 589 378 444 160 1,572 Healthcare Services Provided by Other NHS Bodies 0 10 5 5 20 Continuing Care and Funded Nursing Care 338 655 712 1,128 2,833 Establishment & Transport Expenses 66 92 52 25 234 Premises and Fixed Plan 25,352 (522) 1,420 585 26,835 Other Non-Pay 133 480 (212) 189 589 Total Non-Pay 27,725 1,754 2,889 2,696 35,064 Total 28,798 3,737 7,254 7,064 46,853
6 Appendix 2 – COVID-19 Expenditure and Breakdown of Income
Anticipated income for COVID-19, split between allocated, received and assumed is shown below.
Year to Date Total Allocated Of Which Assumed Category of Expenditure Total Cost Income Income Received Income £m £m £m £m £m Pay costs 11.6 (11.6) (5.4) (5.4) (6.2) Non-pay costs 11.5 (11.5) (2.9) (2.5) (8.6) Field Hospital commissioning costs 23.6 (23.6) (23.6) (12.1) 0.0 Test Trace Protect (TTP) costs 0.2 (0.2) (0.2) Lost income 5.4 (5.4) (5.4) FRG identifed savings (£27.8m) 9.3 (0.3) (0.3) Savings plans identified at M04 (£14.2m) (3.0) Undelivered savings (£17.2m) 5.7 Elective underspend (10.0) Slippage on planned investments (incl. Clusters) (1.7) Total 52.6 (52.6) (31.9) (20.0) (20.7)
2020/21 Forecast Total Allocated Of Which Assumed Category of Expenditure Total Cost Income Income Received Income £m £m £m £m £m Pay costs 23.1 (23.1) (5.4) (5.4) (17.7) Non-pay costs 40.3 (40.3) (4.8) (3.5) (35.5) Field Hospital commissioning costs 23.6 (23.6) (23.6) (12.1) 0.0 Test Trace Protect (TTP) costs 14.5 (14.5) (11.2) (3.3) Lost income 13.9 (13.9) (13.9) FRG identifed savings (£27.8m) 27.8 (9.2) (9.2) Savings plans identified at M04 (£14.2m) (14.2) Undelivered savings (£17.2m) 17.2 Elective underspend (19.3) Slippage on planned investments (incl. Clusters) (2.3) Total 124.6 (124.6) (45.0) (21.0) (79.6)
7 Appendix 2 – COVID-19 Expenditure and Breakdown of Income
The full year forecast for 2020/21 assumes income of £124.6m. Of this, £45.0m has been notified to the Health Board, leaving a risk of £79.6m. Notes: Savings have been split between the plans identified by the FRG at the start of the year and prior to the pandemic, a total of £27.8m, and the remaining £17.2m of savings required, but where no plans had been identified. Savings targets are pro-rata for the YTD figures. All achieved/forecast savings have been allocated to savings identified at the start of the year. Elective underspend and slippage on investments used to offset non-delivery of savings.
8 Appendix 3 – Savings
The financial plan for 2020/21 is based on delivering savings of £45.0m, equating to 3.6% of recurrent base budget (excluding ring-fenced budgets). Savings of £1.2m are reported in Month 4, increasing the overall year to date delivery to £2.9m. The Month 4 figure includes some retrospective savings for schemes not identified in Month 3. The year to date delivery is a £12.0m shortfall against the target, which has been included as a cost of COVID-19.
The total in-year forecast for savings, including pipeline, has increased by £1.5m from last month to £14.2m, of which £11.2m is recurrent. This leaves a shortfall of £30.8m against the full year savings target.
Savings Achieved and Forecast v. Target
50.0
45.0
40.0
35.0
30.0
m 25.0 £
20.0
15.0
10.0
5.0
0.0 M01 M02 M03 M04
Forecast - Schemes in delivery Forecast - Pipeline schemes Achieved YTD Target
In addition to this forecast, schemes that remain in the pipeline amount to £6.6m. Work is progressing to fully develop these schemes and move them into amber and green over the next two months. The full year effect of pipeline schemes, totalling £9.4m, is an estimate at this stage and requires further validation. Critical areas such as workforce will depend upon the ability to deploy sufficient support and resource to re-instate the Improvement Group work programme that was operating in 2019/20 and this forms the basis of the estimates. The Executive Team is currently considering options and capacity requirements for the savings delivery and PMO function to be re-established. This will ensure that there is dedicated capacity available to not only drive the schemes currently identified, but also to develop further opportunities for both in-year savings and the 2021/22 programme.
9 Appendix 3 – Savings
Year to Date Forecast YTD Non- Savings Recurring Total Forecast Savings Savings Variance Recurring Variance Delivered Forecast Forecast FYE Target Target Forecast £000 £000 £000 £000 £000 £000 £000 £000 £000 SCHEMES IN DELIVERY Ysbyty Gwynedd 4,167 1,389 326 (1,063) 332 308 640 683 (3,526) Ysbyty Glan Clwyd 5,079 1,693 38 (1,655) 38 0 38 111 (5,041) Ysbyty Wrexham Maelor 4,414 1,471 193 (1,279) 142 307 449 252 (3,966) North Wales Managed Services 4,300 1,433 173 (1,260) 463 10 473 575 (3,828) Womens Services 1,733 578 37 (541) 152 0 152 174 (1,581) Secondary Care 19,692 6,564 766 (5,798) 1,127 625 1,751 1,796 (17,941) Area - West 4,402 1,467 489 (978) 1,412 275 1,687 1,462 (2,716) Area - Centre 6,408 2,136 537 (1,599) 1,681 0 1,681 1,775 (4,727) Area - East 6,464 2,155 591 (1,564) 158 1,142 1,300 158 (5,164) Area - Other 607 202 0 (202) 0 0 0 0 (607) Contracts 1,000 333 0 (333) 0 0 0 0 (1,000) Area Teams 18,881 6,294 1,617 (4,677) 3,251 1,417 4,667 3,395 (14,213) MHLD 1000 0 420 420 1,000 0 1,000 1,000 0 Corporate 5,426 1,809 93 (1,715) 109 42 151 109 (5,275) Total Schemes in Delivery 45,000 14,667 2,896 (11,771) 5,486 2,084 7,570 6,300 (37,429)
PIPELINE SCHEMES Ysbyty Gwynedd 257 0 257 151 Ysbyty Glan Clwyd 353 0 353 360 Ysbyty Wrexham Maelor 201 138 338 208 North Wales Managed Services 74 0 74 178 Womens Services 0 0 0 0 Secondary Care 885 138 1,023 897 Area - West 65 0 65 65 Area - Centre 1,180 0 1,180 1,215 Area - East 19 15 34 33 Area - Other 0 0 0 0 Contracts 0 0 0 0 Area Teams 1,264 15 1,279 1,313 MHLD 0 0 0 0 Corporate 189 758 947 592 Total Divisional Pipeline Schemes 2,338 910 3,249 2,803 Medicines Management IG 150 0 150 150 Procurement IG 2,000 0 2,000 2,000 Workforce IG 1,236 0 1,236 4,438 Total Improvement Group Holding Schemes 3,386 0 3,386 6,588 Total Pipeline Schemes 5,725 910 6,635 9,391 10 Total Programme 45,000 11,211 2,994 14,205 15,691 (30,794) Appendix 4 – Expenditure
Pay Expenditure
Health Board pay costs in July are £67.3m, a decrease of £0.8m from last month. Month 4 spend includes £4.4m of pay costs directly related to COVID-19, the same as last month, with variable pay costs of £8.3m (12.3% of pay), which is £0.3m lower than in June. Overall, pay is under spent against budget (£2.7m year to date).
Total Pay
£75M
£70M
£65M
£M
£60M
£55M
£50M Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Substantive Agency Bank Locum Other Non Core Overtime Additional Hours WLI's Average Total Pay
11 Appendix 4 – Expenditure
Actual Cumulative YTD YTD YTD M01 M02 M03 M04 Budget Actual Variance £m £m £m £m £m £m £m Variable Pay M01 M02 M03 M04 Total Administrative & Clerical 8.6 8.8 8.8 8.6 37.1 34.8 (2.3) £m £m £m £m £m Medical & Dental 15.2 15.6 15.5 16.1 60.1 62.4 2.3 Agency 2.8 3.1 3.5 3.3 12.7 Nursing & Midwifery Registered 20.6 20.8 21.2 20.6 87.8 83.2 (4.6) Overtime 1.0 1.0 0.9 0.7 3.6 Additional Clinical Services 9.4 9.5 9.8 9.3 35.6 38.0 2.4 Locum 1.2 1.7 1.7 1.9 6.5 Add Prof Scientific & Technical 3.1 3.1 3.0 3.0 12.9 12.2 (0.7) WLIs 0.1 0.1 0.0 0.0 0.2 Allied Health Professionals 3.8 3.8 4.0 4.0 15.1 15.6 0.5 Bank 2.1 1.9 2.1 2.0 8.1 Healthcare Scientists 1.1 1.2 1.2 1.2 4.8 4.7 (0.1) Other Non Core 0.3 0.0 0.1 0.0 0.4 Estates & Ancillary 3.2 3.2 3.4 3.3 13.5 13.1 (0.4) Additional Hours 0.4 0.4 0.3 0.4 1.5 Students 0.0 0.1 1.2 1.2 2.3 2.5 0.2 Total 7.9 8.2 8.6 8.3 33.0 Health Board Total 65.0 66.1 68.1 67.3 269.2 266.5 (2.7) Primary care 1.7 2.1 2.0 2.1 6.4 7.9 1.5 Total Pay 66.7 68.2 70.1 69.4 275.6 274.4 (1.2)
Areas of note are:
Medical and Dental pay has increased by £0.8m from last month, with £0.3m of the increase relating to COVID-19. This includes some backdated payments to doctors for work during the height of the pandemic. In addition, there have been increases in agency (£0.1m) and locum costs (£0.2m). All other pay categories showed reduced costs compared to Month 3. Overtime costs are down by £0.2m and bank costs by £0.1m. Agency costs for Month 4 are £3.3m (4.8% of pay), a decrease of £0.1m from last month. Agency spend related to COVID-19 in July was £0.9m, compared to £0.5m in June. Medical agency costs have increased by £0.1m to an in-month spend of £1.6m. Nurse agency costs totalled £1.2m for the month, the same as in June. Other agency costs fell by £0.2m to £0.5m for July and mainly arise from Admin and Clerical (£0.3m) and Allied Health Professionals (£0.2m).
12 Appendix 4 – Expenditure
Non-Pay Expenditure
Costs this month are £8.0m higher than in June at £85.7m, with a year to date under spend of £3.1m. Month 4 non-pay costs include £2.7m directly related to COVID-19 (£35.1m year to date).
Non-Pay Expenditure (Excluding Capital Costs)
106
101
96
91
m 86 £
81
76
71
66 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20
Actual £m Average Non-Pay
13 Appendix 4 – Expenditure
Actual Cumulative YTD Y T D Y TD M01 M02 M03 M04 Budget Actual Variance £m £m £m £m £m £m £m Primary Care 17.2 17.5 15.9 17.6 70.2 68.2 (2.0) Primary Care Drugs 8.9 8.6 10.5 11.0 36.1 39.0 2.9 Secondary Care Drugs 5.4 5.0 5.5 5.8 23.4 21.7 (1.7) Clinical Supplies 4.8 3.6 4.2 4.6 21.9 17.2 (4.7) General Supplies 2.7 2.6 2.1 4.7 12.7 12.1 (0.6) Healthcare Services Provided by Other NHS Bodies 22.7 22.7 21.5 22.3 90.7 89.2 (1.5) Continuing Care and Funded Nursing Care 8.4 8.2 9.1 9.0 35.9 34.7 (1.2) Other 30.3 4.9 6.6 6.0 42.1 47.8 5.7 Non-pay costs 100.4 73.1 75.4 81.0 333.0 329.9 (3.1) Cost of Capital 2.4 2.4 2.3 4.7 11.8 11.8 0.0 Total non-pay including cost of capital 102.8 75.5 77.7 85.7 344.8 341.7 (3.1)
The main areas of significance this month are:
Primary Care: Expenditure in July has returned to the same level as at the start of the year, following an adjustment in June arising from the quarterly review of General Dental Services (GDS) and the reduced patient charge income that is expected this year. Primary Care drugs: GP prescribing and dispensing costs are a significant concern in 2020/21. The rolling average annual cost continues on an upward trend. As a result, costs are £0.5m higher than reported last month. Based upon the latest available data, the range in forecast outturn expenditure for BCU is between £118m and £126m. This would lead to an over spend in the range of £5m to £13m. General Supplies: Spend against Intermediated Care Funding (ICF) has increased significantly this month, as plans are developed and implemented. This has contributed £2.9m to the increase in expenditure. Healthcare Services Provided by Other NHS Bodies: Due to the agreement to maintain payments to other NHS organisations via block contracts, most contractual payments are fixed, despite those organisations only undertaking very low levels of activity on behalf of the Health Board. Continuing Healthcare (CHC): Expenditure in July has decreased by £0.1m compared to June. COVID-19 related costs of £1.1m were incurred in Month 4, to give a year to date spend of £2.8m. Efforts to review placements and packages, particularly for those patients discharged due to COVID-19, continue. Excluding COVID-19 costs, CHC expenditure is £0.2m more than last month. The increase relates to a number of new high cost Mental Health placements, in addition to an in-month increase in package costs. Cost of Capital: Additional Capital funding that has been received for numerous schemes, including COVID-19 requirements, has led to a £2.4m increase in depreciation costs this month. These costs are fully funded.
14 Appendix 5 – Financial Risks and Opportunities
Key Decision Point & Issue Description £m Risk Owner Summary Mitigation
Opportunity: Red rated savings schemes that total £6.6m are currently Work is progressing to move these schemes into Sue Hill, Acting Red Pipeline held in pipeline and are due to start delivering over the next amber / green in the coming months. It is expected 1 (6.6) Executive Director of Savings two months. that all current schemes will be amber or green by Finance Schemes the end of September:
The finance team are reviewing expenditure and Income has been anticipated for the estimated cost of savings against the original plan to clearly identity COVID-19 for 2020/21, less funding already received. Welsh Risk: WG which costs have been funded by WG and which Sue Hill, Acting 2 Government has not yet confirmed that this will all be funded COVID-19 categories are unfunded. This will support Executive Director of and so it is a significant risk to the financial position. The Funding discussion about the level of risk and what mitigating Finance operational plan is still being developed and so all costs are steps can be taken to reduce the income risk for the only indicative at this stage. remaining months of the year.
Risk: Welsh The projected increased cost of the Welsh Risk Pool (WRP) The cost is being monitored and all-Wales Sue Hill, Acting Risk Pool 3 Risk Share is a risk to the Health Board’s forecast for 2.5 discussions taking place through Deputy Director of Executive Director of (WRP) Risk 2020/21. Finance meetings. Finance Share
It has not yet been determined how this case will Sue Green, Executive Risk: Junior There was a significant test legal case focusing on how NHS impact on the Health Board and what the financial Director of Workforce 4 Doctor organisations should address monitoring for junior doctors. implications may be. Further investigations are & Organisational Monitoring being undertaken to quantify any potential impact. Development NWSSP Employment law team have confirmed that the Sue Green, Executive Risk: Holiday holiday pay issues arising from the Flowers judgement are The Health Board is monitoring the situation and will Director of Workforce 5 Pay ongoing and the outcome of the Supreme Court appeal is respond appropriately to any legal decision. & Organisational awaited. Development
15 1 20.105b M03 Finance Report_Board.docx
Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.20 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Finance Report Month 3 2020/21 Report Title: Cyfarwyddwr Cyfrifol: Sue Hill, Acting Executive Director of Finance Responsible Director: Awdur yr Adroddiad Eric Gardiner, Finance Director - Provider Services Report Author: Craffu blaenorol: Acting Executive Director of Finance Prior Scrutiny: Finance and Performance Committee Atodiadau Appendix 1: Summary of Position by Division Appendices: Appendix 2: Covid-19 Impact Appendix 3: Savings Appendix 4: Expenditure Appendix 5: Financial Risks and Opportunities Argymhelliad / Recommendation: It is asked that the report is noted. Please tick one as appropriate (note the Chair of the meeting will review and may determine the document should be viewed under a different category) Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation: The purpose of this report is to provide a briefing on the financial performance of the Health Board as at June 2020 and reflects the financial impact of the continuing response to the Covid-19 pandemic. Cefndir / Background: The financial plan for 2020/21, approved by the Board, is to deliver a deficit of £40m and is based on delivering savings of £45m. The plan did not take into account the impact of Covid-19, and therefore it will change throughout the year. It is likely that spending will be higher than planned due to the pandemic response and savings delivery will be significantly reduced as the Health Board prioritises the clinical and operational response to the pandemic, particularly in the early months of the year.
Due to the uncertainty around the costs of Covid-19 and the number of unknown variables, forecasting a position for 2020/21 will be extremely difficult. The Health Board is currently anticipating that the plan of a £40m deficit will be achieved. This is based on the assumption that all Covid-19 costs will be funded by Welsh Government although this remains a significant risk to the financial plan. Asesiad / Assessment: 1.0 Strategy Implications This paper aligns to the strategic goal of attaining financial balance and is linked to the well-being objective of targeting our resources to those with the greatest need.
2.0 Options considered Not applicable – report is for assurance only.
1 3.0 Financial Implications 3.1 Summary
Current Month Year to Date Full Year Forecast
Plan £3.3m Deficit Plan £10.m Deficit Plan £40.0m Deficit
Actual £3.3m Deficit Actual £10.0m Deficit Forecast £40.0m Deficit
Variance Balanced Variance Balanced Variance Balanced
Achievement Against Key Targets Revenue Resource Limit Public Sector Payment Policy (PSPP) Savings & Recovery Plans Revenue Cash Balance Capital Resource Limit Medium Term Plan
3.2Revenue Position
Actual Cumulative M01 M02 M03 Budget Actual Variance £m £m £m £m £m £m Revenue Resource Limit (154.7) (128.5) (133.2) (416.4) (416.4) 0.0 Miscellaneous Income (9.7) (9.8) (9.3) (33.0) (28.8) 4.2 Health Board Pay Expenditure 65.0 66.1 68.1 200.5 199.2 (1.3) Non-Pay Expenditure 102.8 75.5 77.7 258.9 256.0 (2.9) Total 3.4 3.3 3.3 10.0 10.0 0.0
Overview (Appendix 1): The £3.3m in-month deficit, £10.0m year to date deficit, is in line with the plan for Month 3. This position assumes that all Covid-19 costs incurred by the Health Board are fully funded. The value of Welsh Government funding available for Covid-19 has not yet been confirmed and this is therefore a significant risk to the financial position.
Impact of Covid-19 (Appendix 2): The cost of Covid-19 for the year to date is £44.7m (£7.8m in Month 3), of which Intermediate Care Fund (ICF) and Cluster monies have funded £1.3m. £17.5m of Welsh Government income has been received to date with a further £25.9m of anticipated funding, to give a nil impact on the position.
2 M01 M02 M03 YTD £m £m £m £m Covid-19 spend (incl. Field Hospitals) 28.8 3.7 7.3 39.8 Lost income 1.2 1.4 1.2 3.8 Non delivery of savings 3.7 3.6 2.0 9.3 Elective underspend (2.4) (2.8) (2.2) (7.4) Slippage on planned investments (0.2) (0.1) (0.5) (0.8) Total Covid-19 costs 31.1 5.8 7.8 44.7 ICF funding (0.3) (0.7) 0.0 (1.0) Cluster funding 0.0 0.0 (0.3) (0.3) WG funding - anticpated & received (30.8) (5.1) (7.5) (43.4) Impact on position 0.0 0.0 0.0 0.0
WG funding received (17.5) WG funding anticipated (25.9) Total (43.4)
Significant additional non-pay expenditure has been incurred as a result of Covid-19, including spend on the establishment of the Field Hospitals, beds, equipment and consumable items (medical, surgical, cleaning, etc.). Spend in June was £7.3m. Offsetting underspends are seen in Elective Care, where activity has significantly reduced as part of the pandemic response, with limited planned activity in June leading to cost reductions of £2.2m. In addition, there has been £0.5m slippage against some investments planned for 2020/21.
Forecast: Due to the uncertainty around the costs of Covid-19 for the rest of 2020/21, forecasting a position for the year is extremely difficult. However, the Health Board is anticipating that it will achieve the £40m deficit at the end of the year, as per the financial plan, on the basis that all Covid- 19 costs are fully funded by Welsh Government.
Savings (Appendix 3): The identification of savings plans and the delivery of plans already identified has been severely impacted by COVID-19. Savings are currently forecast to under deliver by £32.3m against the £45.0m target.
Income: Most of the Health Board’s funding is from the Welsh Government allocation through the Revenue Resource Limit (RRL). Confirmed allocations to date are £1,542.7m, with further anticipated allocations in year of £145.6m, a total forecast RRL of £1,688.3m for the year. Miscellaneous income is showing a year to date shortfall of £4.3m, of which £3.8m is due to the impact of the pandemic on some of the Health Board’s income streams. This has been included as a cost of Covid-19. Total Loss of Income to Month 3 £m Dental Patient Charge Revenue 1.8 Non-contracted activity (NCAs) 1.5 Private patient income 0.3 Other 0.2 Total Income 3.8
Further details on expenditure are included in Appendix 4.
3 3.3 Balance Sheet
Cash: The closing cash balance for June was £4.1m, which included £2.7m cash held for capital projects. The revenue cash balance of £1.4m was within the internal target set by the Health Board. The cash flow forecast is currently reporting a shortfall of £38.7m at the end of the year. The Health Board will consider all possible actions to minimise the level of Strategic Cash Assistance required, with current forecasts indicating that £32.7m will be required from Welsh Government to support payments.
Capital: The Capital Resource Limit (CRL) for 2020/21 is £23.1m. Actual expenditure up to June was £3.3m, which was £1.3m ahead of plan. This is primarily due to Covid-19 expenditure.
PSPP: The Health Board achieved the PSPP target to pay 95% of non-NHS invoices within 30 days.
4.0 Risk Analysis (Appendix 5) There are four risks to the financial position and one opportunity.
5.0 Legal And Compliance Not applicable.
6.0 Impact Assessment Not applicable.
4 Appendix 1 – Summary of Position by Division
M01 M02 M03 Cumulative Actual Actual Actual Budget Actual Variance £000 £000 £000 £000 £000 £000 WG RESOURCE ALLOCATION (154,715) (128,474) (133,260) (416,448) (416,448) 0 AREA TEAMS West Area 13,969 13,417 13,666 39,684 40,277 593 Central Area 18,101 17,247 18,204 51,844 52,811 967 East Area 19,908 19,137 19,730 56,875 57,885 1,010 Other North Wales 364 2,706 3,017 7,964 8,439 475 Field Hospitals 25,037 (539) 1,043 25,544 25,544 0 Commissioner Contracts 17,951 17,816 16,890 53,889 52,656 (1,232) Provider Income (1,170) (1,252) (1,195) (5,113) (3,617) 1,496 Total Area Teams 94,160 68,532 71,354 230,687 233,996 3,309 SECONDARY CARE Ysbyty Gwynedd 8,248 8,076 8,561 24,867 24,878 11 Ysbyty Glan Clwyd 10,151 10,259 10,480 31,129 30,890 (239) Ysbyty Maelor Wrexham 9,054 8,930 9,199 26,634 27,029 395 North Wales Hospital Services 8,520 8,074 8,807 25,021 25,401 379 Womens 3,404 3,514 3,264 9,875 10,181 307 Total Secondary Care 39,377 38,853 40,310 117,527 118,379 852 Total Mental Health & LDS 10,920 10,773 11,349 32,682 33,042 360 CORPORATE Chief Executive 213 209 225 519 647 128 Chief Operating Officer 0 0 233 507 709 202 Estates & Facilities 4,729 4,564 4,631 13,688 13,923 235 Utilities & Rates 1,508 1,409 1,482 3,925 4,398 473 Executive Director of Finance 739 761 750 2,208 2,250 42 Executive Director of Nursing & Midwifery 1,074 1,041 973 2,853 2,882 30 Executive Medical Director 1,760 1,839 1,725 5,100 5,350 250 Executive Director of Workforce & OD 1,068 1,157 1,619 3,297 3,845 548 Director of Planning & Performance 159 229 200 640 601 (40) Executive Director of Public Health 135 88 67 352 290 (62) Director of Corporate Services 0 0 0 0 0 (0) Office to the Board 162 98 93 305 279 (26) Director of Therapies 54 28 30 102 86 (16) Executive Director of Primary Care & Comm Services 66 64 74 253 203 (50) Director of Turnaround 98 98 110 450 306 (143) Total Corporate 11,765 11,585 12,211 34,199 35,769 1,571 5 Total Other Budgets incl. Reserves 1,897 2,059 1,352 11,354 5,308 (6,046) TOTAL 3,404 3,329 3,317 10,000 10,046 46 Appendix 2 – Covid-19 Impact
M01 M02 M03 Total Type £000 £000 £000 £000 Other Income (30) 30 0 0 M01 M02 M03 Total Total Income (30) 30 0 0 Type £000 £000 £000 £000 Additional Clinical Services 170 357 683 1,210 Administrative & Clerical 166 427 417 1,010 Field Hospitals 25,041 (539) 1,043 25,545 Allied Health Professionals 22 50 57 129 Area Teams 607 947 1,852 3,407 Estates & Ancillary (15) 36 166 187 Secondary Care 2,133 2,033 2,811 6,977 Healthcare Scientists 10 34 15 59 Mental Health 289 427 788 1,504 Medical and Dental 437 648 1,255 2,340 Nursing and Midwifery Registered 313 383 1,729 2,426 Corporate 728 868 759 2,355 Professional Scientific & Technical 0 18 43 61 Other Budgets 0 0 1 1 Total Pay 1,103 1,953 4,365 7,421 Total 28,798 3,737 7,254 39,789 Primary Care (10) 21 42 53 Primary Care Drugs 0 0 0 0 Secondary Care Drugs 129 61 38 228 Clinical Services & Supplies 1,129 580 387 2,096 General Services & Supplies 589 378 444 1,411 Healthcare Services Provided by Other NHS Bodies 0 10 5 15 Continuing Care and Funded Nursing Care 338 655 712 1,705 Establishment & Transport Expenses 66 92 52 210 Premises and Fixed Plan 25,352 (522) 1,420 26,250 Other Non-Pay 133 480 (212) 400 Total Non-Pay 27,725 1,754 2,889 32,368 Total 28,798 3,737 7,254 39,789
Funded via ICF 338 669 453 1,460 Funded via Clusters 0 0 316 316 Funded by Welsh Government 28,460 3,068 6,485 38,013
6 Appendix 3 – Savings
The financial plan for 2020/21 is based on delivering savings of £45.0m, equating to 3.6% of budget. Savings of £1.6m are reported in Month 3, increasing the overall delivery to £1.7m for Quarter 1. The Month 3 figure includes some retrospective savings for schemes not identified in Month 2. The year to date delivery is a £9.3m shortfall against the target, which has been included as a cost of Covid-19. The total in-year forecast for savings, including pipeline, has increased by £1.8m from last month to £12.7m, of which £9.5m is recurrent. This leaves a shortfall of £32.3m against the full year savings target.
In addition, schemes that remain in the pipeline amount to £5.6m. Work is progressing to fully develop these schemes and move them into amber and green over the next three months. The full year effect of pipeline schemes, totalling £9.0m, is an estimate and requires further validation. Critical areas such as workforce will depend upon the ability to deploy sufficient support and resource to re-instate the Improvement Group work programme that was operating in 2019/20 and this forms the basis of the estimates.
The Executive Team is currently considering options and capacity requirements for the savings delivery and PMO function to be re-established. This will ensure that there is dedicated capacity available to not only drive the schemes currently identified, but also to develop further opportunities for both in-year savings and the 2021/22 programme.
7 Appendix 3 – Savings
Year to Date Forecast Non- YTD Recurring Total Forecast YTD Plan YTD Actual Recurring Variance Forecast Forecast FYE Forecast £000 £000 £000 £000 £000 £000 £000 SCHEMES IN DELIVERY Ysbyty Gwynedd 156 177 22 506 112 618 612 Ysbyty Glan Clwyd 0 0 0 0 0 0 0 Ysbyty Wrexham Maelor 120 113 (7) 225 414 639 225 North Wales Managed Services 48 106 58 387 10 397 455 Womens Services 24 24 (0) 161 0 161 183 Secondary Care 348 420 72 1,279 536 1,815 1,475 Area - West 209 127 (82) 950 275 1,225 1,000 Area - Centre 206 402 196 1,345 0 1,345 1,775 Area - East 496 498 2 0 1,603 1,603 0 Area - Other 0 0 0 0 0 0 0 Contracts 0 0 0 0 0 0 0 Area Teams 911 1,027 116 2,295 1,878 4,173 2,775 MHLD 250 232 (18) 1,000 0 1,000 1,343 Corporate 8 35 27 80 0 80 80 Total Schemes in Delivery 1,516 1,714 197 4,654 2,414 7,068 5,674
PIPELINE SCHEMES Ysbyty Gwynedd 0 0 0 0 Ysbyty Glan Clwyd 280 0 280 360 Ysbyty Wrexham Maelor 110 0 110 190 North Wales Managed Services 150 0 150 299 Womens Services 0 0 0 0 Secondary Care 540 0 540 849 Area - West 390 0 390 375 Area - Centre 200 0 200 470 Area - East 19 15 34 33 Area - Other 0 0 0 0 Contracts 0 0 0 0 Area Teams 609 15 624 878 MHLD 0 0 0 0 Corporate 189 800 989 592 Total Divisional Pipeline Schemes 1,338 815 2,153 2,319 Medicines Management IG 233 0 233 233 Procurement IG 2,000 0 2,000 2,000 Workforce IG 1,236 0 1,236 4,438 Total Improvement Group Holding Schemes 3,469 0 3,469 6,670 Total Pipeline Schemes 4,807 815 5,622 8,990 8
Total Programme 9,461 3,229 12,689 14,664 Appendix 4 – Expenditure
Pay Expenditure Health Board pay costs in June are £68.1m, an increase of £2.0m from last month and £5.2m above the 2019/20 average. Month 3 spend includes £4.4m of pay costs directly related to Covid-19, £2.4m higher than in May, which accounts for much of the increase.
Total Pay
£75M
£70M
£65M
£M
£60M
£55M
£50M Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Substantive Agency Bank Locum Other Non Core Overtime Additional Hours WLI's Average Total Pay
9 Appendix 4 – Expenditure
Actual Cumulative YTD YTD YTD M01 M02 M03 Budget Actual Variance £m £m £m £m £m £m Variable Pay M01 M02 M03 Total Administrative & Clerical 8.6 8.8 8.8 27.8 26.2 (1.6) £m £m £m £m Medical & Dental 15.2 15.6 15.5 44.5 46.3 1.8 Agency 2.8 3.1 3.5 9.4 Nursing & Midwifery Registered 20.6 20.8 21.2 66.0 62.6 (3.4) Overtime 1.0 1.0 0.9 2.9 Additional Clinical Services 9.4 9.5 9.8 26.7 28.7 2.0 Locum 1.2 1.7 1.7 4.6 Add Prof Scientific & Technical 3.1 3.1 3.0 9.6 9.2 (0.4) WLIs 0.1 0.1 0.0 0.2 Allied Health Professionals 3.8 3.8 4.0 11.2 11.6 0.4 Bank 2.1 1.9 2.1 6.1 Healthcare Scientists 1.1 1.2 1.2 3.6 3.5 (0.1) Other Non Core 0.3 0.0 0.1 0.4 Estates & Ancillary 3.2 3.2 3.4 10.0 9.8 (0.2) Additional Hours 0.4 0.4 0.3 1.1 Students 0.0 0.1 1.2 1.1 1.3 0.2 Total 7.9 8.2 8.6 24.7 Health Board Total 65.0 66.1 68.1 200.5 199.2 (1.3) Primary care 1.7 2.1 2.0 4.8 5.8 1.0 Total Pay 66.7 68.2 70.1 205.3 205.0 (0.3)
Areas of note are:
Covid-19 pay costs contain £1.1m for Band 3 and 4 student nurses (second and final year students respectively) who were recruited by the Health Board as a nursing initiative in response to the pandemic. The majority of these staff commenced in post in Month 2, but no costs were reported. Therefore, Month 3 includes two months costs for these posts. Total variable pay in June was £8.9m, 12.2% of total pay. This is an increase of £0.4m on May and £0.9m above the average for 2019/20. Additional costs relate to agency (£0.4m) and bank (£0.2m). Agency costs for Month 3 are £3.5m, 4.9% of total pay, an increase of £0.4m from last month. Agency spend related to Covid-19 in June was £0.5m, compared to £0.3m in May. Medical agency costs have increased by £0.1m to an in-month spend of £1.5m. Nurse agency costs totalled £1.2m for the month, £0.2m higher than in May. Other agency costs remained at £0.7m for June and mainly arise from Admin and Clerical (£0.4m) and Allied Health Professionals (£0.3m).
10 Appendix 4 – Expenditure
Non-Pay Expenditure
Costs this month are £2.2m higher than in May at £77.7m. Month 3 non-pay costs include £2.9m directly related to Covid-19 (£32.4m year to date).
Non-Pay Expenditure (Excluding Capital Costs)
106
101
96
91
m 86 £
81
76
71
66 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20
Actual £m Average Non-Pay
11 Appendix 4 – Expenditure
Actual Cumulative YTD Y T D Y TD M01 M02 M03 Budget Actual Variance £m £m £m £m £m £m Primary Care 17.2 17.5 15.9 52.8 50.6 (2.2) Primary Care Drugs 8.9 8.6 10.5 25.0 28.0 3.0 Secondary Care Drugs 5.4 5.0 5.5 17.0 15.9 (1.1) Clinical Supplies 4.8 3.6 4.2 16.7 12.6 (4.1) General Supplies 2.7 2.6 2.1 7.9 7.4 (0.5) Healthcare Services Provided by Other NHS Bodies 22.7 22.7 21.5 67.8 66.9 (0.9) Continuing Care and Funded Nursing Care 8.4 8.2 9.1 27.0 25.7 (1.3) Other 30.3 4.9 6.6 37.6 41.8 4.2 Non-pay costs 100.4 73.1 75.4 251.8 248.9 (2.9) Cost of Capital 2.4 2.4 2.3 7.1 7.1 0.0 Total non-pay including cost of capital 102.8 75.5 77.7 258.9 256.0 (2.9)
The main areas of significance this month are: Primary Care: General Dental Services (GDS) Contractors received 80% of the agreed 2020/21 contract value in Quarter 1. Costs of the main dental contract have decreased by £0.8m in June, as the quarterly GDS figures have been reviewed and adjusted to reflect the 20% reduction in contract payments. GP Practices are continuing to offer services, albeit with limited face-to-face patient access, and therefore are receiving the usual core General Medical Services (GMS) contract payments in full. Primary Care drugs: Costs have increased by £1.9m in the month and are a significant concern this year. The rolling average annual cost continues on an unprecedented upward trend and the first prescribing data for 2020/21 (April 2020) received this month showed a significant increase in the cost of items compared to 2019 levels. The actual costs for April were £0.6m higher than had been estimated, which has been adjusted in the Month 3 position. The April data has been used to update the average cost per prescribing day calculations, affecting the estimates for May and June reflected in the Month 3 position. Healthcare Services Provided by Other NHS Bodies: Due to the agreement to maintain payments to other NHS organisations via block contracts, most contractual payments are fixed, despite those organisations only undertaking very low levels of activity on behalf of the Health Board. There has been a reduction in Month 3 spend of £0.9m due to the WHSCC contract reporting an under spend from delayed developments and adjustments to some of the block contract payments. Continuing Healthcare (CHC): Expenditure in June has increased by £0.9m. This is due to patients being transferred into CHC placements to create capacity in acute settings because of Covid-19. Other non-pay expenditure: Spend has increased by £1.7m, with £1.2m arising from additional Covid-19 costs. There has also been a small increase in planned care activity, which has increased non-pay costs.
12 Appendix 5 – Financial Risks and Opportunities
Key Decision Point & Issue Description £m Risk Owner Summary Mitigation
Opportunity: Red rated savings schemes that total £5.6m are currently Red rated savings schemes that total £5.6m are Sue Hill, Acting Red Pipeline held in pipeline and are due to start delivering over the next currently held in pipeline and are due to start 1 (5.6) Executive Director of Savings three months. delivering over the next three months. Finance Schemes
Income has been anticipated for the estimated cost of Covid- This reflects a review of all schemes that were in the 19 for 2020/21, less funding already received. Welsh Risk: WG pipeline programme when the Recovery Programme Sue Hill, Acting 2 Government has not yet confirmed that this will all be funded Covid-19 was suspended, which has identified those schemes Executive Director of and so it is a significant risk to the financial position. The Funding which can be mobilised rapidly to generate savings Finance operational plan is still being developed and so all costs are this year. only indicative at this stage.
Risk: Welsh The projected increased cost of the Welsh Risk Pool (WRP) The cost is being monitored and all-Wales Sue Hill, Acting Risk Pool 3 Risk Share is a risk to the Health Board’s forecast for 0.1 discussions taking place through Deputy Director of Executive Director of (WRP) Risk 2020/21. Finance meetings. Finance Share
It has not yet been determined how this case will Sue Green, Executive Risk: Junior There was a significant test legal case focusing on how NHS impact on the Health Board and what the financial Director of Workforce 4 Doctor organisations should address monitoring for junior doctors. implications may be. Further investigations are & Organisational Monitoring being undertaken to quantify any potential impact. Development NWSSP Employment law team have confirmed that the Sue Green, Executive Risk: Holiday holiday pay issues arising from the Flowers judgement are Director of Workforce 5 The Health Board is monitoring the situation. Pay ongoing and the outcome of the Supreme Court appeal is & Organisational awaited. Development
13 3.4 20.106 Adroddiadau Sicrwydd Cadeiryddion y Pwyllgorau a'r Grwpiau Cynghorol / Committee and Advisory Group Chair's Assurance Reports 1 20.106.1 Chair's Assurance Report Audit 28.07.20 V1.0.docx
Health Board
24th September 2020 To improve health and provide excellent care Committee Chair’s Report
Name of Audit Committee Committee: Meeting date: 28th July 2020 (Extraordinary meeting to discuss the findings of the Auditor General Report: Refurbishment of Ysbyty Glan Clwyd. Name of Chair: Medwyn Hughes, Independent Member Responsible Dawn Sharp, Acting Board Secretary Director: Summary of In Committee items from previous meeting reported in public business Re-Setting Governance Arrangements discussed: BCUHB Annual Report and Annual Quality Statement update Auditor General Report: Refurbishment of Ysbyty Glan Clwyd (YGC) Key assurances Members noted the update on the progress of the Annual provided at this report and the Annual Quality Statement. meeting: The Audit Committee received the Auditor General Report: Refurbishment of YGC. The report set out some of the key steps taken by the Health Board and the Welsh Government to reduce the risk of similar issues occurring with future NHS Wales construction projects. Members noted that the project was completed on time and acknowledged that the work had all been completed within the context of a fully operational hospital. There was no suggestion that the Health Board had paid more than would be expected for the work eventually delivered and the project had ultimately enhanced the facilities that would provide patients and staff with a better experience and environment. Noting that the project timeline of events dates back to 2011-2012, both the Health Board and the Welsh Government have since taken significant steps to strengthen their approaches to the management and approval of capital projects. The Audit Committee monitors the implementation of actions and recommendations arising from the NHS Wales Shared Services Partnership’s Audit and Assurance Services Specialist Services Unit (SSU) Audits and other commissioned reviews.
Key risks including Whilst the Auditor General Report: Refurbishment of YGC mitigating actions did contain positive points noted by Members, the report notes and milestones that the Outline and Full Business Cases were insufficiently prepared, with underdeveloped design and cost plans. Furthermore, the report highlights discrepancies identified in the reporting of information.
1 Ineffective project governance allowed the Project Board, the Board of the Health Board and the Welsh Government to be misled about the project’s overall affordability and its financial performance against its capital budget. Members noted that the report was due to be published on 8th September in advance of it being considered by the Public Accounts Committee.
Special Measures Improvement Governance and Leadership Framework Theme/Expectation addressed Issues to be none referred to another Committee Matters requiring Members of the Audit Committee asked that a briefing note be escalation to the circulated to all Board Members to ensure that they were sighted Board: on the report Well-being of In summary, the purpose of the Audit Committee is to advise and Future Generations assure the Board and the Accountable Officer on whether effective Act Sustainable arrangements are in place – through the design and operation of Development the Health Board’s system of assurance. As such the Committee Principle gives consideration to the sustainable development principles in their widest sense but in particular, the focus on progress of internal and external audit reports supports the principle of putting resources into preventing problems occurring or getting worse. Planned business Range of regular reports to also include; the annual review of gifts for the next & hospitality and Declarations of Interest (DoI); Legislation meeting: Assurance Framework; Dental assurance Framework; Counter Fraud Progress Report from Quarter One. Date of next 17th September 2020 meeting: V1.0
2 1 20.106.2a Chair's Assurance Report QSE 28.8.20 v1.0.docx
Health Board
24.9.20 To improve health and provide excellent care
Committee Chair’s Report
Name of Quality, Safety and Experience Committee Committee: Meeting date: 28 August 2020
Name of Chair: Lucy Reid, Independent Member
Responsible Gill Harris, Executive Director of Nursing and Midwifery/Deputy Director: Chief Executive Summary of The Committee considered reports and updates on the following business subjects: discussed: Two stories of patients who had received hospital care during the pandemic and their experiences Quality and Performance report COVID-19 Pandemic Update Serious Incident Report Make it Safe Process – a brief on the updated rapid review process Quality Governance Structure Review Quality Safety Group Assurance Reports for July and August Mental Health and Learning Disabilities Division Update Holden Report Update HASCAS and Ockenden Improvement Group Chair’s Assurance Report Quality Governance Self-Assessment Action Plan Mortality Review Update HIW Annual Report was received but not presented by HIW Final draft of the Annual Quality Statement Primary Care Update Care Homes Update Essential Services and Restart of Clinical Services Vascular Services Update Internal Audit Report Deprivation of Liberty Safeguards Occupational Health and Safety Annual Report and the Quarter 1 Report Independent Review of Fire Precautions at Ysybty Gwynedd and Action Plan Pharmacy and Medicines Management Annual Report* Annual Organ and Tissue Donation Report* CQC Report for Shrewsbury and Telford NHS Trust * The annual reports may be downloaded via the link below and accessing the 28.8.20 Committee meeting papers https://bcuhb.nhs.wales/about-us/committees-and-advisory- groups/quality-safety-and-experience-committee/ Key assurances The Committee noted that, following concerns raised at the provided at this previous meeting, a communication had been circulated to meeting: mandate the use of face masks for staff. The Committee received an update on the COVID-19 outbreak at Wrexham Maelor Hospital and the actions that had been taken to control the outbreak. Post infections reviews were being undertaken to identify learning and contributory factors included patient and staff movement within the hospital and compliance with personal protective equipment. Mortality reviews were being undertaken and the principles of the duty of candour were being followed. A outbreak review report would be submitted to the next QSE Committee. The creation of four permanent subgroups of the QSE Committee was approved as part of a revised and improved quality governance reporting structure. The Committee supported and approved the commencement of phase 2 to include a review of the reporting structures and groups across the division to improve governance arrangements. The Committee received a briefing on the review being undertaken on the Holden report to go back through the original recommendations and triangulate with the HASCAS and Ockenden recommendations. The outcome of the review would be reported to a future QSE Committee. An update was provided on the delivery of essential services across primary care and the implementation of the primary care recovery plans. The Committee received an update on the commission of an external review into the vascular service and the progress of the Task and Finish Group. The need to improve governance processes and wider benefits realisation for any service change was agreed. The health and safety report provided an update on a number of actions taken to address priority areas that had been highlighted in the gap analysis undertaken. There has been a focus on RIDDOR reporting in particular during COVID. A detailed action plan has also been developed to improve security and address violence and aggression incidents across the Health Board. Key risks including The Committee noted ongoing concerns about the need to mitigating actions improve and be able to demonstrate organisational learning and milestones arising from incidents. An improved level of corporate oversight on incident reporting was being progressed to address this and a review was being undertaken. An exception report highlighted the current risks across the Mental Health and Learning Disabilities Division including vacancies across the leadership team and the need to plan for the anticipated increase in demand in services. It was also noted that the psychological therapies review had been paused during the pandemic but that this would need to be commenced again. The challenges restarting services across secondary care were noted using a risk stratification approach. The winter surge plans were under development and should be aligned with planned and unscheduled care work. Special Measures Leadership and Governance Improvement Framework Theme/Expectation addressed Issues to be The risk relating to the Patient Administration Systems across the referred to another three acute hospital sites has been referred to the Digital and Committee Information Governance Committee Matters requiring None escalation to the Board: Well-being of The Committee gave due consideration to the sustainable Future Generations development principles. Act Sustainable Development Principle Planned business Range of regular reports plus for the next Corporate Risks meeting: Quality and Performance assurance report Mortality and Morbidity report Nurse Staffing report Patient Experience report Primary and Community Care quality assurance report Safeguarding report Prison Healthcare report Complaints process review Date of next 28 August 2020 meeting:
V1.0 1 20.106.2b Chair's Assurance Report QSE Jul 20 v1.0.docx
Health Board
24.9.20 To improve health and provide excellent care
Committee Chair’s Report
Name of Quality, Safety and Experience Committee Committee: Meeting date: 29 July 2020
Name of Chair: Lucy Reid, Independent Member
Responsible Gill Harris, Executive Director of Nursing and Midwifery/Deputy Director: Chief Executive Summary of The Committee considered reports and updates on the following business subjects: discussed: Infection Prevention and Control Report Health and Safety Briefing Serious Incident Report Draft Annual Quality Statement 2019/20 Mortality review update North Wales Vascular Review update Essential Services during COVID-19 Quarter One Plan Monitoring Report Quality and Performance Report Nursing Workforce Key assurances Increased scrutiny of RIDDOR reporting data by area had been provided at this undertaken to identify trends and ensure accurate information. meeting: The establishment of staff health and well being hubs had been beneficial and work was ongoing to support shielding staff returning to work.
Key risks including The Committee voiced concerns about the use of face coverings mitigating actions for patients and the public in healthcare settings. Post infection and milestones reviews had been undertaken to identify learning from health acquired COVID-19 infections. Estates issues were still apparent on a ward in Ysbyty Glan Clwyd and the Committee requested an urgent update be provided. The Committee raised concerns again about the mortality review report and lack of assurance about the process. It was agreed that the Committee would receive a further report at the August meeting addressing these concerns. The challenges around maintaining essential services during the COVID-19 pandemic were highlighted. The added requirements for social distancing and infection prevention controls had a significant impact upon capacity. It was noted the service needed to continue monitoring activity and compliance with the revised essential services guidelines in order to mitigate the risk of harm. The Committee received an update on the resetting and recovery of services and noted the significant challenges that the Health Board were facing. The service is undertaking risk stratifications of waiting lists to manage patient referrals on a risk basis rather than just based upon the longest waits. The waiting list management report was deferred to the next meeting
Special Measures Leadership and Governance Improvement Framework Theme/Expectation addressed Issues to be None referred to another Committee Matters requiring None escalation to the Board: Well-being of The Committee gave due consideration to the sustainable Future Generations development principles. Act Sustainable Development Principle Planned business Range of regular reports plus for the next COVID-19 Pandemic Update meeting: Serious Incident Report Make it Safe Process – a brief on the updated rapid review process Quality Governance Structure Review Mental Health and Learning Disabilities Division Update Holden Report Update HASCAS and Ockenden Improvement Group Chair’s Assurance Report Quality Governance Self-Assessment Action Plan Mortality Review Update HIW Annual Report Final draft of the Annual Quality Statement Primary Care Update Care Homes Update Essential Services and Restart of Clinical Services Vascular Services Update Internal Audit Report Deprivation of Liberty Safeguards Occupational Health and Safety Annual Report and the Quarter 1 Report Independent Review of Fire Precautions at Ysybty Gwynedd and Action Plan Pharmacy and Medicines Management Annual Report Annual Organ and Tissue Donation Report CQC Report for Shrewsbury and Telford NHS Trust Date of next 28 August 2020 meeting:
V1.0 1 20.106.3a Chair Assurance Report FPC 27.8.20 v1.0.docx
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Health Board
24.9.20 To improve health and provide excellent care
Committee Chair’s Report
Name of Finance and Performance Committee Committee: Meeting date: 27.8.20
Name of Chair: Mr Mark Polin, BCUHB Chairman
Responsible Ms Sue Hill, Acting Executive Director of Finance Director: Summary of The following items were discussed business Operational plan 2020/21 Q2 monitoring report (OPMR) discussed: Quality and Performance (QAP) report Planned Care update including RTT and essential services Unscheduled Care and Building Better Care update Capital Programme Month 3 Finance Reports - Month 4 and 3 Interim report on Covid 19 financial governance Nuclear Medicine Consolidation Strategic Outline Business Case Staff Lottery – from Charitable Funds Committee Annual report 2019/20 Monthly monitoring reports Months 4 and 3
Private session: Proposed third party development business case at GP practice Digital Dictation progress update PMO Capacity report Medical and Dental Agency Locum monthly report Key assurances The QAP report had developed, however further work was provided at these required to avoid duplication and improve streamlining of the meetings: report. The Executive Team undertook to address this. Diagnostic and phlebotomy services had improved and it was noted that sickness absence was the lowest in Wales. The majority of essential services were being maintained and actions had been implemented to address shortfalls Work was underway with WG to develop a vulnerability index to address social impacts and health inequalities. The Executive Director of Workforce and OD advised that work was moving forward to improve Equality Impact Assessments to assist in BCU’s socio-economic duty. The redevelopment of the Ablett Unit as a new build had involved wide engagement including the NWCHC. Assurance 2
was given that the organisation was mindful of public opinion, however formal consultation had not been undertaken as there was no service change. In respect of the financial forecast it was anticipated that the organisation would achieve the £40m deficit target on the basis that all Covid19 costs were fully funded. The Nuclear Medicine Consolidation Strategic Outline Business Case had been comprehensively prepared and presented. It was approved for submission for the Board to consider on 24.9.20 Key risks including The Committee emphasised the need to ensure that mitigating actions contingency was built into Q3&4 planning. and milestones Further briefings were requested on bookings processes and outpatient transformation to enable a greater understanding of the current position Planned and Unscheduled Care along with winter protection planning was of significant concern Emergency Department (ED) potential investment was being explored with Kendal Bluck. The customary availability of contractual English providers to draw on during the Winter period would be significantly reduced due to the national covid19 response. The usual scheduled reduction in planned care activity would not be an option in the current climate. A process of re-stratification was taking place with waiting lists over 36 weeks on the incline. Risk and mitigation work was taking place alongside the introduction of new measurements introduced on RTT Orthopaedic alternative ways of providing surgical interventions were requested to be explored and presented at the next meeting, along with detail of a potential diagnostic and treatment centre development. Delays in capital projects and additional measures put in place due to Covid19 were expected to result in potentially increased out-turn costs and extended programme. The Royal Alexandra hospital and Ablett new build business cases were expected to be presented at the next meeting. £3.3m in month deficit / £13.3m year to date deficit was in line with month 4 plan- assuming all Covid19 costs incurred by the Health Board would be fully funded, however this had not yet been confirmed and therefore was a significant risk Savings plans had been severely impacted by the Covid19 response currently forecast to under deliver by £30.8m against the £45m target. It was reported that up to Month 4, the Health Board had reported Covid19 related costs of £56m, with a forecast of £122m, across a number of key Revenue, Capital and Charitable Funds elements. It was noted that the Covid19 specific Finance Risk (ID 3152) – ‘Covid19 expenditure may 3
exceed funding available from WG’ was logged in the Finance Directorate’s risk log. Further detail and lessons learned would be presented to the October meeting The Staff Lottery – from Charitable Funds proposal would be resubmitted to the October meeting, addressing the various governance concerns raised and gauge potential staff support. Special Measures Leadership and Governance Improvement Strategic and Service Planning Framework Financial sustainability Theme/Expectation addressed Issues to be None referred to another Committee Matters requiring Financial Plan 2020/21 position (£3.3m in month deficit / escalation to the £13.3m year to date deficit was in line with month 4 plan- Board: assuming all Covid19 costs incurred by the Health Board would be fully funded, however this had not yet been confirmed and therefore was a significant risk) Planned Care / RTT / Essential services – significant concern was highlighted. The Committee stressed the need to address the situation with ambition and radical change. Future Finance reports would only include confirmed Covid- 19 income within their monthly position reporting, although additional allocations are expected as Q3/4 plans are confirmed. Well-being of The Committee gave appropriate consideration to the sustainable Future Generations development principles. Act Sustainable Development Principle Planned business Discussion of the following items: for the next Planned Care meeting: Finance Savings Date of next 30.9.20 – Additional meeting to address the above areas meeting:
V1.0 1 20.106.3b Chair's Assurance Report FPC 16.7.20 v1.0 .docx
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Health Board
24.9.20 To improve health and provide excellent care
Committee Chair’s Report
Name of Finance and Performance Committee Committee: Meeting date: 16.7.20
Name of Chair: Mr Mark Polin, BCUHB Chairman
Responsible Ms Sue Hill, Acting Executive Director of Finance Director: Summary of The following items were discussed business Chair’s action approval in respect of: discussed: . Full business case for Digital Health Record . Revenue business case for defibrillator replacements Primary and Community Services report - sustainability and transformation Annual plan 2019/20 reconciliation Operational plan 2020/21 Q1 monitoring report Month 2 Quality and Performance report Unscheduled care and building better care update Month 2 Finance report Savings programme 2020/21 month 2 report Approval of BCU Interim discretionary capital programme 2020/21 Annual review Terms of Reference and approval of the cycle of business 2020/21 External contracts Update Workforce quarterly performance report PWC recommendations update NHS Wales Shared Services Partnership Summary Performance Report Quarter 4 2019/20
Private session: Monthly Financial position report – month 2 2020/21 Mental Health Rehabilitation business case update Approval of Wrexham Maelor hospital continuity programme– procurement of external support Covid19 ventilation essential equipment Medical and Dental Agency Locum monthly report Key assurances Significant progress had been made with partners in developing provided at these integrated services and health & wellbeing hubs meetings: 2
Covid 19 indicators were included within the Quality and Performance report including details on Teat, Trace and Protect. The Health Board was expected to deliver on £40m deficit plan should all Covid19 costs be met by Welsh Government 152 volunteers were recruited during the Covid 19 response to a variety of roles that supported the organisation. Plans were in place to continue communication with a potential 600 people whom had come forward. Key risks including Significant risk to the financial plan regarding unknown WG mitigating actions funding response to C19 pandemic. and milestones Primary care services sustainability issues were being managed via a risk based approach - set out within a 5 domains risk assessment matrix Endoscopy service issues were in the process of being addressed, including the introduction of a more effective way of listing patients across North Wales Potential financial implications needed to be addressed in respect of the requirement to test patients prior to care home discharge. Capacity and capability concerns within the Programme Management Office were highlighted. It was agreed that a report be provided to the August meeting to address this Covid 19 was impacting the Health Board’s savings programme, however the Acting Executive Director of Finance was addressing this, along with Executive Team colleagues, with an action plan and was mindful of internal resourcing availability. Special Measures Leadership and Governance Improvement Strategic and Service Planning Framework Financial sustainability Theme/Expectation addressed Issues to be Regular Primary Care quarterly reports would be provided to referred to another the Strategy, Partnerships and Population Health Committee Committee WCCIS alternative to be explored further by Digital and Information Governance Committee Matters requiring Financial Plan 2020/21 position escalation to the Significant risk to the financial plan regarding unknown WG Board: funding response to C19 pandemic.
Well-being of The Committee gave appropriate consideration to the sustainable Future Generations development principles. Act Sustainable Development Principle Planned business A range of regular finance and performance reports plus for the next PMO and Service Improvement resourcing report meeting: Nuclear Medicine Consolidation Strategic Outline Case 3
RTT Unscheduled Care and Building Better Care update
Date of next 27.8.20 meeting:
V1.0 1 20.106.4 Chair Assurance Report SPPHC 13.8..20 v1.0.docx
Health Board
24.9.20 To improve health and provide excellent care
Committee Chair’s Report
Name of Strategy, Partnerships and Population Health Committee Committee: Meeting date: 13.8.20 Name of Chair: Mrs Lyn Meadows, Acting Chair Strategy, Partnerships and Population Health Committee Responsible Mr Mark Wilkinson, Executive Director Planning and Performance Director: Summary of The Committee discussed the following at the meeting held on business 13.8.20 discussed: 2019/20 annual plan reconciliation 2020/21 Quarter 1 operational plan monitoring Q2 plan and development of Q3 2020/21 COVID-19 prevention and response plan Regional Partnership Board update Public Service Board update : Conwy & Denbighshire annual report Community Services Transformation fund update Mental Health Transformation Fund update Learning Disabilities Transformation Fund update University Health Board status review update Covid 19 Research and Innovation report Public Health : Test, Trace and Protect (TTP) Welsh Language 2019/20 annual monitoring report Integrated Care Fund and Partnership Governance Section 33 agreements Draft Committee annual report 2019/20 Key assurances The Conwy and Denbighshire Public Service Board annual provided at this report 2019/20 was received meeting: The Community services transformation programme, which had been impacted by the Covid19 response, had regrouped and was on track. A number of very positive transformative introductions had been moved forward into community areas such as IT infrastructure, integration through workforce governance, maturing care capacity and addressing fragility within the care sector. There was strong agreement by the Committee that the Board should seek to de-conflate strategy from operational planning and ensure that strategy architecture included design principles. Whilst the Learning Disabilities transformation work had been impacted, 3 main areas continued to be progressed ie programme & ’Get checked out’ websites, LD transformation fund and small projects and new activity in response to Covid 19 emergency measures. Staff at the Bryn Y Neuadd site had gone the extra mile to put their patients first during the Covid19 pandemic response. Assurance was given that the move from triennial University status reviews to alignment with integrated plans was not with the intention of removing University status. Meetings would be taking place with Bangor University colleagues to move forward work in this area Whilst many examples of research, innovation and audit had taken place during the Covid 19 response, the Committee encouraged the Health Board to become more involved in large scale studies with Bangor University. Health Care Research was agreed to be moved forward through meetings to be co-ordinated by the Executive Director of Therapies and Health Sciences. Governance processes were in place in relation to Test, Trace and Protect work, the Committee would receive TTP reports at each meeting going forward. Welsh Language 2019/20 annual monitoring report provided a positive report. The limited Internal Audit assurance report had been addressed with the updating and strengthening of the bilingual skills strategy and workforce processes. The limited Internal Audit assurance report on Partnership Governance section 33 had been addressed Key risks including Concern was raised on mitigating actions Business continuity planning - testing, capacity and capability and milestones concerns especially given the current extended Covid 19 response. A report addressing these issues would be provided to the next meeting Capacity within the Intelligence cell to effectively manage the critical work apportioned to it. Winter planning work, which was acknowledged to be a more complex area given that Covid19 remained in circulation, was understood to be in hand by the newly appointed Interim Chief Operating Officer and would be addressed at the next meeting. The need for ‘weighted’ outcomes within planning was stressed by the Committee – as previously incorporated within BCU’s logic based modelling. This would be taken forward in Q3/4 plans. The Committee emphasised the need for Equality Impact Assessments to be undertaken, given the increasing inequalities emerging through the Covid 19 pandemic response. A verbal report was provided on the draft Covid19 prevention and response plan. Given the 2 week turnaround, it had not been possible to schedule the written report by the necessary Committee publication date. The Committee questioned the timing of governance process of regional strategies being considered at Regional Partnership Board and at individual partner organisations. Clarity was sought to be provided at the next meeting. There was potential financing uncertainty regarding transformation funds, including the risk of funding cessation, however the Executive Director Primary and Community Services confirmed work to be underway to ensure staffing costs would be met by existing budgets. Special Measures Leadership and Governance Improvement Strategic and Service Planning Framework Theme/Expectation addressed Issues to be WCCIS delays causing operational delays were to be moved referred to another forward in the Digital and Information Governance Committee Committee Matters requiring Welsh Language Services annual monitoring report 2019/20 was escalation to the approved for submission to the Board prior to publication and Board: presentation to the Welsh Language Commissioner https://bcuhb.nhs.wales/about-us/committees-and-advisory- groups/strategy-partnerships-and-population-health-committee/
Well-being of The Committee gave consideration to the following sustainable Future Generations development principles: Act Sustainable 1.Balancing short term need with long term planning for the future; Development 2.Working together with other partners to deliver objectives; Principle 3. Involving those with an interest and seeking their views; 5.Considering impact on all well-being goals together and on other bodies Planned business Range of regular reports plus:- for the next Q3 &4 sustainable service delivery plan and supporting plans meeting: Winter / Surge Mass vaccinations Covid 19 prevention and response Care homes Test, Trace and Protect Digitally enabled Clinical Services strategy progress update Research, Innovation and University status update Business Continuity update Strategic Programme for Primary Care National Operating Framework for Primary and Community Care and delivery milestones Engagement Update Date of next 1.10.20 meeting:
V1.0 1 20.106.5 LPF Advisory Group Report 7.7.20 v1.0.doc
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Health Board
24.9.20 To improve health and provide excellent care
Advisory Group Chair’s Report
Name of Advisory Local Partnership Forum Group:
Meeting date: 7th July 2020
Name of Chair: Ms Jan Tomlinson
Responsible Mrs Sue Green, Executive Director of Workforce & Organisational Director: Development
Summary of key The COVID-19 Structure Update was discussed. SG agreed items discussed: to circulate a copy of the revised structure, since the Health Board had stepped back from the formal emergency structure.
Mrs G Harris provided an update on The COVID-19 and Quarter 2 Plan – Safely Managing the Balance which focussed on the mental health, primary care and TTP challenges that lie ahead. SG recommended that a group session should be organised with the trade unions where the measures put in place can be described fully and discussed, to understand the impact of these measures and to get the support and feedback from the unions and this was agreed.
Mrs T Owen provided an overview of The COVID-19 – Test, Test and Protect service. TO described the three tiers in the Welsh response, how they work and their individual responsibilities. A description was also provided of each part of the services and how it is working. A question regarding the time taken to receive results was asked and response given.
SG explained the principles proposed in her discussion paper – COVID-19 - The Safe and Agile Working Programme – which was put to the Executive Management Group last week. Questions were received regarding a) the Health Board’s intentions towards supporting its staff when they start to return to work, b) whether the consultation of 12 hour shifts is to continue, c) whether a survey should be carried out amongst the people who have been working from home to discover the problems and benefits encountered whilst doing so and d) Concern was raised regarding Estates who it was believed V1.0 2
have been contracting out work that could be done in-house and the dangers/problems therein. All these concerns were addressed.
SG described the work being carried out for The Interim Debrief and why, and agreed to organise an informal workshop to discuss lessons learned over the past few months.
The Local Partnership Forum Committee Annual Report. SG explained that during COVID the requirement for the Annual Report was stood down however this decision had since been rescinded. A draft report was presented and SG agreed to circulate it before sending to the Board.
A concern was raised regarding the Staff Wellbeing Support Service (SWSS) being closed in WMH – this was to be addressed by both SG and KH.
It was brought to the attention of the LPF that concerns have been raised that some staff are complaining about their colleagues who are shielding, not having to use their annual leave. LH advised the Group that she is in the process of putting together guidance to all staff to encourage them to take annual leave on a health and wellbeing basis
An enquiry was made as to the long-term plan to increase the recruitment. This was addressed by LO, who described the work done so far and SG agreed that she had some data around vacancy levels across several staff groups and would share the data with the LPF members
SG agreed to arrange a meeting with JH and a small number of trade union colleagues, where they could discuss a more effective and quicker way of updating policies.
WN enquired as to the current IT strategy regarding Skype and what emphasis there is about moving away from it, towards Teams, which he feels is a much more suitable system. SH reported that she was about the present a paper to The Board the next day which lays out what needs to be done to accelerate the roll out of Microsoft 365 (the digital platform required for Teams), as it was generally agreed to be a superior system.
Key advice / Update provided on Q2 plan measures put in place to support feedback for the service delivery in Covid environment Board: Overview provided of TTP service V1.0 3
Special Measures Leadership and Engagement Improvement Framework Theme/Expectation addressed Planned business Range of standard reports plus: for the next F&P Report meeting: Unscheduled Care Report Workforce Policies Group Report Workforce Partnership Group Workforce Engagement Update Job Evaluation Programme Report Workforce Report Employee Relations Report Welsh Language Standards Report Prevention and Control of Infection Report Minutes of the Strategic Occupational Health & Safety Group Date of next Tuesday, 20th October 2020 meeting:
Disclosure: Betsi Cadwaladr University Health Board is the operational name of Betsi Cadwaladr University Local Health Board 3.6 20.107 Diweddariad ar yr Uwch Adran Iechyd Meddwl ac Anableddau Dysgu / Mental Health & Learning Disabilities Division Update - David Fearnley/Teresa Owen 1 20.107 MHLD update_management arrangements and pathways work Final V1.0.doc
1
Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.20 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Mental Health & Learning Disabilities (MHLD) Update on Report Title: Management Structure and Pathways Work within MHLD Services Cyfarwyddwr Cyfrifol: Teresa Owen – Executive Director of Public Health Responsible Director: Awdur yr Adroddiad Dr Alberto Salmoiraghi – Medical Director MHLD Report Author: Mike Smith – Interim MHLD Director of Nursing Craffu blaenorol: - Prior Scrutiny: Atodiadau None Appendices: Argymhelliad / Recommendation:
The Board is asked to:
- Note the report which summarises the recent work on care pathways during the covid-19 pandemic, and seek any further assurance; - Support the efforts to stabilise leadership and management within the Division as a priority; - Support the MHLD Division to jointly manage external relationships to enable the necessary service changes over the next year of the covid-19 pandemic - Support the MHLD Division and management changes within the Mental Health and Learning Disability Division, as it facilitates partnership work as the next necessary step to achieve wider community resilience - Support the MHLD Division as it develops and implements evidence based care pathways
Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation:
Over the past year, the Mental Health and Learning Disability (MHLD) Division has undergone significant management changes and covered absences at the most senior levels. For example, shortly after the beginning of the covid-19 pandemic, there was only one substantive director (the Medical Director) and an Interim Director for the MHLD Division.
Therefore, the MHLD Division has had a significant stress test during the covid-19 pandemic within a context of these gaps in management presence over the past 6 months. Despite these evident gaps, the Division has managed significant managerial and service changes within the context of 2
“Command and Control” adopted at national level and delivered within the health board’s agreed model. Staff have demonstrated good resilience, although the anxiety and stress levels have been high, reflected in increased sickness absence and complaints.
During these rapid changes, significant events occurred, such as the discharge of a large number of patients open to the Local Primary Care Mental Health Services. The circumstances that led to this are currently under review and will form part of the learning. However, during the first phase of the management of the pandemic positive results were also achieved. For example, covid-19 related mortality rates are below national average; there has been a good level of physical health care in the inpatients wards (as per mortality reviews); a rapid adoption of tele-mental health both for clinical and managerial use, with good results as evident in the national report commissioned by Welsh Government (Practice Solutions); and positive HIW findings following an unannounced visit at Heddfan unit. The final report is expected shortly.
Furthermore, other long term activity has continued with positive results: ICAN work evaluation is attracting national attention due to positive preliminary results, two leads have been nominated to implement the Physical Health Care strategy, two consultants psychiatrist have been appointed (1.6 WTE) and the Academic Partnership Board has engaged in several international, multicentre C19 related research projects.
The MHLD Division had time to reflect on the first phase of the covid-19 pandemic and to learn about what further changes should be made as the pandemic continues. The clinical needs of the population will remain central to any planning of service response as the pandemic continues to develop, and this will determine the unprecedented and likely changes in psychiatric morbidity. There remains an urgent need to reduce travel and maintain social distancing and so the use of tele- mental health has to remain an important mean for assessments, reviews and delivery of therapies by all staff, along with other means of interventions and assessment. The MHLD Division has already developed ‘Consultant Connect’ in collaboration with other services within the health board and joined the pilots for Attend Anywhere and Silver Cloud.
According to the latest modelling based on international epidemiological data, the next phase of the pandemic is predicted to last well beyond the next 12 months, with some waves of higher number of cases. The Centre for Mental Health, the WHO and the Health Foundation indicate a future increased demand for mental health services, due to social determinants such as social isolation, grief, economic downturn, housing insecurity and reduced access to services. Although this increased demand is difficult to quantify, international data at this time suggest a 20% increase in presentations to services with mental health related issues. This is applicable both to primary and secondary care services.
Considering the above, the Division started to plan ahead at a very early stage and produced a phase 2 plan in an attempt to begin discussion about how to prepare for the continued covid-19 pandemic. Although the intention was to join up long term strategic plans with the management of the pandemic, the document was unfortunately too complex and detailed. Some found it confusing and insufficient consultation and engagement had taken place prior to the plan being shared. Feedback was actively sought and whilst mixed, the proportion of negative feedback both from within the division and wider partners has meant that a new plan will need to be developed to ensure partners are fully engaged as the future plans are redesigned. Much of the phase 2 plan was based upon evidence based care pathways and the safety of patients during unprecedented and rapid pressures on services – these priorities remain as important as ever. 3
Cefndir / Background:
Revised Management Arrangements
From September, the Executive Lead for the MHLD Division has been handed over to the Executive Director for Public Health, to facilitate safe and proper handover of the executive portfolio and preparing for the departure of the Executive Medical Director.
The Interim Director for the MHLD Division, Lesley Singleton will take up a role in NHS Wales from the end of September 2020 and the MHLD Division would like to thank her for the work she has done, notably through the covid-19 pandemic and the rapid redesign of the inpatient and community services. An interim recruitment is in process and the division intends to have an appointment by the time of the board meeting.
Mike Smith has joined the Division from the 10th August 2020 as Interim Director of Nursing.
The Director of Strategy and Partnerships and the Director of Transformation are vacant at the current time and the Director of Operations and Service Delivery and Interim Director of Psychological Services roles in the 2019 structure are currently vacant (from the roles in the 2019 published divisional management structure) but under review.
The Division has short-term interim support at Senior Leadership level in Programme Management, phase 2 covid-19 preparedness/HQIP as well as the Ablett Project, Redesign and Replacement.
Phase 2 covid-19 Planning
The covid-19 situation is unprecedented and has placed huge demands on the whole health and care system as well as society in general. The MHLD Division are moving from the initial period of responding to covid-19 and within the limitations of government restrictions and infection control, are moving to establish a medium term, safe and sustainable MHLD service that will ultimately deliver the Together for Mental Health Strategy previously signed off by the Board.
The Division has reflected upon to understand the impact and outcomes of our actions during the initial phase of the pandemic. As part of our initial phase we enacted a swift clinically led service change to ensure that:
Our bed based provision was organised to manage an unknown number of possible positive cases and was organised around an evidence based Patient Pathway model i.e. Older People’s Mental Health (OPMH), Adults, Rehabilitation Services, Substance Misuse and Learning Disabilities. We maintained area operational management to ensure continuity for essential services amidst disruption of community services through staff dispersion/absences and social distancing. Our resources were focussed on supporting the most vulnerable and high-risk patients to avoid unnecessary social contact, travelling or hospitalisation. We quickly published a comprehensive Divisional Operational Plan and contingency arrangements to deliver care for patients presenting, or possibly presenting with symptoms of covid-19. This Operational Plan was developed by clinical and operational leads from within the Division, agreed and supported by executive directors through the Health Board’s Clinical Pathways Group. 4
However, our learning was that:
The rapid requirement of stepping up our response to Covid-19 did not allow the opportunity we would usually afford to engage and consult on our plan, both inward and outward facing. We did not sufficiently anticipate the anxieties or needs of our staff who were required to work with different patient groups from their normal level of experience and clinical competence. The pathways we developed were not fully established and there was a lack of clarity on managerial responsibilities and accountabilities.
Mindful of this learning, we intend to work with our partners, to further explore Clinical Pathways as a model of working in Wales for mental health and learning disabilities, clearly defining the evidence base for interventions and describing the patient and carer experience as well as the treatments received by whom and at what time. This has been generally positively received by clinical staff but is at an early stage of exploration.
The Division will not continue with the proposals set out within the Phase 2 paper but will continue the care pathway development work above that has broadly been welcomed and this should inform the planning and transformation of the services.
Throughout the remaining quarters of 2020/21 as the division re-groups, the focus of work will be:
Stronger divisional management and clinical governance arrangements which will align with those of the Health Board Re-establishment of the engagement with our staff, patients and key stakeholders on any plans A baseline review of current capacity and capability in delivering business functions to support the agenda of the MHLD Division (this being reflected in the ongoing clinical pathways work streams) Detailed capacity and demand modelling to ensure the MHLD Division is prepared for future demand Deliver clinically led, safe and effective services in partnership with patients, their families, social care and third sector colleagues. We will be re-instating our Patient Experience Group which will ensure the patient/carer voice is at the heart of our services and will follow the structure of the corporate patient experience group and the corporate governance approach Continue to protect our staff and their families and promote staff wellbeing Maintain a focused inpatient service, to ensure we are ready for any possible covid-19 resurgence and ensure that community care is the default option. This will be informed by a frequent review of emerging evidence and adapting to infection prevention control advice Restore and enhance Primary and Community Care services to ensure as many people as possible are cared for in their own homes and communities, compliance with the Welsh Measure in the context of covid-19 guidance from Public Health Wales; Restore the patient/carer experience consultation and governances; Ensure that the Estate and Equipment is fit for purpose to deliver services within covid-19 restrictions.
Asesiad / Assessment & Analysis
Strategy Implications 5
The intention is to continue to develop the MHLD strategy and T4MH strategy in the context of the long term management of the pandemic and in keeping with the recommendations of the Psychological Therapies review.
Financial Implications Financial costs relating to the reinstatement of services and use of interim posts will be considered through the appropriate financial governance arrangements
Risk Analysis
The lack of key leadership roles due to vacancy and absence has impacted on the ongoing sustainability of the division to deliver of care to patients and affects the short term capacity to deliver strategic plans. Short term mitigations are going to be in place, but a longer term solution is necessary.
Legal and Compliance None
Impact Assessment N/A 3.7 20.108 Adroddiad Diweddaru - achosion COVID-19 Economi Iechyd y Dwyrain / Update report - COVID-19 outbreak East Health Economy - Debra Hickman 1 20.108 Update report - COVID-19 outbreak East Health Economy.docx
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Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.20 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Update report - COVID-19 outbreak East Health Economy Report Title: Cyfarwyddwr Cyfrifol: Debra Hickman, Acting Executive Director of Nursing and Responsible Director: Midwifery Awdur yr Adroddiad Naomi Holder, Site Director of Nursing, Wrexham Maelor Report Author: Hospital . Craffu blaenorol: Infection Prevention Sub Group Prior Scrutiny: Atodiadau None Appendices: Argymhelliad / Recommendation: The Board is requested to note the content of information of this report as an update position for East Health Community. The report details the current situation, background to events, current position and the planned next steps for both the local hospital sites and the wider Health Board.
Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er gwybodaeth penderfyniad Trafodaeth sicrwydd For Information X /cymeradwyaeth For Discussion For Assurance For Decision/ Approval Sefyllfa / Situation:
A level 3 outbreak of COVID 19 has occurred in the East Health Community, impacting upon high numbers of patients and staff. The majority of cases are defined as healthcare associated infections (HCAIs). In total there have been 121 positive patient cases associated with the outbreak (of which 74 are HCAIs) and 58 staff cases. Sadly, there have been a number of patient deaths, of which 39 patients died with a HCAI.
Cefndir / Background:
An outbreak of COVID-19 was declared in the East Health Community on the 20th July 2020. This was defined as a level 3 outbreak in line with BCHUB policy (IPC05) Outbreak reporting and control procedure. A level 3 outbreak is defined as an outbreak affecting multiple hospital sites across BCUHB, or which presents a significant risk to a large number of patients, staff or visitors, and/or requires significant control measures such as the closure of a large number of wards or facilities and services, and/or threatens the Health Board’s ability to meet its emergency or elective commitments. 2
A review of the Health Board data confirmed that there had been low prevalence of assumed health care acquired COVID-19 during the week ending the 5th July 2020 and transmission was noted to be present the week ending the 12th July 2020. The week ending 19th July 2020 the significant rise in cases reported positive was noted.
The definition of HCAI is described below (fig 1.0)
Fig 1.0
Patients Staff HCAI Definite >14 days between admission and Confirmed positive SARS-CoV-2 specimen date result Probable I 8 - 14 days (inclusive) between Indicative symptoms without admission and specimen date laboratory confirmation or result awaited None HCAI Indeterminate 3 – 7 days (inclusive) between admission and specimen date Community < 3 days between admission and Acquired positive sample
The number of HCAIs by week for East Health Community (fig 1.1) currently sits at 74.
Fig 1.1
Week Ending Number of HCAIs 12th July 2020 4 19th July 2020 17 26th July 2020 32 2nd August 2020 17 9th August 2020 4 16th August 2020 0 23rd August 2020 0 30th August 2020 0 6th September 2020 0 13th September 2020 0
Wards that were mainly associated with this wave of positive cases were within Wrexham Maelor Hospital and Deeside Community Hospital.
As part of the Outbreak Control Group and in conjunction with Public Health Wales colleagues, the outbreak definition was refined to include all positive case since the 6th July 2020 given the epidemiological information that was reviewed. The cases included in the outbreak definition were clearly defined and agreed as the following:
Outbreak case definitions 3
Outbreak cases are those individuals that meet the criteria described under ‘Person, Place, and Time’.
Person: Patient case: Any in-patient with a positive SARS-CoV-2 test OR Any in-patient with a positive SARS-COV-2 test, who has been discharged or transferred within 14 days prior to sample collection date
OR Staff case: A member of staff with a positive SARS-CoV-2 test OR A member of staff with symptoms indicative of COVID-19 infection
Place: Wrexham Maelor, Mold, Deeside, or Chirk hospitals
Time: A first positive specimen collection date on or after 6th July 2020
A hospital outbreak meeting was convened on the 22nd July 2020 followed by the formal Outbreak Control Group being formed and meeting on the 25th July 2020. The Outbreak Control Group met daily, chaired by an Executive representative of the Health Board and membership included representation from all relevant Health Board services (including workforce and health and safety), Welsh Government, Public Health Wales and staff side partners (UNISON, RCN, UNITE and BMA). In addition to this the Outbreak Control Team (OCT) Chair also led on the provision of regular updates to the First Minister (WG), regular communication both across the Health Board and externally to communities.
The role of the Outbreak Control Group is to; Investigate the source of the outbreak, supported by epidemiological information Implement and have oversight of a suite of control measures in light of the investigation findings Consider additional support, resources or action that may be required to control and close the outbreak and stop further transmission. Lead communications with patients, public and staff members.
To date there have been 121 patients, considered to be part of the outbreak, who have had a positive test for COVID-19 since the 6th July 2020. The information (fig 1.2) below shows the epidemiological curve (distribution of cases over time) in relation to positive tests associated with outbreak.
Staff cases are also displayed of which have been determined to be as part of the outbreak. There are, to date, 58 members of staff (included agency workforce members) who have had a positive COVID -19 test.
Fig. 1.2 4
Of the 121 cases the split of definition is as detailed in the table below (1.2)
Fig: 1.3
Patients confirmed Categorisation Number of Patients as positive HCAI cases Definite 48
Probable 26
Non- HCAI cases Indeterminate 18
Community 29
Total cases 121
There has unfortunately been a number of patient’s deaths associated with the outbreak the detail of which is added in the table below (1.3). This details deaths that have occurred with 28 days of a positive test.
Fig: 1.3: 5
Patients confirmed Categorisation Number of Patients Number of deaths as positive HCAI cases Definite 48 14
Probable 26 10
Non- HCAI cases Indeterminate 18 7
Community 29 8
Total cases 121 39
Current Position
As of the 9th September 2020 it has been 33 days since the last patient case of Health Care Acquired infection, associated with the outbreak, across the East Health Community. Therefore 2 complete cycles of incubation period have successfully been passed through. This is 2 phases of incubation period (each incubation period is 14 days).
There are no bed or ward closures as a result of COVID-19 in either the Community or Acute hospitals. However, there were significant bed closures that occurred during the outbreak across wards at Wrexham Maelor, Deeside, Mold and Chirk. This was appropriate to ensure that further patients were not exposed to COVID-19.
All patients who remain in hospital are in or beyond the recovery phase. The recovery phase is reached when a patient moves beyond day 15 of a positive test for COVID 19 and their ongoing care needs are not related to COVID-19.
The Outbreak Control Group is moving to closure phase with reduced frequency of meetings and an anticipated stand down date of the 17th September 2020. This date allows for an incubation period (14 days) to have elapsed in relation to positive staff tests.
Learning has taken place through a variety of methodologies including post infection reviews, root causes analysis, thematic health and safety reviews and qualitative peer review.
Initial Learning and Key Themes
As part of the response to the outbreak a number of learning opportunities have been pursued and whilst that opportunity has not reached completion, there have been a number of key themes identified and lessons learned.
i) Patient Movement
A number of non-clinical transfers were undertaken, mainly in response to capacity pressures. These moves are most likely to have seeded the spread of infection across multiple areas 6
ii) Staff movement
Whilst the position in terms of nurse staffing and vacancies is acknowledged, particularly at the Wrexham Maelor site, there were a high number of staff moves being undertaken. This was generally to respond to acuity (clinical need of patients) and unforeseen gaps in the workforce. At times, staff were noted to be moving from COVID cohort areas to Non Covid cohort areas in response to shortages or patient demand.
iii) Staff Testing
At the commencement of the outbreak the policy in relation to staff testing was not robust in terms of leadership and ownership and there was no proactive staff testing policy in place. Therefore, there was a risk that asymptomatic staff in particular were within the work environment.
iv) Social distancing
Social distancing for patients, in some areas was challenging. This was mainly in relation to patients who required enhanced supervision and were unable to comply with requirements such as the wearing of face coverings. Early indication shows that asymptomatic, highly mobile patients may have been the index cases of ward outbreak.
v) Environmental issues
The estate at both Wrexham Maelor Hospital and some community sites lack isolation facilities and individual bathroom provision, leading to an increased risk of transmission of any organism, not only COVID-19. The environments are aged in areas and require upgrade to allow for adequate and effective cleaning.
Due to the age of the estates concerned, most areas are not complaint with the current 3.6 metre bed spacing guidance that exists for newer builds. However, a full survey was undertaken prior to the outbreak to identify areas that were not compliant with the 2.6 metre bed spacing guidance as requested by the responsible officer. Most areas were found to be compliant with this measure and where noncompliance was identified, mitigating actions such as removal of beds were put in place.
Action taken in response to the findings:
A number of actions have been progressed and implemented as a result of the learning that has been undertaken and a result of the expert oversight of the Outbreak Control Group.
i) Non Clinical Patient Transfers BCHUB policy in relation to patient transfers has been revised and relaunched alongside a governance process for reviewing patient movement. This review involves clinical oversight. Assurance reports are provided to the Outbreak Control Team on a weekly basis. The internal process with continue when the Outbreak Control Team stands down and assurance will be reported through the Secondary Care Quality Group. ii) Reduction in staff movement A process for monitoring and reviewing staff moves to ensure that they are safe and appropriate has been introduced. Daily reviews are undertaken at service level alongside workforce colleagues and a weekly assurance report provided to the Outbreak Control Group. 7
There is already a mortality review process in place but this has been further defined in relation to the review of deaths of patients with COVID-19 (HCAI). iii) Staff Testing A clearly defined strategy for staff testing has been launched in agreement and under the oversight of key experts of the Outbreak Control Team. This involves a risk based approach to testing staff based on their role and mobility across different services. iv) Design and implementation of daily COVID audits for clinical areas. These audits review a range of metrics and observations. Compliance and improvement actions are present weekly to the outbreak control group. v) Development of standard operating procedures in relation to management of COVID positive patients and testing. Standardised protocols have been devised and approved by the Outbreak Control Team. The aim of these protocols is to remove variation and provide clear guidance and direction for all team members. There is monitoring of protocols through audit and the dashboard information available. vi) Environmental reviews Clinically led and supported by estates colleagues review of space at the Wrexham Maelor site for potential repurposing to increase isolation capacity. vii) Implementation of COVID specific mortality reviews A mortality review process exists across the health board and this is not being deviated from but has been enhanced to ensure inclusion of a comprehensive review of Healthcare Acquired Infection. viii) Development of a comprehensive patient and staff line list. The line list is a register and agreed record of all patients and staff who have tested positive, in this circumstance, for COVID-19 (separate documents). The list is validated by all partners and agreed as a single ‘version of the truth’. The list enables quick access to reliable information and is updated via an electronic process reducing the potential room for human error. ix) Individual Post Infection Reviews All patients with a positive test have had a rapid post infection review undertaken by the infection prevention team to identify immediate learning. This has been presented to the Outbreak Control Team. x) Development of standardised sitrep reporting The development of a standardised reporting tool that satisfies the reporting requirement during an outbreak scenario and can be utilised by all services including staff services. The daily sitreps that have been developed will now become business as usual. The sitreps are also shared with PHW and WG on a daily basis. xi) Communications Communications strategy implemented to ensure all key stakeholders (patients, public and staff) are informed the latest position and key messages. xii) Duty of candour to patients and families A task group has been convened to ensure that all patients or family member, where appropriate, receives notification of hospital acquisition related to the East outbreak and informing them of the ongoing investigation to which they will receive further information upon its completion. Contact details have been provided so that they can raise any further concerns or queries in relation to any aspect of the investigation.
This is not an exhaustive list of actions undertaken but captures a number of key areas. Actions and learning have been shared across sites and services to ensure standardisation and reduction of 8 risk. There are further key opportunities identified in the coming weeks where further sharing will take place.
Next Steps
It is crucial that the learning that has taken place and the successful actions that have been implemented as part of the response to the East Health Economy Outbreak are firmly embedded within BCU as an organisation.
Therefore, as the Outbreak Control Group draws to its anticipated closure, a formal Delivery Group will commence. The focus and remit of this group is to effectively embed systems and processes developed as a result of learning to reduce/minimise further avoidable nosocomial (hospital associated) infection.
It is responsible for leading the review of literature and intelligence together with linking with relevant organisations / stakeholders to share learning and best practice, ensuring the dynamic review and improvement of systems in place and to review evidence and ensure that the Health Board responds appropriately to ensure safety of public, patients and staff.
The COVID-19 Delivery Group is also responsible for the review and operational implementation of local outbreak control plans to ensure they meet the safety requirements of our service and ensure Health Board wide dissemination Asesiad / Assessment & Analysis
Y:\Board & Committees\Governance\Forms and Templates\Board and Committee Report Template V2.0 July 2020.docx 3.8 20.109 Rhaglen Frechu Covid-19 / Covid-19 Vaccination Programme - Teresa Owen 1 20.109 COVID-19 Vaccination Programme Planning.docx
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Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.20 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad COVID-19 Vaccination Programme – Initial planning update Report Title: Cyfarwyddwr Cyfrifol: Teresa Owen, Executive Director of Public Health Responsible Director: Awdur yr Adroddiad Joanna Garner, Specialty Registrar in Public Health Report Author: Craffu blaenorol: North Wales COVID-19 Vaccination Tactical Delivery Group Prior Scrutiny: Atodiadau N/A Appendices: Argymhelliad / Recommendation: The Board is asked to receive the briefing and note the work required to deliver a mass COVID-19 vaccination programme if / when a vaccine becomes available. Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er X penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation: UK governments, including Wales, have ordered millions of doses of promising COVID-19 vaccines. Currently it is not known which vaccine will be available first, or when, but Welsh Government have stated they hope a COVID-19 vaccination programme could start in late 2020 for those most at risk.
Preliminary plans are being drawn up so that if / when a COVID-19 vaccination becomes available, BCUHB and partners have plans in place to deliver a vaccination programme at scale and pace. A North Wales COVID-19 Tactical Delivery Group has been established with representatives from BCUHB, Public Health Wales, the local authorities and partners to draft plans. This Tactical Group reports to the BCUHB Strategic Immunisation Group and will work with partners on the Recovery Co- ordinating Group to ensure strategic leadership of delivery across the partnership. The Tactical Group will work closely with Welsh Government and Public Health Wales in the development and delivery of the programme.
A UK national body, the Joint Committee on Vaccination and Immunisation (JCVI), will be advising on priority groups for vaccination. It is anticipated that when vaccines to protect against COVID-19 are first approved, the first doses will be reserved for the people who need them most i.e. individuals at highest risk of exposure to the virus. This means the vaccine will likely be offered to frontline health and social care staff first and people in certain high risk groups. In North Wales, this would equate to tens of thousands of people, scaling up to hundreds of thousands of people. 2
Cefndir / Background: The long term response to the COVID-19 pandemic requires a safe and effective vaccine to be available for all who need it. Vaccination will reduce the risk of serious illness and death from COVID-19. Welsh Government have stated that mass vaccination is the best chance to end the pandemic and to be able to ease restrictions on society.
Many potential vaccines for COVID-19 are being studied to establish if they are effective and safe. Potential UK-made vaccines are being tested on large numbers of people in Wales and many other countries around the world. Asesiad / Assessment & Analysis The scale and pace of delivering any mass vaccination programme in the short/medium term would present the following implications for North Wales: an increase to the workforce would be needed to support implementation of the programme venues would need to balance the ability to provide an accessible service whilst maintaining social distancing there would need to be an interface with other vaccination programmes e.g. flu service delivery and staff absence could be affected by a second wave of COVID-19
In addition, planning is challenging due to uncertainty around vaccine supply, vaccine characteristics and the number of doses required. A risk register has been drafted and risks will be escalated as required.
Senior finance colleagues are working with the Tactical Delivery Group to support the development of a detailed financial plan. Some of the costs of a COVID-19 vaccination programme may need to be borne by BCUHB and regional partners and any required expenditure will be included in financial planning. The following cost headings are anticipated: Staffing costs Site development and preparation, site rental, site increased running costs IT software, licenses and hardware Consumables (including clinical waste disposal) Vaccine and consumable stock storage (including Cold Chain costs) Transportation and travel for staff
Screening for an Equality Impact Assessment has been undertaken. There are significant positive impacts of the proposed vaccination programme because of the protective impact for health and life. However, for many of the protected characteristic groups, there are already negative impacts and intensified inequalities as a result of COVID-19 and the measures introduced to control the pandemic. Care needs to be taken to ensure that a vaccination programme addresses the inequalities and mitigates against any disproportionate impact for different groups. Issues of Welsh Language accessibility have also been raised. When the locations of vaccination centres and greater detail regarding the potential availability and delivery of vaccines are known, the EqIA screening will be reviewed and completed and a decision taken whether to proceed to full impact assessment. 4.1 20.110 Achos Amlinellol Strategol Atgyfnerthu Meddygaeth Niwclear / Nuclear Medicine Consolidation Strategic Outline Case - Adrian Thomas 1 20.110a Nuclear Medicine SOC Board Coversheet Sept 20.docx
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Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.20 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Nuclear Medicine Consolidation Strategic Outline Case Report Title: Cyfarwyddwr Cyfrifol: Adrian Thomas, Executive Director Therapies and Health Sciences Responsible Director: Mark Wilkinson, Executive Director Planning and Performance Awdur yr Adroddiad Ian Howard, Assistant Director – Strategic and Business Analysis Report Author: Pat Youds, Professional Lead, Radiography/Radiology Manager Craffu blaenorol: In line with the organisation’s Procedure for Managing Capital Prior Scrutiny: Projects the Business Case has been endorsed by the Secondary Care Division, the Estates Improvement Group, the Executive Team and the Finance and Performance Committee. Atodiadau The Business Case and its 11 appendices are attached. Appendices: Argymhelliad / Recommendation: The Board is asked to approve the Business Case for submission to Welsh Government.
Please tick as appropriate Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Y Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation:
This is a Strategic Outline Case, which is the first stage in the process of seeking capital from Welsh Government. Its purposes are to set out the case for change and outline a suggested way forward, rather than to propose a definitive preferred option. Capital and revenue figures are high level approximations based on a set of explicit assumptions. The key decisions, and definitive costings, are established at Outline Business Case/Full Business Case stage. SOC approval will release funding from Welsh Government to work up a fully costed proposal.
This case addresses the Nuclear Medicine Service provided by BCUHB. Currently the service is provided utilising three Gamma Cameras - one on each of the three main acute hospital sites - and one mobile PET-CT, which is located in Wrexham for two days a week. The case has the following objectives:
Investment Objective 1 To provide services which meet the strategic direction / requirements as detailed within the Health Board’s plans, and key all-Wales strategies including the Imaging Statement of Intent (2018) and “Positron Emission Tomography (PET) in Wales – Overview and Strategic Recommendations” 2
Investment Objective 2 To create and provide an environment that delivers safe and effective care whilst achieving key efficiency targets throughout the service, including meeting increased demand for PET services Investment Objective 3 To maintain legal compliance through service redesign to attract and retain specialist licenced practitioners
Investment Objective 4 To deliver services that are affordable and represent value for money, maximising opportunities to deliver revenue savings whilst continuing to deliver and improve nuclear medicine services
Investment Objective 5 To avert current risk of service failure and provide a sustainable and reliable programme for the replacement of existing equipment
Cefndir / Background: There are a series of issues with the current service configuration which make it unsustainable in the short and long term. There is an imminent threat to the delivery of this service due to staff shortages - in particular there may soon be insufficient holders of a licence from the Administration of Radioactive Substances Advisory Committee (ARSAC), which is required to deliver the service. In terms of the Gamma Cameras, all three are well past their planned lifespan and are increasingly unreliable and prone to breaking down. They also have relatively low technological capability compared to current models and not all cameras support the same examinations, resulting in a sub-optimal and inequitable service. Demand for the service is falling, and current and projected future demand could be accommodated by two machines. As regards PET, the number of sessions required is likely to increase. The current two day a week service is inflexible and there are a number of practical issues associated with the use of a mobile scanner - for example patients on trolleys cannot be accommodated, there are no toilet facilities, and there are regular problems with data transfer. There are very limited opportunities to participate in clinical trials, which is important in itself as well as being a factor in the recruitment and retention of staff.
Asesiad / Assessment & Analysis 3
Strategy Implications
The main strategic drivers for Radiology across Wales are summarised in the Imaging Statement of Intent (2018), which identifies four key themes: increasing demand; workforce issues; ageing equipment; and the need for a networked approach to services, all of which apply to North Wales. In terms of PET, the key document is the 2018 report of the All Wales PET Advisory Group and the Welsh Scientific Advisory Committee “Positron Emission Tomography (PET) in Wales - Overview and Strategic Recommendations.” This report states that PET-CT has become a central diagnostic tool, and is significantly underutilised in Wales compared to the rest of the UK, which is itself behind the USA and Europe. The report recommends an expansion of the service in Wales, and WHSSC is currently developing a Strategic Programme Business Case for PET-CT capacity in Wales that considers increased demand projections, estates, staffing requirements and research. BCUHB are fully engaged with the development of the all-Wales business case, and this case is fully aligned with it.
The need for this development is highlighted in the Health Board’s Operational Plan, and the key risks are identified in the Health Board’s risk register.
Options considered
Various options have been considered, focusing on the location and scale of services to be provided and the merits of a permanent vs a mobile PET-CT, and the attached case includes a full option appraisal. The Community Health Council have been fully involved, and have confirmed that the engagement undertaken to date in evaluating these options has been appropriate. A possible solution is to reduce the number of sites providing a Gamma Camera service to two. However there is a strong argument in terms of service resilience and reduced revenue costs in favour of purchasing two new gamma cameras to replace the existing three, and co-locating them on a single site. There would be further resilience and revenue cost savings if these two cameras were co-located with a permanent fixed PET-CT. The service would then be run by the same radiographers and administrative staff. This would create a centre of excellence which will be able to accommodate the likely increase in demand for PET-CT, support research and provide a flexible and robust service. This is the preferred way forward.
It is important to be clear that the PET element of this preferred way forward is subject to agreement through the all-Wales PET-CT Strategic Board which is producing the Programme Business Case. It is understood that the all-Wales Programme Business Case will be produced in 2021. WHSCC, as commissioners of the service, have endorsed the following statement: “Given the imperatives to resolve the wider issues with the Nuclear Medicine service in North Wales it would be unwise - as well as unnecessary - to delay this case until the all-Wales case is produced and approved. As with any business case the option appraisal in this SOC will be revisited at OBC/FBC stage, and the final preferred option will be consistent with the final all-Wales position. BCUHB is currently exploring with the Programme Board the possibility of reaching a clear position on the North Wales PET in advance of the publication of the all-Wales PBC, to avoid delaying the production of the OBC/FBC and so prolonging further the risk that the current service configuration poses to the Nuclear Medicine service.”
It is also important to note that this option appraisal addresses the number of sites that should provide the service, but does not identify the preferred site (or sites). This analysis will be undertaken as part of developing the OBC/FBC, and will require a further systematic engagement exercise. 4
Financial Implications
In terms of capital expenditure, the total costs will depend to a degree on the site selected. A high level estimate of the capital cost for the preferred way forward (2 new Gamma Cameras co-located with a permanent PET-CT) is between £10 million and £11 million. The revenue costs will also vary depending on the site selected. However the overall recurring saving from consolidating the service, stopping the lease of the mobile PET and maintaining only two Gamma Cameras is estimated at approximately £210,000 per annum.
Risk Analysis
The Project Board has identified the risks and counter-measures as follows:
Risk Counter Measure Risk Level Projected revenue . Savings achievement to be actively managed and savings not reviewed at 6 month intervals for the first 2 years of achieved implementation and variations reported. 10 . Recruitment to be strictly in line with planned staff skill mix within the business case. Capital funding bid . Ensure the scheme is fully aligned with WHSSC and to WG not approved AWPET strategic direction. . Scoping document shared with WG and initial meeting held due to lack of 15 strategic alignment to discuss intent and scope. . Dialogue to be maintained in monthly WG meetings and discussions with WHSCC. Unrealistic . Timescales within SOC reviewed July 2020 to reflect programme adopted delay. given the priority of . Time allowances consistent with past business case 9 implementation processes.
Programme delay . Delayed SOC to be submitted to first possible meetings for internal approval prior to submission to WG. 25 . Separate BJC to be developed for WMH gamma camera replacement given End of Life/Support Dec 2020. OCP and HR . Consultation with staff and staff side representatives has related risks commenced with HR representation. 1-2-1 discussions to take place. . OCP to be applied in full if applicable to the final preferred 9 option. Staff to be offered alternative opportunities where transfer isn't practical. . Phased transfer to be considered. 5
Availability of . Availability to be discussed with the Hospital Director and suitable site for Site Clinical Directors and included in development control preferred option plans. . Option appraisal to be completed at the earliest 9 opportunity. . Initial feasibility investigations underway. . All aspects to be documented and considered during site appraisal against weighted criteria. High selected site . Identifiable abnormals to be considered in the site selection abnormal costs wherever possible. 12 . Some allowances made within budget costs. Existing mechanical . Some allowances made within SOC budget costs. and electrical . Surveys and site investigations to be completed as soon as possible at OBC stage. infrastructure found 12 to be inadequate or in a poor condition
Effect of COVID 19 . Considered by Project Board, capacity provided by 2 pandemic on project gamma cameras considered adequate. . Air changes to be provided in ventilation design. 10 . Any additional Infection Prevention requirements to be considered in design.
Legal and Compliance
Subject to approval of this case by the Board and Welsh Government, a combined OBC/FBC will be produced. This will go through the same governance process as the SOC.
Impact Assessment
An Equality Impact Assessment has been carried out, and is enclosed as Appendix I of the business case. It concludes that there is an impact on a small number of patients who would have to travel further, as a result of the consolidation of the service. However current service risks could lead to no service, and patients would have to travel to England. Patients with disabilities that prevent them from getting up stairs currently cannot access mobile PET-CT and have to travel to England and also experience delays to diagnosis. 1 20.110b DRAFT SOC V0.24 Board Sept 2020.docx
Nuclear Medicine Consolidation Strategic Outline Case (SOC) BCUHB Board September 2020
VERSION HISTORY
Version Date Issued Brief Summary of Change Owner’s Name Draft V0.01 11.09.2019 Initial draft document Project Team Draft V0.02 05.10.2019 Amendments following review by Service Project Team Draft V0.03 09.10.2019 Amendments following review by Service Project Team Draft V0.04 14.10.2019 Consolidation of comments received Project Team Draft V0.05 15.10.2019 Review Investment Objectives / Options Project Team Draft V0.06 05.11.2019 Rationalised text Project Team Draft V0.07 11.11.2019 Amendments following receipt of comments Project Team Draft V0.08 11.11.2019 Amendments following receipt of comments Project Team Draft V0.09 19.11.2019 Consolidation of comments received: issued Project Team for further review Draft V0.10 22.11.2019 Further amendments following comments Project Team received Draft V0.11 26.11.2019 Format / draft Executive Summary Project Team Draft V0.12 16.12.2019 Capital costs included Project Manager Draft V0.13 10.01.2020 Further amendments / format Project Team Draft V0.14 03.02.2020 Further amendments/format following scrutiny Project Team by the Assistant Director Strategic & Business Analysis scrutiny Draft V0.15 17.02.2020 Amendments by Assistant Director Strategic & Project Team Business Analysis Draft V0.16 17.02.2020 Amendments by Assistant Director Strategic & Project Team Business Analysis Draft V0.17 19.02.2020 Amendments by Assistant Director Strategic & Project Team Business Analysis Draft V0.18 19.02.2020 Amendments by Assistant Director Strategic & Project Team Business Analysis Draft V0.19 10.05.2020 Format BC Manager Draft V0.20 15.07.2020 Update to capital cost range, timeline and risks Project Manager Draft V0.21 22.07.2020 Amendments by Assistant Director Strategic & Project Team Business Analysis Draft V0.22 24.07.2020 Amendments following feedback from the Project Team Director of Planning & Performance Draft V0.23 19.08.2020 Cover change for F&P Project Team Draft V0.24 27.08.2020 Cover change for Board following F&P Project Team approval
Page 2 of 28 DRAFT V0.23 19.08.2020 Page 3 of 28 DRAFT V0.23 19.08.2020 Contents Page 1. Executive Summary 4 - 6 2. Structure and Contents of the Document 7 3. The Strategic Case 8 - 17 4. The Economic Case 18 - 21 5. The Commercial Case 22 - 23 6. The Financial Case 24 - 25 7. The Management Case 26 8. Conclusion and Recommendation 26 List of Acronyms 27
Appendices Appendix A: Imaging Statement of Intent Appendix B: Radiology Services in Wales, November 2018 Appendix C: All Wales PET Advisory Group (AWPET) and the Welsh Scientific Advisory Committee, Positron Emission Tomography (PET) in Wales - Overview and Strategic Recommendations, November 2018 Appendix D: Positron Emission Tomography (PET) in Wales Programme Brief Appendix E: Patient Flow Diagram Appendix F: Capital Costs Appendix G: Revenue Costs Appendix H: Risk Register Appendix I: Equality Impact Assessment Appendix J: Nuclear Medicine PET CT Change Protocol Appendix K: RPA 1
Page 4 of 28 DRAFT V0.23 19.08.2020 1. Executive Summary
1.1 Introduction This case addresses the Nuclear Medicine Service provided by BCUHB. Currently the service is provided utilising three Gamma Cameras - one on each of the three main acute hospital sites - and one mobile PET-CT, which is located in Wrexham for two days a week. There are a series of issues with this service configuration which make it unsustainable in the short and long term - in particular: difficulties in staffing three separate services; obsolete equipment; falling demand for the Gamma Camera service, and increasing demand for PET-CT. There is an opportunity to improve the quality of the service, make it more resilient and reduce revenue costs. The preferred way forward at this stage in the development of the business case is to consolidate services in a single Centre of Excellence for Nuclear Medicine at one of the three acute sites. The Centre would consist of two Gamma Cameras and one permanent fixed PET-CT, and would be housed by a combination of new building and refurbishment work. The Gamma Camera and PET-CT service would be run by the same radiographers and administrative staff. The estimated capital cost of this proposal is in a range between £10 million and £11 million. There is an estimated recurring revenue saving of approximately £210,000 to provide the same level of service as is provided now. There would also be a lower additional marginal cost per case for any future investment by WHSSC in the expansion of PET-CT than would be achieved by expanding the current mobile service.
1.2 Summary of the Case Nuclear medicine is a specialised form of imaging involving the administration of small amounts of intravenously injected radioactive pharmaceuticals or radionuclides to patients. Both Gamma Cameras and PET cameras (or scanners) produce images of injected radioactivity distributed through the body. The images produced depend on which tracers are used. Tracers have specific uses and target different processes that need to be examined. Generally gamma cameras image lower energy radioactivity and cannot readily image the higher energies. This is appropriate for the range of tests done with the gamma camera, such as bone scans, heart perfusion scans, kidney scans and thyroid function. PET scans image the higher energy radiation. They are mainly used as a primary diagnostic test and in treatment planning for certain indications in cancer, but are also increasingly used in diagnosing neurological conditions and cardiac disease.
The main strategic drivers for Radiology across Wales are summarised in the Imaging Statement of Intent (2018), which identifies four key themes: increasing demand; workforce issues; ageing equipment; and the need for a networked approach to services, all of which apply to North Wales. In terms of PET, the key document is the 2018 report of the All Wales PET Advisory Group and the Welsh Scientific Advisory Committee “Positron Emission Tomography (PET) in Wales - Overview and Strategic Recommendations.” This report states that PET-CT has become a central diagnostic tool, and is significantly underutilised in Wales compared to the rest of the UK, which is itself behind the USA and Europe. The report recommends an expansion of the service in Wales, and WHSSC is currently developing a Strategic Programme Business Case for PET-CT capacity in Wales that considers increased demand projections, estates, staffing requirements and research. BCUHB are fully engaged with the development of the all-Wales business case, and this case is fully aligned with it.
Page 5 of 28 DRAFT V0.23 19.08.2020 In BCUHB the nuclear medicine service is currently provided from three Gamma Cameras - one on each of the three main acute hospital sites - and one mobile PET- CT, which is located in Wrexham two days a week. There is an imminent threat to the delivery of this service due to staff shortages - in particular there may soon be insufficient holders of a licence from the Administration of Radioactive Substances Advisory Committee (ARSAC), which is required to deliver the service. In terms of the Gamma Cameras, all three are well past their planned lifespan and are increasingly unreliable and prone to breaking down. They also have relatively low technological capability compared to current models and not all cameras support the same examinations, resulting in a sub-optimal and inequitable service. Demand for the service is falling, and current and projected future demand could be accommodated by two machines. As regards PET, the number of sessions required is likely to increase in line with the Advisory Group’s recommendations. The current two day a week service is inflexible and there are a number of practical issues associated with the use of a mobile scanner - for example patients on trolleys cannot be accommodated, there are no toilet facilities, and there are regular problems with data transfer. There are very limited opportunities to participate in clinical trials, which is important in itself as well as being a factor in the recruitment and retention of staff. In terms of the COVID-19 pandemic, this has highlighted the risks of relying on a mobile service provided by a third party, as mobile PET-CTs were requisitioned in the UK for operational use at the Nightingale Hospitals.
Based on this analysis of the issues, the following key objectives for the project have been identified:
Investment Objective 1 To provide services which meet the strategic direction / requirements as detailed within the Health Board’s plans, and key all-Wales strategies including the Imaging Statement of Intent (2018) and “Positron Emission Tomography (PET) in Wales – Overview and Strategic Recommendations” Investment Objective 2 To create and provide an environment that delivers safe and effective care whilst achieving key efficiency targets throughout the service, including meeting increased demand for PET services Investment Objective 3 To maintain legal compliance through service redesign to attract and retain specialist (ARSAC) licenced practitioners Investment Objective 4 To deliver services that are affordable and represent value for money, maximising opportunities to deliver revenue savings whilst continuing to deliver and improve nuclear medicine services Investment Objective 5 To avert current risk of service failure and provide a sustainable and reliable programme for the replacement of existing equipment
A range of options to meet these objectives have been considered, focusing on the location and scale of services to be provided and the merits of a permanent vs a mobile PET-CT. The Community Health Council have been fully involved, and have confirmed that the engagement undertaken to date in evaluating these options has been appropriate. A possible solution is to reduce the number of sites providing a Gamma
Page 6 of 28 DRAFT V0.23 19.08.2020 Camera service to two. However there is a strong argument in terms of service resilience and reduced revenue costs in favour of purchasing two new gamma cameras to replace the existing three, and co-locating them on a single site. There would be further resilience and revenue cost savings if these two cameras were co- located with a permanent fixed PET-CT. The service would then be run by the same radiographers and administrative staff. This would create a centre of excellence which will be able to accommodate the likely increase in demand for PET-CT, support research and provide a flexible and robust service. This is the preferred way forward.
It is important to be clear that the PET element of this preferred way forward is subject to agreement through the all-Wales PET-CT Strategic Board which is producing the Programme Business Case. It is understood that the all-Wales Programme Business Case will be produced in 2021. WHSCC, as commissioners of the service, have endorsed the following statement: “Given the imperatives to resolve the wider issues with the Nuclear Medicine service in North Wales it would be unwise - as well as unnecessary - to delay this case until the all-Wales case is produced and approved. As with any business case the option appraisal in this SOC will be revisited at OBC/FBC stage, and the final preferred option will be consistent with the final all- Wales position. BCUHB is currently exploring with the Programme Board the possibility of reaching a clear position on the North Wales PET in advance of the publication of the all-Wales PBC, to avoid delaying the production of the OBC/FBC and so prolonging further the risk that the current service configuration poses to the Nuclear Medicine service.”
It is also important to note that this option appraisal addresses the number of sites that should provide the service, but does not identify the preferred site (or sites). This analysis will be undertaken as part of developing the OBC/FBC, and will require a further systematic engagement exercise.
In terms of capital expenditure, the total costs will depend to a degree on the site selected. A high level estimate of the capital cost for the preferred way forward (2 new Gamma Cameras co-located with a permanent PET-CT) is between £10 million and £11 million. The revenue costs will also vary depending on the site selected. However the overall recurring saving from consolidating the service, stopping the lease of the mobile PET and maintaining only two Gamma Cameras is estimated at approximately £210,000 per annum.
Page 7 of 28 DRAFT V0.23 19.08.2020 2. Structure and Contents of the Document This case has been prepared using the agreed standards and format for business cases, as set out in the NHS Wales Infrastructure Investment Guidance, the format being the Five Case Model which comprises the following key components:
. The Strategic Case: this sets out the strategic fit and case for change, together with the supporting investment objectives for the scheme . The Economic Case: this demonstrates that the organisation has selected a preferred option which optimizes public value for money . The Commercial Case: this outlines that the preferred option will result in a viable procurement and well-structured deal . The Financial Case: this demonstrates that the preferred option will result in a fundable and affordable deal . The Management Case: this demonstrates that the scheme is achievable and can be delivered successfully in accordance with accepted best practice
There are normally three key stages in the development of a project business case, these are: . the Strategic Outline Case (SOC) . the Outline Business Case (OBC) . the Full Business Case (FBC)
This SOC: . Establishes the strategic context . Makes a robust case for change . Provides a suggested way forward, rather than a definitive preferred option
Subject to this SOC being approved, the intention is to produce a combined OBC / FBC which will:
. Identify the option which optimises value for money . Prepare the scheme for procurement . Set out the negotiated commercial and contractual arrangements for the deal . Put in place the necessary funding and management arrangements for the successful delivery of the scheme . Demonstrate that the scheme is unequivocally affordable
It is anticipated that the OBC / FBC will be submitted to Welsh Government in November 2021 and the scheme will become fully operational in November 2023.
Page 8 of 28 DRAFT V0.23 19.08.2020 3. The Strategic Case
3.1 Introduction The purposes of this section are: to explain how the scope of the proposed scheme fits within the existing organisational strategies; and to provide a compelling case for change, in terms of the existing and future operational needs of the service.
Part A: The Strategic Context
3.2 Organisational Overview Betsi Cadwaladr University Health Board (BCUHB) was established on 1st October 2009. It provides a full range of primary, community, acute and mental health services for a population of approximately 700,000 across North Wales and some parts of North Powys and North-West England. BCUHB is responsible for the operation of over 90 health centres, clinics, community health team bases and mental health units, 19 community hospitals and three acute hospitals. The Health Board employs approximately 16,500 staff and has an annual revenue budget of approximately £1.4 billion.
3.3 Alignment to Existing Policies and Strategies This section of the business case outlines how the project fits with the existing policies and strategies of the organisation, and of NHS Wales as a whole.
3.3.1 Overall Radiology Policies and Strategies Radiology is a key diagnostic and interventional service used to help diagnose, monitor and treat disease and injuries. As such is it, and will remain, a core service provided by the Health Board. Nationally, the main strategic drivers for Radiology as a whole are summarised in various documents - notably the Imaging Statement of Intent (2018) and the Auditor General for Wales report Radiology Services in Wales, November 2018 (enclosed as Appendices A and B). There are four broad strategic national themes that are relevant to this case: increasing demand; workforce issues; ageing equipment; and the need for a co-ordinated approach to service change across Wales.
In terms of increasing demand and workforce, to quote the Positron Emission Tomography (PET) in Wales - Overview and Strategic Recommendations, “current services are under increasing pressure with major growth in demand as a result of more effective clinical pathways, increasing numbers of older people, increasing cancer incidence, improved technology, new techniques and workforce pressures resulting in delays to patients accessing the appropriate imaging services for their needs. The demand for imaging, both image acquisition (scanning) and prompt clinical interpretation and reporting significantly outstrips current capacity across all types of imaging, compromising high-quality patient care and incurring unnecessary delays in care pathways.” This case seeks to address the future demand for the Nuclear Medicine service in North Wales and to reduce workforce pressures.
As regards ageing equipment, the WAO have concluded that across Wales, “ageing and underutilised equipment are making it harder for health boards to meet demand." One of its recommendations is to “ensure that there is a national coordinated approach to address equipment needs, with sufficient funding for the replacement of equipment and purchase of new technology to meet increasing demand and technology advances.” This case proposes to resolve issues with both ageing and underutilised equipment.
Page 9 of 28 DRAFT V0.23 19.08.2020 The Imaging Statement of Intent emphasises the need for a networked approach to services: “imaging service will be strengthened as part of a co-ordinated and networked approach to their planning and delivery. We will review service models and clinical pathways to provide optimal imaging services for the adult population of Wales.” As is outlined further below (para: 3.3.2), this project is fully aligned with the co-ordinated approach across Wales, and seeks to establish a single Nuclear Medicine service in North Wales.
3.3.2 Nuclear Medicine This business case focuses on the future of Nuclear Medicine services - both Gamma Camera and PET. The key policy document related to PET is the 2018 report of the All Wales PET Advisory Group and the Welsh Scientific Advisory Committee “Positron Emission Tomography (PET) in Wales: Overview and Strategic Recommendations” (Appendix C). The report states that PET-CT has become a central diagnostic tool in the management of patients with cancer, and that its role in cancer and other diseases continues to evolve. It points out that in the UK the development of PET services has been slow compared to the United States and other European countries, and that the Wales lags significantly behind the other 3 devolved nations, in terms of funded indications for PET scans, development of PET scanning infrastructure, specialist workforce, and research opportunities. The report outlines the strategic vision for the development of PET services, and makes the following recommendations that are relevant to this case:
1. The All Wales PET Advisory Group (AWPET), a subgroup of the Welsh Scientific Advisory Committee, should recommend to Welsh Health Specialised Services an expanded indication list for PET scanning based on best available evidence. There should be provision for increased growth and appropriate funding. In future AWPET should continuously review evidence based best practice clinical pathways incorporating PET scanning in Wales.
2. WHSSC should be commissioned to produce a Strategic Programme Business Case for PET-CT capacity in Wales that considers increased demand projections, estates, staffing requirements and research.
3. Constitution of a Welsh PET innovation strategy to develop research, clinical, technological, and industrial collaboration within a formal framework. This will encompass horizon-scanning and development of subjects such as PET in radiotherapy planning, and in novel malignant and non-malignant indications.
The PET element of this business case is fully aligned to the work being done by the PET-CT Strategic Board to develop the all-Wales Programme Business Case for PET- CT (recommendation 2). The following exposition of this alignment has been endorsed by WHSCC:
. The drivers for this case are the same as those outlined in the Programme Brief for the all-Wales programme (enclosed as Appendix D). . BCUHB is represented on the PET-CT Strategic Board by Dr. Elias who is joint chair of the clinical model sub-group. . As the case develops to OBC/FBC, there will continue to be full alignment with the all-Wales work. For example, the level of future PET activity will be determined by WHSSC, informed by the all-Wales modelling and capacity work currently being undertaken to inform the all-Wales Programme Business Case.
Page 10 of 28 DRAFT V0.23 19.08.2020 At the time of drafting this case, it is understood that the all-Wales Programme Business Case will be produced in 2021. Given the imperatives to resolve the wider issues with the Nuclear Medicine service in North Wales, outlined elsewhere in the document, it would be unwise - as well as unnecessary - to delay this case until the all-Wales case is produced and approved. The key strategic judgement that is required for the preferred option to be finalised is whether the all-Wales case will recommend that a permanent static PET-CT scanner should be located in North Wales. The judgement in the option appraisal for this SOC (para 4.4) is that a permanent static PET-CT scanner in North Wales is preferred as this seems to be clearly the best (including most cost-effective) way to meet projected future demand for the service, and to facilitate service integration. However, as with any business case, this option appraisal will be revisited at OBC/FBC stage and the final preferred option will be consistent with the final all-Wales position.
In terms of BCUHB’s plans and governance, the need for this development is highlighted in the Health Board’s Operational Plan, and the key risks are identified in the Health Board’s risk register.
Part B: The Case for Change
3.4 Investment Objectives Given the strategic context outlined above, and the specific case of need outlined in section 3.6, this project’s objectives are as follows:
Investment Objective 1 To provide services which meet the strategic direction / requirements as detailed within the Health Board’s plans, and key all-Wales strategies including the Imaging Statement of Intent (2018) and “Positron Emission Tomography (PET) in Wales – Overview and Strategic Recommendations” Investment Objective 2 To create and provide an environment that delivers safe and effective care whilst achieving key efficiency targets throughout the service, including meeting increased demand for PET services Investment Objective 3 To maintain legal compliance through service redesign to attract and retain specialist (ARSAC) licenced practitioners Investment Objective 4 To deliver services that are affordable and represent value for money, maximising opportunities to deliver revenue savings whilst continuing to deliver and improve nuclear medicine services Investment Objective 5 To avert current risk of service failure and provide a sustainable and reliable programme for the replacement of existing equipment
The benefits criteria related to these objectives are outlined in para 3.8.
Page 11 of 28 DRAFT V0.23 19.08.2020 3.5 Existing Arrangements for Nuclear Medicine in North Wales
The nature of the service Nuclear medicine is a specialised form of imaging involving the administration of small amounts of intravenously injected radioactive pharmaceuticals or radionuclides to patients. Both Gamma Cameras and PET cameras (or scanners) produce images of injected radioactivity distributed through the body. The images produced depend on which tracers are used. Tracers have specific uses and target different processes that need to be examined. Generally gamma cameras image lower energy radioactivity and cannot readily image the higher energies. This is appropriate for the range of tests done with the gamma camera, such as bone scans, heart perfusion scans, kidney scans and thyroid function. PET scans image the higher energy radiation. They are mainly used as a primary diagnostic test and in treatment planning for certain indications in cancer. PET CT scans can provide greater staging certainty, increasing the likelihood of the correct therapeutic treatment option being chosen and reducing the use of sometimes unnecessary surgical approaches with high morbidity risks. PET CT has been shown to change proposed treatment in around 40% of cases. Stage certainty improves accuracy of cancer datasets which in turn allow outcomes to be more accurately attributed and understood. There is increasing use of PET CT in non- oncology indications with the recent adoption of inflammatory and infective indications. They are increasingly used in diagnosing neurological conditions and cardiac disease.
PET CT access is governed in Wales by WHSCC Policy CP50. PET CT referrals need to fall within a restricted range of funded indications determined by WHSSC with any other cases only accepted if IPFR (Individual Patient Funding Requests) funding is made available.
North Wales service provision In North Wales there are nuclear medicine services with a gamma camera room and supporting rooms, along with radio pharmacies on each of the 3 DGH sites in North Wales (Bangor, Glan Clwyd and Wrexham).
In terms of PET, there is a commercially leased mobile and staffed PET CT at Wrexham for 2 days of the week. Patients from the north of Powys are also referred to the mobile PET CT, having previously travelled to Cardiff. At present the existing referral restrictions outlined above mean that demand is being met within the 2 days the leased PET CT is onsite at WMH. The PET service is commissioned by WHSSC.
3.6 Business Needs / Benefits of the Scheme This section describes the issues associated with the existing service which this business case seeks to address.
3.6.1 Difficulties in recruiting and retaining key staff for Nuclear Medicine Service as a whole, which threaten the continuation of the service There are some significant workforce issues which apply to the service as a whole and threaten its continued provision. This problem is the main driver for the urgency of the scheme. Both the Imaging Statement of Intent and the WAO report Radiology Services in Wales refer to major difficulties across the UK in recruiting and retaining radiologists, radiographers, radio pharmacists and other nuclear medicine staff. The issues with the fragmented nature of the service, out-of-date equipment and inability to conduct research, outlined in full below, mean that there are particular problems in North Wales. For example two radiology trainees, who did a 6th year specialising in nuclear medicine, have recently left BCUHB to work in specialist centres in Cardiff and
Page 12 of 28 DRAFT V0.23 19.08.2020 Manchester. There is concern that with the existing service model further staff could leave, particularly with other organisations with Nuclear Medicine Centres of Excellence actively trying to attract staff.
Provision of nuclear medicine services is dependent on consultants who have completed a 6th year on top of their specialist training and provide ongoing evidence of competence to be awarded and retain a licence from the Administration of Radioactive Substances Advisory Committee (ARSAC). The Health Board is required to have an ARSAC licence holder on each site with Nuclear Medicine services to maintain legal compliance - the service is not able to operate otherwise. However, the number of licence holders within the service is reducing with retirement and in the mid- term there will only be two existing ARSAC certificate holders remaining in North Wales. Recent attempts to recruit consultants to the current service model have failed. Given the legal requirement for a licence holder to spend time on, and be familiar with, the site for which they provide specialist cover, any less than three ARSAC certificate holders (one per DGH site) would result in onerous travel between sites and the loss of clinical capacity if the current service configuration is maintained.
In addition to this fundamental concern, the fragmented service model does not promote a high quality integrated workforce. The opportunities for integration rely upon pan BCUHB study events where attendance is restricted by the need to keep the local service running. Opportunities for service development, innovation, learning and improving team integration are limited.
3.6.2. Gamma Camera Service In addition to the workforce issues outlined above, there are a number of specific issues associated with the existing gamma camera service:
Lack of reliability due to age: Gamma cameras have a planned lifespan of approximately 7 years before replacement should take place to avoid image quality, performance, maintenance, software upgrade and part availability issues. All of the gamma cameras are beyond this planned lifespan - the existing WMH gamma camera was installed in 2007, YGC’s in 2006 and YG’s in 2011.
The original manufacturers are currently maintaining the WMH gamma camera but this is the last of its type in the UK still in clinical use and it has had a significant number of breakdowns and spare parts are becoming difficult to source. In 2018/2019 £28k was paid at WMH to extend the life of the software alone for just one year to enable it to continue to operate but this contract may not be extendable for further years. The ingenuity of a specialist 3rd party contracted company is being relied on until parts are no longer available for maintaining the gamma camera at YGC but this company does not have the technical experience to support the WMH camera when the original manufacturer is unable to offer a further service contract. A 3rd party company is also maintaining the YG gamma camera.
The growing unreliability of the gamma cameras also increases the risk that patients could be injected with a radionuclide and then not be scanned which means they have been irradiated for no benefit. These events are classed as reportable radiation incidents and have to be reported to Health Inspectorate Wales (HIW).
Without planned replacement the difficulty in sourcing spare parts will eventually lead to equipment failure and the need to complete one or more unplanned replacements, without prior notice. This would result in appointment cancellations, the need to divert
Page 13 of 28 DRAFT V0.23 19.08.2020 patients at short notice to another site and loss of service during a long procurement lead time for the equipment and enabling works which for planned replacements takes place while the old scanner remains in use.
Low technological capability: The age of the 3 gamma cameras means that they have low technological capability when compared to current models and the type and complexity of scans that the YGC gamma camera in particular can complete is limited. Throughput is also restricted with current models having lower scanning times as well as lower radiation doses.
Fragmented service: The service is fragmented across the 3 sites with associated communication and co-ordination issues. The different licenses on each site results in a service where not all the studies can be performed on each site, resulting in an inconsistent and inequitable service. Appointment bookings are being made by the 3 teams on each separate site in an inefficient manner and the fragmentation reduces the ability to provide a quality service to patients.
In-equality of access: The different gamma cameras also mean that some examinations such as Myocardial Perfusion Imaging (MPIs) are performed differently on patients and there is a lack of consistency and equity in service provision.
Lack of resilience: Having only 1 gamma camera on each site means that in the event of a breakdown patients have to travel to another site or have their appointment cancelled. The need to provide staffing ‘cross cover’ across the 3 sites for resilience necessitates travel during valuable clinical time and incurs travel costs. The different specifications and technological capabilities of the 3 gamma cameras means that it is difficult in practice to provide this ‘cross cover’ of staff for the 3 sites as not all staff are able to gain familiarity with and experience on each gamma camera.
Limited staff competencies: The variations is scanner capabilities contribute to differing skill sets amongst the workforce. This subsequently contributes to scheduling difficulties.
Over capacity to meet current and projected demand: while the general trend in Radiology is one of increasing demand, the demand for Gamma Camera services is in decline and predicted to decline further. The number of patients receiving the service has reduced from approximately 3,700 in 2016/17 to 3,500 in 2019/20, and none of the three cameras are fully utilised, with the workload of each gamma camera below the recommendations of Royal College of Radiologists. The current and projected levels of activity can be accommodated by two machines. It is therefore inefficient to maintain three separate services, and service consolidation could release significant cash savings.
3.6.3 PET There are a number of specific issues associated with the current use of the commercially leased and staffed PET CT mobile:
Capacity: As outlined earlier in the document, the need to expand PET services throughout Wales is articulated in the 2018 report of the All Wales PET Advisory Group and the Welsh Scientific Advisory Committee - “Positron Emission Tomography (PET) in Wales - Overview and Strategic Recommendations.” (Appendix C). The all-Wales PET-CT Strategic Board is working to develop a demand and capacity model for
Page 14 of 28 DRAFT V0.23 19.08.2020 Wales as part of the all-Wales Programme Business Case for PET-CT. This will inform the future level of service commissioned by WHSSC.
Flexibility: In addition to the shortfall in the total capacity in North Wales, the time- sensitive nature of scans means that the scanner only being available for 2 days a week creates a further problem. It is a requirement of the existing commissioning route that patients are scanned within 10 working days. This is likely to be shortened to accommodate the requirements of the Single Cancer Pathway. This is a very tight window to scan and report PET CT patients, particularly when trying to accommodate breakdowns and failure of the injected FDG (Fluorodeoxyglucose) delivery, does not allow patients to be scanned in time. Treatment is either delayed or takes place without the appropriate staging which may mean that it is also inappropriate.
Practicality: Patients and staff have to go out in all weathers to access/egress the mobile.
Data transfer: A frequent operational issue is the failure of data transfer from the mobile via a data cable to PACS for reporting which results in having to manually import studies from DVD which is slow and delays reporting.
Accessibility: The mobile does not provide equitable access as the more poorly patients on trollies or beds can’t be accommodated on the mobile and either do not receive the service or have to travel to Wigan which delays treatment.
Lack of space: The mobile has room for 2 patients to rest before scanning which limits the potential throughput.
Lack of facilities: There are no toilets on the mobile van, patients deciding that they need the toilet before scanning have to come back off the mobile and into the main building, this results in further delays and inefficiencies.
Lack of opportunity to develop staff: As the mobile is a staffed leased service the BCUHB nuclear medicine radiographers do not have the opportunity to undertake hands on PET scanning and develop scanning skills further.
Lack of ability to participate in clinical trials/research: The capacity issues of the mobile service and the specific needs of research trials means a number of studies are ineligible to open in BCUHB. This reduces BCUHB's reputation as a research organisation and denies local patients access to trial participation. This also has a negative effect on retention and recruitment of skilled staff.
Revenue cost: The cost of leasing the staffed mobile is likely to be relatively high per patient compared to a fixed site PET.
3.7 Potential Scope This section describes the potential scope for the project.
Given that staffing issues are a major driver for the project, and a common set of staff are able to run a PET service and a Gamma Camera service, this project looks at Nuclear Medicine as a whole. It explores the location of the services, as supporting Gamma Cameras in three locations is placing pressure on staffing and diluting the service. It also examines the scale of future services, to take account of the increasing demand for PET and reducing demand for Gamma Cameras. The limitations as a
Page 15 of 28 DRAFT V0.23 19.08.2020 result of having a mobile PET means that the potential for having a permanent static PET is also explored.
3.8 Main Benefits Criteria This section describes the main outcomes and benefits associated with the implementation of the potential scope in relation to business needs. Satisfying the potential scope for this investment will deliver the following high-level strategic and operational benefits. By investment objectives, these are as follows:
Investment Objective 1 Main Benefits Criteria To provide services which meet the strategic Compliance with: direction / requirements as detailed within . 10 day turn-round for PET CT patients the Health Board’s plans, and key all-Wales (WHSCC Standard) strategies including the Imaging Statement . Single Cancer Pathway requirements of Intent (2018) and “Positron Emission . Future proofing of increased capacity Tomography (PET) in Wales - Overview and requirements Strategic Recommendations”
Investment Objective 2 Main Benefits Criteria To create an environment that delivers safe . Provide fit for purpose accommodation and effective care whilst achieving key . Modern technology with increased efficiency targets throughout the service i.e.: reliability is installed meet increased demand for PET indications . Enable non-ambulatory PET patients to be scanned and not sent to Wigan . Reduce variation in service delivery . Enhance radiographic skills . Increase participation in research
Investment Objective 3 Main Benefits Criteria To maintain legal compliance through Support regulatory compliance by: service development to attract and retain . Maximising chance of retention of staff specialist (ARSAC) licenced practitioners . Maximising potential for recruitment . Minimising risk of reportable radiation incidents arising from failure of a single camera.
Investment Objective 4 Main Benefits Criteria To deliver services that are affordable and . Appropriate radiographic staffing represent value for money, maximising requirement opportunities to deliver revenue savings . Introduces the correct skill mix whilst continuing to deliver and improve . Reduction in cost per case nuclear medicine services Provides opportunity for income generation through: . Participation in research trials . Offer of specialist scanning services to other Health Boards /Trusts
Page 16 of 28 DRAFT V0.23 19.08.2020 Investment Objective 5 Main Benefits Criteria To avert risk of service failure and provide a . Avoid unplanned equipment sustainable and reliable programme for the replacement replacement of existing equipment . Provide a flexible booking schedule and ability to provide for service growth . Offer later appointments to patients who have to travel further distances mitigating FDG supply issues . Improved resilience
The specific metrics for the main benefits criteria will be fully developed in the OBC/FBC.
3.9 Main Risks The main business and service risks associated with achieving the project’s outcomes, and the proposed mitigations, are as follows:
Risk Counter Measure Risk Level Projected revenue . Savings achievement to be actively managed and savings not reviewed at 6 month intervals for the first 2 years of achieved implementation and variations reported. 10 . Recruitment to be strictly in line with planned staff skill mix within the business case. Capital funding bid . Ensure the scheme is fully aligned with WHSSC and to WG not approved AWPET strategic direction. due to lack of . Scoping document shared with WG and initial meeting held 15 strategic alignment to discuss intent and scope. . Dialogue to be maintained in monthly WG meetings and discussions with WHSCC. Unrealistic . Timescales within SOC reviewed July 2020 to reflect programme adopted delay. 9 given the priority of . Time allowances consistent with past business case implementation processes. Programme delay . Delayed SOC to be submitted to first possible meetings for internal approval prior to submission to WG. 25 . Separate BJC to be developed for WMH gamma camera replacement given End of Life/Support Dec 2020. OCP and HR . Consultation with staff and staff side representatives has related risks commenced with HR representation. 1-2-1 discussions to take place. . OCP to be applied in full if applicable to the final preferred 9 option. Staff to be offered alternative opportunities where transfer isn't practical. . Phased transfer to be considered.
Page 17 of 28 DRAFT V0.23 19.08.2020 Availability of . Availability to be discussed with the Hospital Director and suitable site for Site Clinical Directors and included in development control preferred option plans. . Option appraisal to be completed at the earliest 9 opportunity. . Initial feasibility investigations underway. . All aspects to be documented and considered during site appraisal against weighted criteria. High selected site . Identifiable abnormals to be considered in the site selection abnormal costs wherever possible. 12 . Some allowances made within budget costs. Existing mechanical . Some allowances made within SOC budget costs. and electrical . Surveys and site investigations to be completed as soon as infrastructure found possible at OBC stage. 12 to be inadequate or in a poor condition Effect of COVID 19 . Considered by Project Board, capacity provided by 2 pandemic on project gamma cameras considered adequate. . Air changes to be provided in ventilation design. 10 . Any additional Infection Prevention requirements to be considered in design.
3.10 Constraints and Dependencies a. The following constraints have been identified: . The availability of the sites which will be included in an option appraisal at OBC/FBC stage . The ability to retain staff and recruit to new staff posts
b. The following dependencies have been identified: . The project is dependent on capital funding from Welsh Government
To note: The project is not dependent on the ongoing TRAMS (Transforming Access to Medicine) reconfiguration of pharmacy services across Wales and assurance has been provided that the production of radionuclide injections by radio-pharmacy will be maintained.
Page 18 of 28 DRAFT V0.23 19.08.2020 4. The Economic Case
4.1 Introduction The purposes of the Economic Case are to identify and appraise the options for the delivery of the project, and to recommend the option which is likely to offer the best Value for Money (VfM). This is achieved in two steps: first, by identifying and appraising a wide range of realistic and possible option (the long list); and second, by identifying and appraising a reduced number of possible options in further details (the short list).
4.2 Critical Success Factors The Critical Success Factors (CSF) for the project are as follows: . CSF 1: Business Needs: how well the option satisfies the existing and future business needs of the organisation . CSF 2: Strategic Fit: how well the option provides holistic fit and synergy with other key elements of national, regional and local strategies. . CSF 3: Benefits Optimisation: how well the option optimises the potential return on expenditure; business outcomes and benefits (qualitative and quantitative, direct and indirect to the organisation) and assists in improving overall Value for Money (VfM) (economy, efficiency and effectiveness). . CSF 4: Potential Achievability: the organisation’s ability to innovate, adapt, introduce, support and manage the required level of change, including the management of associated risks and the need for supporting skills (capacity and capability). Also the organisation’s ability to engender acceptance by staff. . CSF 5: Supply-side Capacity and Capability: the ability of the market place and potential suppliers to deliver the required services and deliverables. . CSF 6: Potential Affordability: the organisation’s ability to fund the required level of expenditure, namely the capital and revenue consequences associated with the proposed investment.
4.3 The Long-listed Options The long list of options was generated using the options framework, which systematically works through the available choices for what (scope), how (service solutions), who (service delivery), when (implementation), and funding. This process results in options either being discounted, carried forward for further consideration in the short list or identified as a preferred choice. The options framework for this project is as follows:
Options Finding 1.0 Scope 1.1 Business as Usual: Continue with Discounted: it would not address the service current arrangements for service delivery risks and issues outlined in the strategic for the Nuclear Medicine service case. This option is retained as a comparator against which to assess whether other options offer value for money 1.2 Do Minimum: limit the scope of the Discounted: this would not result in the business case to address the Gamma potential benefits of integrating the Gamma Camera service only Camera and PET services, in terms of staffing or physical location. It would not address the limitations of the current PET service
Page 19 of 28 DRAFT V0.23 19.08.2020 1.3 Intermediate: limit the scope of the Discounted: this would not address the business case to address the PET only fundamental staffing and equipment issues related to the Gamma Camera service. 1.4 Maximum: Consider the Nuclear Preferred: this would allow the case to Medicine service as a whole – i.e. address all of the issues with the service. It Gamma Camera and PET would allow exploration of the benefits of fully integrating the Nuclear Medicine service as a whole and creating a centre of excellence. 2.0 Service Solution 2.1 Business as usual: Continue with Discounted: current arrangements for service delivery - it would not address the service risks with incremental investment as and when outlined in the strategic case including required to replace obsolete equipment ARSAC licence holder risk - does not develop PET CT services which remain dependant on 3rd party provision - expensive equipment continues to be used inefficiently (3 departments continue to operate along with 3 supporting radio pharmacies) - retained as a comparator against which to assess whether other options offer value for money 2.2 Replace 2 of the 3 gamma cameras, Possible: it would reduce, but not eliminate, reducing service provision to two sites. the risks related to staffing and equipment No change to the PET service. failure. It would not address the issues related to PET. 2.3 Co-locate 2 new gamma cameras on the Possible: same site as the commercially leased - allows the service to operate from a single and staffed mobile PET CT scanner. site (rather than 3) and consolidation of specialist staff & equipment - does not address the limitation of a mobile PET service 2.4 Co-locate 2 gamma cameras on the Discounted: same site as the commercially leased - allows the service to operate from a single mobile PET CT scanner but staffed by site (rather than 3) and consolidation of BCU staff. specialist staff, equipment and disinvestment in aseptic services - consolidation of staff is greater than option 2.3, as the PET scanner is staffed by BCUHB employees - does not address the limitations of a mobile PET service - probably more expensive than a permanent PET, particularly if the number of PET sessions commissioned by WHSSC increases 2.5 Co-locate 2 gamma cameras on the Preferred: same site and in the same building as a - Would meet all benefits criteria along with permanent, static PET CT scanner service efficiency, improved service
Page 20 of 28 DRAFT V0.23 19.08.2020 staffed by BCUHB staff to form a quality, requirements of national strategic Specialist Nuclear Medicine Centre policy - addresses service delivery and ARSAC risks - future proof PET services across N. Wales - allows consolidation of specialist staff, equipment and rational disinvestment in aseptic services and scanning equipment - promotes a centre of excellence for recruitment and retention - greater opportunities for revenue savings - greater opportunities for research 3.0 Service Delivery 3.1 In-house Preferred: In line with WG Policy 3.2 Outsource Possible: some of the service solutions include leasing a staffed mobile PET, which could be described as partially outsourcing the service 4.0 Implementation 4.1 Big Bang/Single Phase Implementation Possible: the creation of a single centre of excellence could be achieved as a single implementation. However it would involve both a significant service change for the Gamma Camera service (from 3 sites to 1) and for PET at the same time, with concentrated capital expenditure. 4.2 Phased Preferred: for the reasons outlined above 5.0 Funding 5.1 Private Funding Discounted as unaffordable 5.2 Public Funding Preferred
4.4 Short-listed Options The preferred and possible options identified in the table above have been carried forward onto the short list for further appraisal and evaluation. All the options that were discounted as impracticable have been excluded at this stage. On the basis of this analysis, the recommended short list for further appraisal within the OBC/FBC is as follows:
Option 1: Business as usual (included as a benchmark): Continue with current arrangements for service delivery with incremental investment as and when available to replace obsolete equipment. Option 2: Replace 2 of the 3 gamma cameras and deliver the gamma camera service on two sites. No change to the PET service. Option 3: Co-locate 2 gamma cameras on the same single site as a mobile PET CT scanner - the Nuclear Medicine service would therefore be provided on a single site. Option 4: Co-locate 2 gamma cameras on the same site, and in the same building, as a permanent static PET CT scanner, staffed by BCUHB staff to form a Specialist Nuclear Medicine Centre. The potential flow of patients through this department is enclosed as Appendix E. This is the preferred way forward.
Page 21 of 28 DRAFT V0.23 19.08.2020 The work on creating and appraising options has been developed with extensive stakeholder engagement. The project team have identified a number of internal and external stakeholders whose opinion on the proposals have been sought.
. Internal Stakeholders: - Nuclear medicine and PET CT referrers - Radiology staff working in nuclear medicine - Radiology service - Hospital management teams and Board - Staff side
. External Stakeholders - Current and former service users from North Wales, and communities potentially affected in Mid Wales - North Wales Community Health Council -3 rd Sector organisations - Powys CHC
The engagement strategy for the project has involved a number of meetings with the various stakeholder groups with presentations and question and answer sessions. Meetings have been held across all three BCUHB regions at different times of day and evening in accessible facilities. Sessions have been held with current and former service users, and with representatives from the Cancer Network Patients’ forum. Members of radiology staff on the project team have also attended clinical advisory groups to discuss the proposals. In parallel with the meetings, people who have recently attended for nuclear medicine or PET CT examinations have been invited to take part in a survey to gain their views. As people from North Powys have PET CT scans in Wrexham their views have also be obtained. Concurrently meetings have been held across BCUHB with referrers, radiology staff and senior management. The CHC have been fully involved with the approach from the outset, and have confirmed that the engagement undertaken to date has been appropriate. We have also shared the information and facilitated discussion with Powys CHC.
It is important to note that at this stage the case does not identify the preferred single site (as in options 3 and 4) or two sites (as in option 2). This analysis will be undertaken as part of developing the OBC/FBC, and will require a further systematic engagement exercise.
Page 22 of 28 DRAFT V0.23 19.08.2020 5. The Commercial Case
5.1 Introduction This section of the SOC outlines the proposed deal in relation to the preferred way forward, as outlined in the economic case and provides a very high level, preliminary view. Detailed analysis will take place at OBC stage.
5.2 Required Services The current anticipated nett departmental or construction cost is below £4m so it is intended that the construction works will be procured via Sell to Wales with support from NHS Wales SSP. NWSSP-SES typically provide support to BCUHB for the larger equipment procurements from NHS Supplies frameworks.
5.3 Potential for Risk Transfer This section provides an initial assessment of how the associated risks might be apportioned between BCUHB and the contractor. The general principle is to ensure that risks should be passed to the party best able to manage them, subject to value for money. The table below outlines the potential allocation of risk, which is the standard distribution at this stage in the development of a scheme.
Risk Category Potential Allocation Public Private Shared 1. Design Risk √ 2. Construction and Development Risk √ 3. Transition and Implementation Risk √ 4. Availability and Performance Risk √ 5. Operating Risk √ 6. Variability of Revenue Risks √ 7. Termination Risks √ 8. Technology and Obsolescence Risks √ 9. Control Risks √ 10. Residual Value Risks √ 11. Financing Risks √ 12. Legislative Risks √ 13. Other Project Risks √
5.4 Personnel Implications (including TUPE) It is anticipated that the TUPE (Transfer of Undertakings (Protection of Employment) Regulations 1981) will not apply to this investment as outlined above.
5.5 Procurement Strategy and Implementation Timescales With an anticipated nett departmental or construction cost of below £4m these works will not be procured via the Designed for Life: Building for Wales major capital framework which applies to schemes over this level. An outline design for the department or construction works to support the OBC/FBC will be completed by the multi-disciplinary design team from the existing BCUHB consultant framework and prepared for tender issue via Sell to Wales by the cost advisers on the same framework.
Page 23 of 28 DRAFT V0.23 19.08.2020 A clinical evaluation of gamma cameras and PET CT systems available to the UK market will be completed by evaluation teams to inform the typical 60% this element forms with the remaining 40% being the technical and commercial responses returned by suppliers in response to BCUHB specifications. BCUHB is normally supported through this process by NWSSP-SES and Procurement Services with the equipment being procured via existing NHS Supplies frameworks.
Page 24 of 28 DRAFT V0.23 19.08.2020 6. The Financial Case
6.1 Introduction The purpose of this section is to set out the indicative financial implications of the preferred way forward (as set out in the economic case section).
The detailed analysis of the financial case, including the final conclusion about affordability, will take place at OBC/FBC stage.
6.2 Capital Costs The estimated total cost of the preferred way forward is between £10 and £11 million at PUBSEC Index 248, and the cost forms are enclosed as Appendix F.
The preferred way forward is also the option with the highest capital cost, so this is the best estimate of the maximum capital cost of the scheme.
The cost includes the purchase of two new Gamma Cameras as well as a PET-CT scanner, at a combined equipment cost of approximately £3.4 million. It should be noted that the Gamma Camera in Wrexham is on BCUHB’s list of equipment requiring urgent replacement. If early funding is available this camera could (and should, given the current risks) be purchased prior to the completion of the OBC/FBC, as Gamma Cameras can be relocated if necessary.
6.3 Impact on the Organisation’s Income and Expenditure Account The revenue analysis below compares the current costs with a preliminary analysis of the preferred way forward. Overall, this project delivers recurring revenue savings, currently estimated at £210,000.
The main reasons for this are as follows: . The number of gamma cameras goes down from three to two, reducing equipment running costs . Staffing efficiencies can be achieved by consolidating the gamma camera service onto a single site. The same staff can also run the PET-CT service. This means that there only needs to be a small increase in the number of staff employed to allow the Health Board to run the PET-CT service, while there are substantial savings from ending the contract for the current mobile service.
The scale of saving fluctuates during the first four years, depending on when maintenance costs are incurred (it is assumed that there are no maintenance costs in the first year after the 2 Gamma Cameras and the PET-CT are purchased).
The cash flow projection based on current information is detailed below:
Page 25 of 28 DRAFT V0.23 19.08.2020 ** Years 5 and 6 will be the same as year 4. In year 7 the centralisation/excess travel costs cease, giving the recurring position.
Further detail about the revenue calculations are enclosed in Appendix G.
It should also be noted that while it is envisaged that the level of PET activity will increase, and one of the drivers of this case is to accommodate that increase in the most cost-effective way, the analysis at this stage is a like-for-like comparison assuming no change in current activity. However it is important to understand that the marginal cost per case of any increased activity will be significantly lower under the preferred way forward than through the current service configuration. This will be explored further in the OBC/FBC. The OBC/FBC will also explore the potential to increase income by offering capacity for neighbouring organisations and undertaking research.
Given that there is a net revenue saving for current levels of activity, and any additional activity will be commissioned via WHSSC, this case is affordable.
Page 26 of 28 DRAFT V0.23 19.08.2020 7. The Management Case
7.1 Introduction This section of the SOC addresses the achievability of the scheme. Its purpose is to set out the actions that will be required to ensure the successful delivery of the scheme.
7.2 Project Management Arrangements The project management arrangements for capital projects are outlined in the Procedure Manual for Managing Capital Projects, which was adopted by the Health Board in May 2015 (updated October 2018).
The project will be managed in accordance with PRINCE 2 project management methodology to enable a well-planned and smooth transition to the new service models. There will be a strong focus on the delivery of the objectives and benefits.
The Senior Responsible Officer (SRO) for the project is Adrian Thomas, Executive Director of Therapies and Health Sciences.
7.3 Target Milestones The target milestones for the project are as follows:
Milestones Target Date Submit SOC to Welsh Government September 2020 Receipt of SOC approval by Welsh Government January 2021 Submit combined OBC / FBC to Welsh Government November 2021 Receipt of OBC / FBC approval by Welsh Government April 2022 Completion and Handover November 2023
7.4 Use of Special Advisers Special advisers will be used as required, procured via the BCUHB Framework supported by NWSSP
8. Conclusion and Recommendation This Business Case is recommended for approval.
Page 27 of 28 DRAFT V0.23 19.08.2020 List of Acronyms
Acronym Definition ARSAC Administration of Radioactive Substances Advisory Committee AWPET All Wales PET Advisory Group BCUHB Betsi Cadwaladr University Health Board BJC Business Justification Case CHC Community Health Council CSF Critical Success Factors CT Computed Tomography DGH District General Hospital EqIA Equality Impact Assessment EMG Executive Management Group GMP Guaranteed Maximum Price HIA Health Impact Assessment HIW Health Inspectorate Wales IPFR Individual Patient Funding Request IR(ME)R 2017 Ionising Radiation Medical Exposure Regulations MRI Magnetic Resonance Imaging NWSSP NHS Wales Shared Services Partnership PET Positron Emission Tomography PET CT Positron Emission Tomography Computed Tomography TUPE Transfer of Undertakings (Protection of Employment) Regulations VfM Value for Money WG Welsh Government WHSSC Welsh Health Specialised Services Committee WMH / YMW Wrexham Maelor Hospital YG Ysbyty Gwynedd YGC Ysbyty Glan Clwyd
Page 28 of 28 DRAFT V0.23 19.08.2020 1 20.110c Appendix F SOC Cost Forms 24.06.2020.xlsx
Betsi Cadwaladr University Hospital Nuclear Medicine Consolidation Project
Strategic Outline Case
Costs at Reporting Level of PUBSEC 248
24 June 2020
Nuclear Medicine Consolidation Project OUTLINE BUSINESS CASE COST FORMS
CONTENTS
OPTION - Preferred
NOTES
COST FORMS SO1
COST FORMS SO2
COST FORMS SO3
COST FORMS SO4
COST FORMS SO5
COST FORMS SO6
Contents STRATEGIC BUSINESS CASE
Health Board: BCUHB SCHEME: Nuclear Medicine Consolidation Project Issue date: 24 June 2020 PHASE : SOC
OUTLINE BUSINESS CASE COST FORMS NOTES
A) BASIS OF CALCULATIONS:
a) Areas:
i) Drawn Areas etc (Departmental & Communications Space) areas are based on Liz Lloyd email dated 11.10.19
b) Costs :
i) All Costs based on £/m2 rates with allowance for on costs. ii) The Provisional Location Factor Adjustment of 0.97 has been used. iii) Costs are at PUBSEC index 248.
c) On Costs (Form OB3)
i) Calculation based upon build-up for abnormals
d) Equipment Costs - Based on % at this stage
e) Fees calculations based on % basis
f) Non-Works Costs based upon build up .
g) Value Added Tax calculated at a 'Standard Rate' of 20% on ALL. VAT Reclaim has been applied at 100% on Professional Fees.
k) Inflation -
The anticipated construction duration (< two years) of this Project means that the 'VOP' (Variation of Price) provisions of the DfL Framework WILL NOT apply.
j) Within the cash flow expenditure year 1. 2020/21 includes for the replacement of the WMH gamma camera
Notes/4 of 9 STRATEGIC OUTLINE CASE COST FORM SO1 Health Board: BCUHB Nuclear Medicine Consolidation SCHEME: Project
PHASE : SOC
CAPITAL COST SUMMARY
Cost Exc. VAT VAT Cost Incl. VAT £ £ £
1. Works Cost (OBC) 3,553,100 710,620 4,263,720
2. Fees 738,334 147,667 886,001
3. Non-works Costs 32,000 6,400 38,400
Equipment Costs (14%) 3,353,503 670,701 4,024,203 4.
5. Contingency (15% items 1 to 4) 1,151,541 230,308 1,381,849 Forecast Project Out-turn Cost (Pre VAT Recovery) 6. 8,828,477 1,765,695 10,594,173
7. Less Recoverable VAT (OBC) 147,667 147,667
Forecast Project Out-turn Cost (VAT Recovery) 8,828,477 1,618,029 10,446,506 8.
Proposed Contract Period: TBC Months Excluding Early Proposed Starting Date: TBC (m/y) Works & Proposed Completion Date: TBC (m/y) Substation
Year 1 2 3 4 Total Financial Year 20/21 21/22 22/23 23/24 Works Cost 218,950 2,333,905 1,000,245 3,553,100 Fees 71,540 380,633 143,080 143,080 738,334 Non-works Costs 32,000 32,000 Equipment Costs 704,000 2,649,503 3,353,503 Contingencies 21,895 790,752 338,894 1,151,541 VAT 14,308 265,096 659,947 826,344 1,765,696 Sub total 85,848 1,590,574 3,959,685 4,958,067 10,594,173
Recoverable VAT 14,308 76,127 28,616 28,616 147,667 Total 71,540 1,514,447 3,931,069 4,929,450 10,446,506
This form completed by : BCUHB Telephone No : Address : Date : 24 June 2020 Authorised by :
Reference : Health Board - BCUHB STRATEGIC OUTLINE CASE COST FORM SO2 Health Board: BCUHB SCHEME: Nuclear Medicine Consolidation Project PHASE : SOC
CAPITAL COST : WORKS AND EQUIPMENT Function Units/ Space Functional Content Space Allowance N/A/C (Note 2) Equipment Cost (£) Requirements (1) Cost Allowance
Major / HCI Version 2.0 N/A/C m² £/m² Minor (PUBSEC 248) £
Functional unit 617 3,000 1,851,000
On Costs (excluding Fee) 1,702,100
Equipment PET CT 1,600,000 2 x gamma camera 1,300,000 dose dispenser 120,503 injector 33,000 processing software 150,000 Group 2 and 3 items 150,000
Less abatement for transferred Equipment if applicable - Included Included
Departmental Costs and Equipment Costs* to Summary (Form OB1) £ 3,553,100 £ £3,353,503 STRATEGIC OUTLINE CASE COST FORM SO3
Health Board: BCUHB Nuclear Medicine Consolidation SCHEME: Project
PHASE : SOCSTAGE 0 OBC
CAPITAL COSTS: ON-COSTS
Percentage of Estimated Cost Departmental (exc. VAT) Cost
1. Communications £ % a. Space b. Lifts £
2. ''External'' Building Works (1) a. Drainage b. Roads, paths, parking (reduced part c. Sitemeasured layout, elsewhere) walls, fencing, gates d. Builder's work for engineering services outside buildings £
3. ''External'' Engineering Works (1) a. Steam, condensate, heating, hot water and gas supply mains b. Cold water mains and storage c. Electricity mains, sub-stations, stand-by generating plant d. Calorifiers and associated plant e. Miscellaneous services (services in the road) £
4. Auxiliary Buildings £
5. Other on-costs and abnormals (2) a. Link glazed corridor 300,000 b. Rooftop Plantroom 225,000 c. Varying ground conditions 70,000 d. Diverting/reinstating existing services 30,000 e. External lighting and landscaping 35,000 f. Electrical cable connections for the 3 scanners, AHUs and building 64,500 g. Substation 80,000 h. Generator 450,000 i. UPS/IPS N+1 68,000 j. BMS panel and connections to existing 50,000 k. 600x600 LED ceiling combined emergency lighting panels 63,600 l. L1 Fire alarm system inc m. Nurse call system inc n. AHU inc o. Radiant panel wet heating system 66,000 p. Duplex medigas pump 100,000 q. 8 x AC 6kw splitter units 100,000
£ 1,702,100
Total On-Costs to Summary SO1 £ 1,702,100 STRATEGIC OUTLINE CASE COST FORM SO4
Health Board: BCUHB SCHEME: Nuclear Medicine Consolidation Project PHASE : SOC Cost/m² Basis CAPITAL COSTS: FEES AND NON-WORKS COSTS
Percentage of £ Works Cost (Net of Loc Fact Adj) % 1. Fees (including ''in-house'' resource costs)
Trust/Health Board:
a Project Manager 3.00% b Health Board Cost Advisor 2.00% c Architect 6.16% d Civil and Structural Engineer 5.04% e Building Services Engineer f Planning Supervisor 1.88% g Director and Inhouse Sponsor 1.00% h Supervisor 1.50% i Other (List and Describe) Audit 0.20%
Trust/Health Board Total £
Total Fees to Summary (SO1) £ 20.78%
£ % of Works Cost 2. Non-Works Costs
a Statutory and local authority charges 12,000 b Planning and Building Control fees c Other (list and describe) d Surveys 20,000 e Decant
Non-Works Costs to Summary (OB1) £ 32,000 £ 0.90% OUTLINE BUSINESS CASE COST FORM SO5 Health Board: BCUHB SCHEME: Nuclear Medicine Consolidation Project PHASE : STAGE SOC
Proposed start on site: May 2022 Proposed completion date: October 2023
Year 1 2 3 4 Total Financial year 20/21 21/22 22/23 23/24
Works Cost 218,950 2,333,905 1,000,245 3,553,100 Fees 71,540 380,633 143,080 143,080 738,334 Non-works Costs 32,000 32,000 Equipment Costs 704,000 2,649,503 3,353,503 Contingencies 21,895 790,752 338,894 1,151,541 VAT 14,308 265,096 659,947 826,344 1,765,696 Sub-total 85,848 1,590,574 3,959,685 4,958,067 10,594,173 Less: Reclaimable VAT 14,308 76,127 28,616 28,616 147,667 TOTAL 71,540 1,514,447 3,931,069 4,929,450 10,446,506
/ /OB5 1 20.110d Appendix G Revenue v.5.xlsx
20/21 21/22 22/23 23/24 Recurrent
Year 1 Year 2 Year 3 Year 4 Year 5
£000's £000's £000's £000's £000's
Projected Costs
Capital Costs 72 1,514 3,931 4,930 0
Revenue Costs 1,362 1,362 1,364 1,107 1,207
Depreciation 10 227 788 1,492 1,492
Total Costs 1,444 3,103 6,083 7,529 2,699
Proposed Funding Stream
WG Capital 72 1,514 3,931 4,930 0
WG Funding Depreciation Charge 10 227 788 1,492 1,492
Existing Revenue Funding 1,417 1,417 1,417 1,417 1,417
Total Funding Stream 1,499 3,158 6,136 7,839 2,909
Saving (55) (55) (53) (310) (210) 19/20 20/21 21/22 22/23 23/24 Recurrent
Year 0 Year 1 Year 2 Year 3 Year 4 Year 7**
Available funding
Existing revenue stream 1,417,228 1,417,228 1,417,228 1,417,228 1,417,228 1,417,228
Costs
Pay
Principal Lead - - 55,985 55,985
Band 7 Physicist - - 23,483 23,483
Consultant reporting sessions - - 62,000 62,000
Radiographer & support staffing 448,312 448,312 448,312 383,447 383,447
Centralisation protection/Excess travel reserve - - 29,962 -
Pay sub-total 448,312 448,312 448,312 554,877 524,915
Non-Pay
PET maintenance - - - 67,365 202,096
NM Maintenance 75,796 75,796 78,000 156,000 156,000
NM Software Support 30,678 30,678 30,678 30,678 30,678
PET Consumables - - 10,641 10,641
PET Pharmaceuticals - - 210,000 210,000
Christies PET scans - - 9,100 9,100
PET Delivery & Transport - - 33,696 33,696
Non pay & training - 10,000 5,000
Utilities increase - lighting and heating & cleaning - - 25,000 25,000
External PET Contract 806,997 806,997 806,997 - -
Non-Pay sub-total 913,471 913,471 915,675 552,480 682,211
Total 1,361,783 1,361,783 1,363,987 1,107,356 1,207,126
Change - 55,445 - 55,445 - 53,241 - 309,872 - 210,102
*Year 0 is 2019/20. Figures do NOT include inflationary uplift.
** Years 5 and 6 will be the same as year 4. In year 7 the centralisation/excess travel costs cease, giving the recurring position. Existing Costs Full Year (£)
£ £
NM Existing Staffing 394,136
NM Maintenance 137,082
NM Software Licenses 24,837
Total Cost Nuclear Medicine 556,055
PET Existing Staffing 54,176
PET Mobile Lease 806,997
Total Cost PET CT 861,173
Grand Total 1,417,228
Summary
Revenue
NM Maintenance - 137,082
NM Software Licences - 24,837
NM Existing Staffing - 394,136
Total Cost of Nuclear Medicine
PET Medical - 45,091
Admin Support - 9,085
PET CT Forecast for 1000- scans806,997 based on cost
Total Cost PET CT
Grand Total 1 20.110e Board Nuclear Medicine SOC Companion Slides v3.pptx
Radiology Nuclear Medicine Consolidation Strategic Outline Case Background
Clinical Utility Services Supported Physiological and Hybrid Imaging Paediatrics Very sensitive method of imaging – highly Oncology sensitive and can be the only method of imaging certain diseases Inpatient / Outpatient MSK imaging (Gamma Camera) MSK – trauma / infection imaging Cancer Service – PET-CT & Routine Nuclear Neighbouring trusts e.g. RJAH (which does Medicine for Staging and treatment follow not have a facility) up Medicine – e.g. PE imaging Paediatrics e.g. Renal Imaging required by Cardiology – MPI imaging tertiary centres Neuroendocrine Service Complementary imaging for those unable to have IV contrast or MRI compatibility Organ Transplant services Cardiac Imaging Current Service & Deteriorating Sustainability
National Shortage - Recruitment and Retention of Sub-Specialty trained Consultants and Radiographers increasingly difficult
Compliance – Licencing Issues surrounding maintaining services
Wales currently not providing equivalent access to patients compared to England for PET-CT (AWPET / WHSSC)
Under provision Linked to lack of PET-CT facilities
Currently operating 3 Nuclear Medicine departments
Three Gamma Cameras – all at ‘end of life status’ & under utilised /some routine Nuclear Medicine tests migrating to PET- CT
PET-CT provided by 3rd Party on Mobile Unit
WHSSC – regularly increasing funded indications – with growth in service accelerating
Retirements and impacted recruitment means that services are now difficult to run with the remaining licenced consultants
Expensive Imaging Equipment and Support Services Need for Stability in Clinical Deliverability and Service Development / Evolution
Whole Nuclear Medicine Service Including PET-CT reliant on an ARSAC licence issued to the Employer & to each Radiologist with Additional Training in NM/PET Number of Licences in HB much reduced Services cannot run without a Licenced Clinician Recruitment /Retention/ Continuation of Current Services - Dependent on Centre of Excellence / Consolidated service PET-CT service growing – need to provide in house service Capital purchase of PET-CT and infrastructure – allowing long term revenue savings HB staff run own service (saving on revenue) – allowing for staff development / skill mix / optimised equipment use/ Full weekly service possible Accessible to patients with disabilities / mobility / bariatric patients Proposed Solutions
Reduction to 2 Gamma Cameras – in alignment with evolution of patient pathways and transition of Gamma Camera work to PET-CT
Fit for Purpose Imaging Unit – future proof / legislation compliance / clinical utility
Consolidated Centre of Excellence:
1 Nuclear Medicine Department –
2 x Gamma Cameras(Back to Back)
1 x PET-CT
Site Option Appraisal to be undertaken Service Reconfiguration - Impact
Provision of Centre of Excellence for Nuclear Medicine within BCUHB
Likely to recruit and retain radiology trainees and consultants with NM Specialty
Opportunity for revenue saving (Equipment /AML contract/ Staffing)
Optimal Use of State of the Art Facility and Equipment
Ability to expand service to include future indications by WHSSC / WG
Ability to facilitate research trials for cancer patients currently unable to access novel research treatments in the region 5.1 20.111 Crynodeb o Fusnes Heb y Cyhoedd y Bwrdd i gael ei adrodd arno'n gyhoeddus / Summary of Private Board business to be reported in public 1 20.111 Private session items reported in public.docx
Cyfarfod a dyddiad: Health Board Meeting and date: 24th September 2020
Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Summary of business considered in private Report Title: session to be reported in public
Cyfarwyddwr Cyfrifol: Ms Dawn Sharp, Acting Board Secretary Responsible Director: Awdur yr Adroddiad Mrs Kate Dunn, Head of Corporate Affairs Report Author: Craffu blaenorol: None Prior Scrutiny: Atodiadau None Appendices: Argymhelliad / Recommendation:
The Board is asked to note the report
Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation: To report in public session on matters previously considered in private session
Cefndir / Background: Standing Order 6.5.3 requires the Board to formally report any decisions taken in private session to the next meeting of the Board in public session. This principle is also applied to Committee meetings.
During the Covid pandemic, Board meeting agendas were focused on key priorities and this governance paper for noting was deferred. The assessment below therefore incorporates information from several meetings.
Asesiad / Assessment
The Health Board considered the following matters in private session on 23.1.20:
Draft Three Year Outlook and Annual Plan 2020/23 A Pathway Approach to Delivering Sustainable Elective Orthopaedic and Musculoskeletal (MSK) Services A verbal update from an extraordinary meeting of the Remuneration and Terms of Service (R&TS) Committee held on 17.1.20
The Health Board considered the following matters in private session on 14.5.20:
Approval of settlement of a high value claim
The Health Board considered the following matters in private session on 23.7.20:
Increase to Approval Limit for Executive for Microsoft Enterprise Agreement Approval of settlement of a high value claim Full Business Case for Delivering an Acute Digital Health Record Pan BCU Defibrillator Replacement Programme : Revenue Business Case 5.2 20.112 Adroddiad Blynyddol Arolygiaeth Gofal Iechyd Cymru / Healthcare Inspectorate Wales Annual Report - Debra Hickman 1 20.112a HIW Report annual report_overview.docx
1
Cyfarfod a dyddiad: Health Board Meeting and date: 24.9.20 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Healthcare Inspectorate Wales (HIW) Annual Report 2019-2020 Report Title: Cyfarwyddwr Cyfrifol: Debra Hickman Responsible Director: Acting Executive Director of Nursing and Midwifery Awdur yr Adroddiad Matthew Joyes, Acting Associate Director of Quality Report Author: Assurance/Assistant Director of Patient Safety and Experience and Erika Dennis, Business Manager, Quality Assurance Craffu blaenorol: Review by Acting Associate Director of Quality Assurance and Acting Prior Scrutiny: Executive Director of Nursing and Midwifery Atodiadau HIW Annual Report Appendices: Argymhelliad / Recommendation: The Health Board is asked to receive for assurance this report and the annual report presentation from Healthcare Inspectorate Wales (HIW). Please tick one as appropriate (note the Chair of the meeting will review and may determine the document should be viewed under a different category) Ar gyfer Ar gyfer Ar gyfer Er penderfyniad Trafodaeth sicrwydd X gwybodaeth /cymeradwyaeth For For Assurance For For Decision/ Discussion Information Approval Sefyllfa / Situation: The purpose of this paper is to provide the Health Board with the Healthcare Inspectorate Wales (HIW) Annual Report 2019-2020 which was presented to the Quality, Safety and Experience (QSE) Committee on 28 August 2020. The HIW Annual Report for 2019-20 was received by the Health Board on 5 August 2020. Below is an overview of the report and an update on the Health Board’s position, based on the findings listed in the report.
Overview
Over the past year, HIW have carried out 206 visits to various wards, establishments, Health Boards and healthcare providers across Wales in the NHS and in the independent sector (179 in 2018-19). For BCUHB, HIW completed the following inspections;
7 hospital inspections (2 in 2018-19) 6 general practice inspections (5 in 2018-19) 8 dental practice inspections (21 in in 2018-19) 3 mental health inspections (3 in in 2018-19) 2
Further details of the inspection type and locations are located on slides 5, 6 and 7 of the PowerPoint provided by HIW. As noted above, there has been an overall increase in the amount of inspections which have been undertaken by HIW. There is also a noticeable increase in the amount of hospital inspections and a significant decrease in the amount of dental practice inspections.
Key themes / findings
Whilst it is positive to know that patients felt they were treated with respect by staff and the quality of the care they received was of a good standard, it is concerning to hear that there are still issues across the Health Board in relation to the following areas;
Training being provided and kept up to date, as well as the overall standard of record keeping. Lack of action as a result of HIW inspections (particularly evident across the two hospital Mental Health inspections conducted in 2018/19).
For assurance, please refer to the table below which confirms the progress of actions arising from HIW inspections of our Mental Health & Learning Disabilities Service. There are no outstanding actions from 2017. These are located in the archived HIW Corporate Tracker held by Corporate Quality Assurance. All actions for 2018 are implemented (complete) and some actions remain in progress for 2019 and 2020.
Overall, 79% of actions have been implemented by Mental Health & Learning Disabilities. A total of 15 actions from 2019 remain in progress. The Business Manager (Quality Assurance) is working with leads within the Division to ensure that these actions are implemented in a timely manner, to provide support and to escalate any issues to the Quality and Safety Group (QSG)
Action Status Mental Health & Learning Disabilities Inspection In Grand Inspection Implemented Progress Total Bryn y Neuadd (West) January 2020 Acute, Psychiatric and Rehabilitation unit 14 4 18 Kestrel Ward (West) June 2018 Child and Adolescent Mental Health Service (CAMHS) 19 19 Ty Derbyn (East) October 2019 Community Mental Health Team (CMHT) 34 11 45 Cemlyn Ward (West) September Older Persons Mental Health 2019 3 4 7 Grand Total 70 19 89
The most common Health and Care Standards themes which relate to the actions noted in the table above are as follows;
Safe and Clinically Effective Care Managing Risk and Promoting Health & Safety Medicines Management Timely Access Health Promotion, Protection and Improvement 3
The Mental Health & Learning Disabilities Service are responsible for their local action plans, as are each Division/Speciality. The Corporate Quality Assurance Team ensure oversight of HIW improvements plans, reporting monthly to QSG, and up to QSE Committee ad hoc. This ensures that actions are continuously monitored, reviewed and allows for escalation and assurance.
With reference to slides 11 and 12, it is important to highlight to the Board that not all dental and general practice inspections are BCUHB managed. As such, only 2 of the 14 inspections relate to BCUHB managed practices (namely general practices). For the remainder which are not managed practices, the Primary Care Directorate have worked with practices to support completion of improvement plans but these remain the accountability of the independent provider.
Hospital Inspections
As confirmed by HIW, 7 hospital inspections (secondary care) took place at BCUHB during 2019-20;
1. Unscheduled Care, Emergency Department, Ysbyty Gwynedd, June 2019 2. Midwifery & Women’s Services, Midwifery Led Units, Glan Clwyd, September 2019 3. Trauma & Orthopaedics, Ysbyty Glan Clwyd, July 2019 4. Unscheduled Care, Emergency Department, Wrexham Maelor, August 2019 5. Midwifery & Women’s Services, Midwifery Led Units, Ysbyty Gwynedd, November 2019 6. Midwifery & Women’s Services, Midwifery Led Units, Wrexham Maelor, January 2020 7. Midwifery & Women’s Services, Birth Units x 3 (West), January 2020
The table above provides an overview of progress against actions for all 7 hospital inspections. Of the total 254 actions across all hospital site inspections, 219 actions have been implemented (completed) by services which is 86%. The remaining 14% of actions are in progress. The Business Manager (Quality Assurance) continues to work with Heads of Services and Divisional Leads to ensure that those actions are reviewed monthly and a report on progress is provided to QSG.
From the 7 hospital inspections, HIW have identified the following areas for improvement (slide 9);
Poor infection prevention and control compliance in some areas Learning from audit, concerns and incidents Overall governance and leadership within the community birthing units.
In addition to the progress against actions, it is important to consider what improvements have been implemented. As a direct result of the above, listed below are some of the improvement actions which our services have taken to ensure the provision of safe care and quality of care; 4
Freestanding Midwifery Units (FMUs) were temporarily closed. As such, the maternity teams were temporarily relocated to non NHS premises that have been risk assessed for clinical activity which are exclusively used for antenatal clinics. This has been updated again as a result of Covid-19 and HIW updated accordingly. Standard Operating Procedures developed and ratified at QSG. Quality Assurance audits undertaken and reported to QSG via exception reports. Infection Risk Assessments undertaken with support from the Infection Prevention Control (IPC) team, including input from Health & Safety and Estates where applicable. Local improvement plans developed with updates reported from local level meetings such as clinical governance, up to QSG. Business cases submitted in order to increasing the support of demand and patient flow.
Publication
Publication of the HIW Annual Report was scheduled for 28 August 2020. The BCUHB report has been presented to the QSE Committee and will be presented to the Health Board on 10 September 2020. The report will feature in future reporting to QSG to ensure it continues to be considered throughout the year.
Cefndir / Background:
HIW inspect the NHS in Wales, from general practices to hospitals. HIW assess compliance based on the Health and Care Standards 2015, the Independent Health Care (Wales) Regulations 2011, and National Minimum Standards (NMS) for Independent Health Care Services in Wales. They also have a specific responsibility to ensure that vulnerable people receive good care in mental health services. As such, HIW also inspect mental health and learning disability settings and considers compliance with legislation.
There is an agreed internal Standard Operating Procedure (SOP) for HIW along with a timeline which confirms the HIW timescales for issuing the Health Board with any immediate concerns and/or improvement plans for completion, based on the findings from the inspections.
Corporate Quality Assurance is responsible for;
1. Managing all HIW correspondence and improvement plans 2. Quality assuring all HIW correspondence 3. Managing the Corporate HIW Tracker Tool and expediting actions / updates from Divisions 4. Act as the conduit between the Health Board and HIW 5. Preparing monthly exception reports for Quality & Safety Group
Each improvement plan is captured in the Corporate HIW Tracker Tool which allows for further review of actions once they have been implemented. The aim of which is to provide further assurance and to ensure oversight of improvements required. 5
Asesiad / Assesent & Anaysis
Strategy Implication
The provision of quality care in a safe environment is paramount to the Health Board’s Quality Strategy, and Living Healthier Staying Well. These are part of our overall key objectives.
Financial Implications
Costs will be incurred in each service / area and will differ depending on HIW recommendation / Health Board action, and some costs will be part of the maintenance / refurbishment programme. Failure to provide safe care, can result in a complaint, claim and compensation of which there can be significant financial implications.
Risk Analysis
There is a risk of harm to staff if the estate or facilities is not fit for purpose. If staff are unable to provide suitable care, there is a risk of harm to the patient. There is also a reputational risk, particularly in terms of the press following any negative reports and immediate concerns.
Financial risk is associated with costs of any claims.
There is a risk of non-compliance with regulations. When standards are not met, HIW make recommendations for improvement, these feed into the NHS Wales Escalation and Intervention Arrangements.
In addition, if HIW do not receive sufficient assurance that action has been taken to address issues, they can take enforcement action.
Members are asked to note, that one of the matters raised in the HIW inspection report for Midwifery & Women’s Services (ensuring that policies and procedures are reviewed and updated within appropriate timescales), are reflected on the corporate risk register under risk ID 2052, Tier 2, with a current score of 12 (High) and a target score of 4 (Moderate). Mitigating actions currently in place include;
1. Full list of Clinical written control documents (WCDs) have been compiled and sent to Compliance and Assurance Manager on 5 December 2019. 2. Compliance and Assurance Manager will review and input into the main database format developed. 3. New list to be cross referenced against existing database and cascade extraction to identify duplicates/omissions (Office of the Board Secretary). 4. Final list to be reviewed and segmented into priority/area for submission to QSG prior to moving into newly developed intranet site (Office of the Board Secretary). 5. Stratification of list in progress in preparation for migration onto internet by Office of Board Secretary identified gaps will be presented to QSG by the Office of Board Secretary this will form part of the Office of the Board Secretary work plan.
Further actions are in place to help achieve our target score. 6
Legal and Compliance
There is a risk of non-compliance with regulations as per the risk analysis
Impact Assessment
This report is purely administrative, there are no associated impacts or specific assessments required. At present, Covid-19 has placed a significant impact on the work carried out by HIW and as such, all routine inspections and scheduled reports have been placed on hold. 1 20.112b HIW Annual Report.pptx HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020
HIW Annual Findings 2019-2020 Betsi Cadwaladr University Health Board
Emma Algieri Scott Senior Healthcare Inspector / Relationship Manager
28 August 2020 Agenda
• All Wales Summary • Health Board Title – Our Work • Key themes / findings • Hospitals • Mental Health • GP’s • Dentists
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 All Wales Summary This year HIW completed 206 visits to various wards, establishments, health boards and healthcare providers across Wales in the NHS and in the independent sector In 2019-2020 we did: • 37 general hospital inspections • 1 surgical inspection • 25 GP inspections • 68 dental inspections • 28 inspections of NHS and independent mental health units • 3 inspections of community mental health teams • 5 IR(ME)R inspections • 41 inspections of Independent care providers • We received 367 concerns about health services. 15 of these were categorised as needing urgent action
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 Betsi Cadwaladr – Our work
• 7 hospital inspections • 6 general practice inspections • 8 dental practice inspections • 3 mental health inspections
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 Betsi Cadwaladr – Our work
Setting Inspection Type
Ysbyty Alltwen Hospital Inspection Ysbyty Gwynedd Hospital Inspection Wrexham Maelor hospital Hospital Inspection Glan Clwyd hospital Hospital Inspection Ysbyty Gwynedd Hospital Inspection Wrexham Maelor hospital Hospital Inspection BCUHB Birth Units Hospital Inspection Cefni hospital Mental Health Inspection Wrexham CMHT Mental Health Inspection Bryn Y Neuadd hospital Mental Health Inspection Stables Medical Centre GP Inspection
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 Betsi Cadwaladr - Our work
Setting Inspection Type
Bron Derw Medical Centre GP Inspection Meddygfa Gyffin GP Inspection Hillcrest Medical Centre GP Inspection
Panton Surgery GP Inspection
Ty Doctor GP Inspection Flint Dental Centre Dental Inspection Talking Teeth Dental Inspection Signature Smiles Dental Practice Dental Inspection My Dentist Menai Bridge Dental Inspection Eirlys Dental Practice Dental Inspection Total Orthodontics Wrexham Dental Inspection Beauwood Dental Care Dental Inspection
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 Betsi Cadwaladr – Our work
Setting Inspection Type
BUPA Dental Care Colwyn Bay Dental Inspection
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 Key themes/findings
Overall, across all inspections, patients felt they were treated with respect by staff and the quality of the care they received was of a good standard.
There are issues across the HB with regards to training being provided and kept up to date, as well as the overall standard of record keeping.
A key message to highlight is that it is clear that action isn’t always taken as a result of HIW inspections, and this has been particularly evident across the two hospital Mental Health inspections conducted in 2018/19. This is concerning given this was highlighted in 2017 and 2018, and is still an issue across the HB.
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 Hospitals There were 7 hospital inspections in Betsi Cadwaladr during 2019- 2020 – Ysbyty Alltwen, Ysbyty Gwynedd , Wrexham Maelor Hospital, Glan Clwyd Hospital, Ysbyty Gwynedd, Wrexham Maelor Hospital, BCUHB Birth Units Good practice or positive findings: • Good evidence of person-centred care and staff engagement • Safe and effective care demonstrated across the range of inspections • Good arrangements in place in maternity to provide women and families with bereavement and perinatal mental health support.
Themes or most significant areas where improvements were required: • Poor infection prevention and control compliance in some areas • Learning from audit, concerns and incidents • Overall governance and leadership within the community birthing units.
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 Mental Health
There were 3 mental health inspections during 2019-2020 –Cefni Hospital, Wrexham CMHT, Bryn Y Neuadd Hospital
Good practice or positive findings: • Positive feedback from service users regarding staff engagement and person centred care planning and provision • Clinical auditing, reporting and escalation processes good within CMHT Care • Established governance arrangements that provide safe and clinically effective care.
Themes or most significant areas where improvements were required: • Provision of information available for patients • Safe and effective medicines management • Assessing of ligature risks.
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 GPS There were 6 GP inspections during 2019-2020 – Stables Medical Centre, Bron Derw Medical Centre, Meddygfa Gyffin, Hillcrest Medical Centre, Panton Surgery, Ty Doctor Good practice or positive findings: • Patients treated with dignity and respect and engaged throughout care • Good evidence of robust record keeping • Staff within all inspections happy within their roles.
Themes or most significant areas where improvements were required: • Infection prevention and control measures require strengthening • Staff personnel records review required to ensure compliance is clearly documented such as DBC, immunisations and training compliance.
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 Dentists There were 8 Dental inspections during 2019-2020.
Good practice or positive findings: • Good mechanisms for obtaining and responding to patient feedback • Suitable range of health promotion and oral hygiene material • Appropriate adult and child safeguarding training.
Themes or most significant areas where improvements were required: • Use of clinical audits to be expanded, particularly smoking cessation and antimicrobial prescribing • Infection prevention and control measures require strengthening • Sharps bins to be wall mounted.
HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020 HEALTHCARE INSPECTORATE WALES Annual Report 2019-2020
Thank you. Any questions?
Emma Algieri Scott Senior Healthcare Inspector / Relationship Manager
28 August 2020 5.3.1 20.113.1 Cofnodion Cymeradwy y Fforwm Arwain Cydweithredol 15.1.20 / Collaborative Leadership Forum Approved Minutes 15.1.20 1 20.113.1 Approved Minutes of CLF 150120 v1.docx
Paper Ref: LF-2007-01 NHS Wales Health Collaborative Leadership Forum Minutes 15/01/20
NHS Wales Collaborative Leadership Forum Minutes of Meeting held on 15 January 2020 Author: Mark Dickinson Version: 1 (Approved)
Members Ann Lloyd (Chair), Chair, Aneurin Bevan UHB (AL) present Maria Battle, Chair, Hywel Dda UHB (MB) (part of meeting) Tracey Cooper, Chief Executive, Public Health Wales (TC) (part of meeting) Sharon Hopkins, Interim Chief Executive, Cwm Taf Morgannwg UHB (SHo) Charles Janczewski, Interim Chair, Cardiff and Vale UHB (CJ) (CJa) Chris Jones, Chair, Health Education and Improvement Wales (CJo) Gary Doherty, Chief Executive, Betsi Cadwaladr UHB (GD) Vivienne Harpwood, Chair, Powys tHB (VH) Sian Harrop-Griffiths, Director of Planning, Swansea Bay UHB (for Tracy Myhill) Donna Mead, Chair, Velindre NHS Trust (DM) (part of meeting) Judith Paget, Chief Executive, Aneurin Bevan UHB (JP) Martin Woodford, Chair, Welsh Ambulance Service NHS Trust (MW) In Mark Dickinson, NHS Wales Health Collaborative (MD) attendance Rosemary Fletcher, Director, NHS Wales Health Collaborative (RF)
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Apologies Steve Ham, Chief Executive, Velindre NHS Trust Alex Howells, Chief Executive, Health Education & Improvement Wales Jason Killens, Chief Executive, Welsh Ambulance Service NHS Trust Marcus Longley, Chair, Cwm Taf Morgannwg UHB Tracy Myhill, Chief Executive, Swansea Bay UHB Steve Moore, Chief Executive, Hywel Dda UHB Mark Polin, Chair, Betsi Cadwaladr UHB Len Richards, Chief Executive, Cardiff & Vale UHB Carol Shillabeer, Chief Executive, Powys tHB Jan Williams, Chair, Public Health Wales Emma Woollett, Interim Chair, Swansea Bay UHB
Welcome and introduction Action AL welcomed colleagues to the meeting and noted apologies for absence.
Approval of minutes of previous meeting (LF-2001-01) Action The minutes of the meeting held on 17 September 2019 were approved as a correct record.
The minutes will be forwarded to the board secretaries of the 11 NHS Wales organisations for noting at board meetings. MD
Action log (LF-2001-02) Action The action log was reviewed. RF reported that all actions agreed to have been completed at the previous meeting had been removed from the action log and that: action LF/A/114 (circulation of minutes) had been completed actions LF/A/116 to LF/A/119 (major trauma) would be addressed later in the meeting under the relevant agenda item action LF/A/120 (peer review) remained open pending reviewing the Act in its final form action LF/A/122 (risk register) will be addressed through the development of the Collaborative Work Plan for 2020/21
Matters arising from minutes (LF-2001-01) Action River House
The previous minutes record that “the letter [from WG] confirms that River House is to be the main hub of the Executive and that the ground floor is being acquired”.
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RF reported that this is now on hold, pending further decision making in WG. This has been communicated to the landlord. It was noted that this constraint on accommodation represents a significant risk and challenge to the Collaborative. Staff numbers have approximately doubled over the last 18 months in response to demands, particularly from WG, to undertake additional work and functions. Contingency plans are being revised, including through liaison with other NHS bodies, and RF has emailed Andrew Goodall to raise concerns
It was agreed that there is a need to look after the wellbeing of staff and that chief executives should discuss this matter further at the next meeting of the Collaborative Executive Group and follow this up with Andrew Goodall. JP/CEs
Funding for Implementation Groups
AL reported that she and Jan Williams had arranged to meet with the Chief Medical Officer (CMO) and will be requesting a clear statement of intent in relation to the £1M per annum allocations for major conditions implementation groups. This follows a letter from the Deputy CMO that was not sufficiently clear about the future arrangements. AL/JW
There was a brief discussion about the potential for the Collaborative to have an increased role in the management and allocation of all the £1m allocations. AL noted that, as Chair, her preference was to keep the overall management of the allocations at arm’s length.
Major Trauma Programme Update (LF-2001-03) Action AL introduced this item, thanking Dr Dindi Gill, Network Clinical Lead, for his recent briefing for Boards, Sian Lewis for the support from WHSSC and members of the Collaborative team for the huge amount of work on the development of the business case.
RF presented the update report, which summarised the current situation following board discussions in November. RF highlighted the following points: Draft minutes of the discussion are awaited from some Boards The importance of workforce planning and the need for new staff, which has resulted in a strengthening of this work stream
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The importance of ensuring appropriate and responsive rehabilitation The need for assurance around operational readiness Ongoing concerns about value for money continue to be expressed The budget allocation (section 3 of the report) does not include specific figures but the wording confirms that funding will be provided for specified aspects As part of the move to the implementation phase, a final meeting of the existing network board will be held in late January, prior to the transition to the new network implementation board. The new board will be leaner, made up of executive leads, who will, in turn, lead local implementation groups All organisations have been asked for information about readiness for ‘go live’, including appropriate mitigations where required. This feedback will be collated with the results of readiness assessment visits to health boards and WAST, and reported to the implementation board. The implementation board will make recommendations to inform a formal decision by WHSSC Joint Committee on when to ‘go live’ Independent support to Cardiff and Vale, in preparation for ‘go live’ is being provided by Chris Moran, National Clinical Director for Trauma, for NHS England A desk top exercise on repatriation will be held at the end of February, with operational input from health boards and WAST. This will also inform the ‘go live’ readiness assessment Work is ongoing on the development of the Memorandum of Understanding for the Operational Delivery Network (ODN) A further briefing will be provided for Boards in March Swansea Bay UHB need to identify the SRO for the ODN
[TC and MB joined the meeting during the above summary]
CJa extended an invitation to other organisations to attend the Cardiff and Vale readiness assessment meeting for the Major Trauma Centre.
CJo commented on the importance of transport and suggested that the desktop exercise needs to simulate repatriation, transport timescales and communications challenges in times of escalation. It was agreed that this RF
Date: 15/01/20 Version: 1 (Approved) Page: 4 of 8 Paper Ref: LF-2007-01 NHS Wales Health Collaborative Leadership Forum Minutes 15/01/20 should be considered in the design of the exercise. SH-G highlighted the need for medical director involvement in the desk top exercise.
CJ asked if there is clarity about ‘go/no go’ parameters for a ‘go live; decision. RF responded that this is informed by the standards and which needs to be supported by clinical engagement via medical directors informed by readiness assessment visits.
AL asked how WG is scrutinising the request for central funding. RF replied that WG had reviewed the programme business case and had come back for some clarifications, which had been provided. There are also regular monthly trauma policy meetings, chaired by the Deputy CMO, and involving WG policy and capital leads, and other key interests.
RF reported that the next Gateway review is expected in March 2021 after the network is fully operational, as both Gateway 3 and 4 requirements had been assessed as having been met at the time of the last review in October 2019.
Single Cancer Pathway (SCP) Update (LF-2001-04) Action TC introduced the report and highlighted the following points: An SCP Strategic Leadership Group had been established, with LR, SM and AH involved and with links to diagnostic programmes and other key stakeholders. Work is continuing on a ‘case for investment’ in improving cancer outcomes in Wales. The £3m allocated in support of the implementation of the SCP is only a starting point and is not considered sufficient to transform cancer outcomes in Wales The emerging evaluation, by Swansea University, of the pilot Rapid Diagnostic Centres (RDCs) had attracted significant media interest and consideration of scaling up this service would be considered by the Cancer Implementation Group Issues with the high threshold for referral from primary care in Wales for cancer diagnostics The need for further consideration of the contribution that AI could make to cancer diagnostics and the role the Life Sciences Hub could play in this
[DM joined the meeting during the above summary]
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SH noted the unbalanced communications regarding the Swansea Bay RDC in comparison with the equivalent in Cwm Taf Morgannwg and suggested there is a need for better join up. SH-G responded that the media interest had been instigated by the local lead clinician, a GP. DM queried whether the RDCs had generated the significant increase in referrals to Velindre. TC responded that this was the result of a range of factors that were driving up referrals across the country.
The fact that Wales has only one PET scanner at the moment was noted by CJo. TC commented that the number of PET and CT scanners per head of population in Wales is amongst the lowest in Europe.
SH noted the recent seminar on AI held at the Imaging Academy.
RF noted that the development of a robust ‘case for investment’ is challenging, including as a result of issues with data availability and robustness. The work on demand and capacity in endoscopy was noted.
Informatics Projects Update (LF-2001-05) Action RF introduced the update report on three projects.
LINC (Pathology) RF reported that the LINC Outline Business Case had been considered by individual Boards about a year ago. Progress had been delayed by discussions over the appropriate length of contract that should be entered into. WG had proposed ‘3+2’ years and a revised position of ‘7+2’ years has been agreed as a basis on which to test the market. The programme board has agreed to proceed to procurement on this basis.
It was noted that health boards have agreed to support the achievement of 90% electronic test requesting by 2022
RISP (Radiology) RF reported that this was a new project, which incorporates a new PACS system as a part of a wider ‘end to end’ informatics solution for radiology. Work was behind schedule, with a Strategic Outline Case currently under development, informed by experience in the LINC project.
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CJo queried whether there was the potential to combine the radiology and pathology systems. RF agreed to seek advice on this. RF
CC-CIS (Critical Care) MD provided an update on post-procurement attempts to agree a funding package, using revenue and capital, that is affordable and compatible with accounting regulations and the terms of the procurement.
CJo comment on the need to ensure staff education in the use of a new critical care system. MD responded that the implementation will be managed as a change management programme, facilitated by an informatics solution, rather than as an informatics implementation project.
New work commissioned from the Collaborative Team Action (LF-2001-06) RF introduced a discussion of new work that the Collaborative is being asked to undertake. RF noted that some requests are clearly in keeping with the overall role and remit of the Collaborative and can often be incorporated within existing programmes of work. Other requests are clearly in addition to existing responsibilities and need additional resources. New functions and roles have led to a significant expansion in staffing and additional corporate support and management is also needed. Constant ad hoc and incremental expansion is not helpful and it would be better if the development of the Collaborative could be planned and implemented in a more strategic way.
In relation to the specific requests being reported on, RF noted that work on Inflammatory Bowel Disease and childhood surgery did not require major resource, but that some additional clinical capacity was required.
The Collaborative role suggested in relation to Allied Health Professionals would represent a more significant change. WG want to put a team into the Collaborative, with a senior programme lead and a budget of approximately £0.5m per annum. It was agreed that there was a need for further discussion with WG as to whether this was the best approach. RF
AL noted the need to assess whether new areas of work are in line with collective NHS Wales priorities. CJo observed that
Date: 15/01/20 Version: 1 (Approved) Page: 7 of 8 Paper Ref: LF-2007-01 NHS Wales Health Collaborative Leadership Forum Minutes 15/01/20 many emerging technological developments will require staff under the broad category of AHPs and there is a need to join up the key themes, including how innovative new roles will be regulated.
It was noted that the direct commissioning of Collaborative work by WG is incompatible with the current governance arrangements for the Collaborative, with accountability to the Collaborative Executive Group and Collaborative Leadership Forum. It was agreed that the Collaborative Executive Group should discuss this matter further. JP/RF It was noted that there had been no significant recent developments relating to the planned establishment of the NHS Wales Executive function.
Recording language preference of members Action Members of the Forum were reminded of the need to inform the Collaborative of their language preference, Welsh or English, for Forum related papers and correspondence. All
Date of next meeting It was noted that the Forum is scheduled to meet next on Tuesday 14 April 2020 from 9am to 12 noon.
Date: 15/01/20 Version: 1 (Approved) Page: 8 of 8 5.3.2 20.113.2 Pwyllgor Gwasanaethau Ambiwlans Brys - Cofnodion wedi'u cadarnhau 14.7.20,12.5.20 Crynodeb o'r Prif Faterion 8.9.20, 14.7.20 / Emergency Ambulance Services Committee Confirmed Minutes 14.7.20, 12.5.20 Summary of Key Matters 8.9.20, 14.7.20 1 20.113.2a EASC confirmed minutes 14.7.20.doc
EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE MEETING
CONFIRMED MINUTES OF THE MEETING HELD ON 14 JULY 2020 AT 0930 AM VIRTUALLY BY MICROSOFT TEAMS PRESENT Members: Chris Turner Independent Chair Stephen Harrhy Chief Ambulance Services Commissioner Judith Paget Chief Executive, Aneurin Bevan ABUHB Simon Dean Interim Chief Executive, Betsi Cadwaladr UHB Len Richards Chief Executive, Cardiff and Vale UHB Nick Lyons Medical Director, Cwm Taf Morgannwg CTMUHB Steve Moore Chief Executive, Hywel Dda UHB Carol Shillabeer Chief Executive, Powys THB In Attendance: Jason Killens Chief Executive, Welsh Ambulance Services NHS Trust (WAST) Stuart Davies Director of Finance, Welsh Health Specialised Services Committee (WHSSC) and EASC Joint Committees Ross Whitehead Assistant Director of Quality and Patient Experience James Rodaway Head of Commissioning & Performance Management Craige Wilson Deputy Chief Operating Officer, Swansea Bay UHB Rachel Marsh Director of Planning, Strategy and Performance, Welsh Ambulance Services NHS Trust David Lockey National Director EMRTS Cymru (for Agenda item 2.3) Matthew Edwards Programme Manager EMRTS Cymru (for Agenda item 2.3) Gwenan Roberts Assistant Director Corporate, National Collaborative Commissioning Unit (NCCU) (Committee Secretary)
Part 1. PRELIMINARY MATTERS ACTION
EASC WELCOME AND INTRODUCTIONS 20/49 Chris Turner (Chair), welcomed Members to the virtual meeting (using the Microsoft Teams platform) of the Emergency Ambulance Services Committee.
EASC APOLOGIES FOR ABSENCE 20/50 Apologies for absence were received from Tracy Myhill, Sian Harrop-Griffiths and Sharon Hopkins. Craige Wilson, Deputy Chief Operating Officer for Swansea Bay UHB was welcomed to the meeting.
Confirmed Minutes of the EAS Joint Meeting Page 1 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 EASC DECLARATIONS OF INTERESTS Chair 20/51 There were no additional interests to those already declared.
EASC MINUTES OF THE MEETING HELD ON 12 MAY 2019 Chair 20/52 The minutes were confirmed as an accurate record of the Joint Committee meeting held on 12 May 2019.
EASC ACTION LOG 20/53 Members RECEIVED the action log and NOTED specific progress as follows:
EASC 19/08 & EASC 19/21 & EASC 19/23 Emergency Medical Retrieval Service (EMRTS) Refresh of the commissioning framework CASC Members noted that the work to develop the framework was almost complete and would be provided at the next meeting (Added to the Forward Look). EASC 19/12 Risk Register Members noted the delay in developing the register in line Head of with the host body arrangements. It was agreed that this Commissioning would be received and considered by the EASC Management Group and then by the Joint Committee at its next meeting (On the Forward Look).
EASC 20/29 Safe Cohorting of Patients EASC Management Group to report back to the Committee CASC (added to the Forward Look).
EASC 20/26 Coronavirus - Actions Information would be presented for discussion at the EASC CASC Management Group and shared with Members in due course.
EASC 20/44 Integrated Medium Term Plan It was agreed that a revised plan would be received at the Head of next meeting. Commissioning
EASC 20/45 Learning Lessons during a pandemic It was agreed that the next WAST provider report would share CEO WAST early findings.
Members RESOLVED to: NOTE the Action Log.
Confirmed Minutes of the EAS Joint Meeting Page 2 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 EASC MATTERS ARISING 20/54 EASC 19/55 & 19/92 & 20/29 Carol Shillabeer reported that work was continuing in relation to Mental Health and progressing well; the latest work included data collection to understand the demand on the service and the challenges faced. A further update would be provided at the next meeting.
EASC CHAIRS REPORT 20/55 The Chair’s report was received. In presenting the report, Chris Turner highlighted the various discussions that had taken place since the previous meeting, including one to one with Martin Woodford, Chair of the Welsh Ambulance Services NHS Trust. Members also noted that Chris Turner had been invited to serve a further year as interim Chair of the Committee and he had accepted.
Members RESOLVED to: NOTE the Chair’s report.
Part 2. ITEMS FOR DISCUSSION ACTION
EASC CHIEF AMBULANCE SERVICES COMMISSIONER’S 20/56 REPORT
The Chief Ambulance Services Commissioner’s (CASC) report was received. In presenting the report, Stephen Harrhy highlighted the following key items: The link within the report to the Year End Accounts and the Annual Governance Statement. Members noted the key actions identified going forward which reflected the discussions at each meeting and were felt to be proportionate and supported the agreed focus going forward. Ministerial Ambulance Availability Task Force – Members noted that the work had been temporarily stood down, although plans were in place to recommence the work; the Minister had been made aware of the plans. However, the work would need to be modified for the members of the Taskforce and would involve greater emphasis on critiquing work and proposals emerging from the work of sub groups. The aim was to try and provide an interim report to the Committee in the autumn in line with the commissioning cycle and the first cut of the Integrated Medium Term Plan at the November meeting. Members noted the importance of the work to implement the Demand and Capacity report recommendations in terms of additionality and direction.
Confirmed Minutes of the EAS Joint Meeting Page 3 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 Members noted that the Welsh Ambulance Services NHS Trust response times were generally good, although performance in the most rural areas was not at the level expected.
Members noted the desire to learn from the impact of the pandemic on the service and what changes had been made to inform future service provision. Other changes, including transfer and discharge services, as well as the other ongoing changes in NHS Wales would have significant impact on how ambulance services are provided.
Members noted that the Emergency Medical Services (EMS) Framework Agreement needed to be reviewed. Members noted that the framework was fit for purpose at the time it was developed but would now need to be modified to get a better balance between the service provision, patient safety / harm and staff experience. Members noted that the EASC Management Group would lead on the development of the EMS Framework Agreement and it would be presented at a future Committee meeting (Added to the Forward Look).
Members discussed the issues related to the performance in rural areas which until recently had been good and consistent. Members noted that this had changed over the last 8 weeks and the performance was well under 50%. It was agreed that further information be provided by WAST to understand why this had occurred (Added to the Action Log).
Members noted that it was felt that good progress was being made on plans to open the Grange University Hospital. Judith Paget thanked the EASC Team for the support given to assist the Health Board and WAST to get near a solution for the new transport arrangements. Members noted that proposal would be received shortly by the Aneurin Bevan Board to secure the resourcing needed. It was noted that emergency surgery and trauma would be centralised and there may be additional issues with patients needing to be transferred from Nevill Hall sooner than anticipated. Some concerns had been raised by staff at ABUHB and Judith Paget agreed to share the Datix reports from the UHB in order that the WAST team could understand the issues involved (Added to the Action Log).
Members RESOLVED to: NOTE the Chief Ambulance Services Commissioner’s report.
Confirmed Minutes of the EAS Joint Meeting Page 4 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 EASC WELSH AMBULANCE SERVICES NHS TRUST (WAST) 20/57 PROVIDER REPORT
The update report from the Welsh Ambulance Services NHS Trust (WAST) was received and in presenting the report Jason Killens highlighted key areas which included:
Response to the Pandemic The internal debriefing process in relation to the first wave was now coming to a close, a report was being developed for the Trust Board and would be shared with the Committee CEO WAST (added to the Action Log).
Members noted that 500 staff had given their reflections on pandemic so far which included sharing good practice and areas of learning. Jason Killens explained that an action plan would be developed during July and August to share back with staff i.e. ‘You said-we did’. Members noted that WAST was referring to itself as being in a ‘monitoring’ phase of the pandemic; the organisation had not yet “recovered” and was referring to itself as “in recovery” and this work would help to shape its plans going forward.
Summary of long waits for ambulances Members noted that very few patients experienced long waiting times between April and June this year due to the reduced activity and additional capacity in the service.
In terms of RED performance, Members noted that across the first quarter the performance had been over 70% but not in rural areas. Jason Killens explained that the Community First Responders had not been utilised initially during the response to the pandemic, although they were now gradually coming back into service with the appropriate personal protective equipment. It was anticipated that this would have a positive impact and improve performance in rural areas.
Members also noted that most of the rapid response vehicles had not been utilised during the initial response to the pandemic which had an impact on red performance. In line with the findings in the Demand and Capacity Report, Members felt the challenge remained to deploy the right number of staff in the right place.
Plans for the Grange University Hospital Members noted that teams from across WAST, Aneurin Bevan UHB and the EAS Team were working together to get a settled position, it was anticipated that 84 additional staff would need to be employed.
Confirmed Minutes of the EAS Joint Meeting Page 5 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 Quarter 2 Operational Framework plan submissions to the Welsh Government Jason Killens provided an overview of the Q2 plan and highlighted that 3-4 areas had been identified for Q3 and 4.
Emergency Departments Jason Killens gave an overview of the work which was aiming to divert patients away from emergency departments using Consultant Connect.
Len Richards highlighted the ongoing work at Cardiff and Vale UHB, in conjunction with Aneurin Bevan UHB, using the data to determine how patients accessed services during the pandemic and how potentially this could be used to plan or have early warning for surges in activity. Members noted the work and suggested that EASC could consider the implications of this work for potential roll out across NHS Wales. Members noted that additional funding had been requested from the Welsh Government to support having a live feed of data to develop the early warning system.
Members noted that Aneurin Bevan UHB were waiting for agreement from the Welsh Government officials in terms of whether the Grange University Hospital would open in November. Judith Paget supported the work of the team at WAST in terms of Consultant Connect and phone first. The pod at the Royal Gwent hospital had experienced staffing issues and the Health Board and WAST were working to resolve.
Nick Lyons supported the work and explained that Cwm Taf Morgannwg UHB was also keen to take forward Consultant Connect. Members felt that the pandemic had highlighted the different policies in place across Wales and felt that it would be beneficial to work collectively to avoid the unnecessary pressure within NHS Wales by using the same systems. Members noted the different uses and requirements of personal protective equipment across Wales and agreed that it would be helpful if the WAST team highlighted the differences in approach across Wales (Added to the Action CEO WAST Log).
A broader discussion took place on the wider unscheduled work and Stephen Harrhy highlighted that work had been identified within the ‘Amber Review’ and discussions could be held with the NHS Wales Informatics Service (NWIS) regarding what could be achieved in real time.
Confirmed Minutes of the EAS Joint Meeting Page 6 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 Members noted that the Welsh Government officials had shown some interest in developing an unscheduled care dashboard system and Stephen Harrhy agreed to find out CASC more and report back to the Committee (Added to the Action Log).
Stephen Harrhy suggested that further information be presented for discussion at the EASC Management Group to align with the Demand and Capacity Report. Members wished to note the impact of Consultant Connect on conveyancing and the connection to the Clinical Contact Centres within WAST. Other issues to be considered would include the booked appointment processes for emergency departments and the reduced capacity issue related to social distancing.
In summarising this section of the meeting, the Chair welcomed the discussion on the interesting initiatives for unscheduled care and the opportunity for the system as a whole to be more coordinated.
Healthcare Inspectorate Wales Members noted that WAST had received a draft Healthcare Inspectorate Wales report which was positive overall although was not complimentary with regard to handover delays at emergency departments. The report would be available to CASC Members when published (added to the Action Log).
Health and Safety Executive (HSE) Jason Killens explained that WAST had received a notification from the HSE regarding a material breach of Health and Safety laws in relation to staff using personal protective equipment for excessive periods of time. WAST were providing evidence of the systems employed to the HSE and a further report would be provided at the next meeting (added CEO WAST to the Action Log).
Members RESOLVED to: NOTE the provider report and the actions agreed.
EASC FOCUS ON – EMERGENCY MEDICAL RETRIEVAL AND 20/58 TRANSFER SERVICE
In presenting the report, Professor David Lockey highlighted: Phase 1 of the 24/7 went live from the Cardiff Heliport on 1 July 2020 Summary of EMRTS and activity improving service provision and service transfer Activity levels Support to the wider NHS Community
Confirmed Minutes of the EAS Joint Meeting Page 7 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 Much of the EMRTS work took place by road not air during the pandemic, particularly the twilight rapid response vehicle, although it was anticipated that the service would soon be flying more again The impact of the Covid 19 pandemic which included flying restrictions by the air operator (and reduction in the numbers of pilots available); curtains are in place on all aircraft; importantly the EMRT service was maintained throughout Network work; noted to be time consuming in relation to tele conferencing and maintaining links Severe escalation plan in place; worked with the Critical Care Network and planned to mobilise key staff to any hospital overwhelmed with Covid 19 cases and would transfer patients to less affected areas for critical care treatment Monthly activity by base: rapid response vehicle usage was clear and in constant demand within the south east Wales region Twilight rapid response vehicle (RRV) originally resourced through winter funding; averaging 3.2 calls per shift; nature of calls include: cardiac arrest, road incidents, falls and unconscious patients RRV – useful project met unmet need this service enabled the move to 24/7 expansion 24/7 service expansion; noted the national shortage of pilots; the charity was working with the provider and aiming for an All Wales response; phase 2 for North Wales would be more difficult with a workload of 160 each year at night National Critical Care Transfer Service; working together with the Critical Care Network; separate to the core work and ring fenced; aiming for set up in 9-12 months time; recruitment of key staff, project manager and clinical lead – interviews next week.
Members asked whether Professor Lockey felt there was any danger that the work to extend the EMRT service to 24/7 would accelerate the major trauma network work and if this could overwhelm trauma centres. Prof Lockey explained that patients were already taken to the unit for definitive care and doubted whether a lot of change would impact on centres. Members noted the outstanding requirements for the service to be provided 24/7 in terms of the capital for the EMRT service and for critical care services.
Confirmed Minutes of the EAS Joint Meeting Page 8 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 Members noted that the processes for distributing capital were on hold with Welsh Government at present. As the capital allocation would be made through the Committee a revenue to capital transfer might be considered by Members to ensure progress is maintained. This would be further discussed at a future meeting (Added to the Action Log).
The Chair thanked Professor David Lockey and Matthew Edwards from the EMRT Service for excellent work during the pandemic as well as the informative presentation and report.
Members RESOLVED to: NOTE the presentation and report.
Part 3. ITEMS FOR APPROVAL OR ENDORSEMENT ACTION
EASC FINANCE REPORT 20/59 Stuart Davies presented the finance report.
Members noted that over the next few months further work would take place with WAST to ensure that the new investment including the additional staff would be isolated in Director of terms of the costs and a reconciliation exercise would provide Finance clarity on the activity and the costs incurred.
Members RESOLVED to: APPROVE the report and note the future work on costs
EASC EASC GOVERNANCE UPDATE 20/60 The EASC Governance update report was received. In presenting the report Gwenan Roberts highlighted the following: The EASC Annual Report 2019-2020 was received for the first time. This outlined the work of the Committee, its Members and attendance. Members noted that two of the associate members had not attended a committee meeting for the last two years and the Chair agreed to write a letter to the organisations to remind them. Members agreed to complete the effectiveness survey separately and return to the Committee Secretary and receive an overview of the findings at the next meeting (Added to the Action Log). Gwenan Roberts The EASC Annual Governance Statement had been previously circulated to Members and it was noted that it had been received and noted at the Audit and Risk Committee in line with the host body arrangements (Cwm Taf Morgannwg UHB).
Confirmed Minutes of the EAS Joint Meeting Page 9 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 Risk Register – Members noted the current situation in relation to the development of the risk register through the EASC Management Group and agreed to receive a new Gwenan register in line with the host body arrangements at the Roberts next meeting.
The EASC Management Group Annual Report 2019-20 and Terms of Reference was received.
The Non-Emergency Patient Transport Service Delivery Assurance Group Annual Report 2019-20 and Terms of Reference (and Internal Audit Report) was received The Emergency Medical Retrieval and Transfer Service Hosted Bodies Annual Report 2019-2020 was received.
In terms of the Sub Groups of EASC, Members noted that all would complete the effectiveness survey and a composite Gwenan report, including the EASC Members information would be Roberts provided at the next meeting.
Members noted that Welsh Government officials had written to the NHS Wales Chairs’ Group enquiring about the public’s access to board meetings. Further work was underway with Gwenan the Board Secretary group and Gwenan Roberts agreed to Roberts report back from an EASC perspective at the next meeting.
Members RESOLVED to: NOTE the report APPROVE the EASC Committee Annual Report for 2019- 2020 RATIFY the EASC Annual Governance Statement 2019- 2020 APPROVE the EASC Management Group Annual Report for 2019-2020 and the Terms of Reference APPROVE the NEPTS DAG Annual Report for 2019-2020 and the Terms of Reference and NOTE the Internal Audit Report. RATIFY the EMRTS Hosted Bodies Annual Report for 2019- 2020.
EASC CONFIRMED MINUTES OF SUB GROUPS 20/61 Members received the confirmed minutes of the EASC Sub Groups as follows:
EASC Management Group - 21 February 2020
Confirmed Minutes of the EAS Joint Meeting Page 10 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 Non-Emergency Patient Transport Service Delivery Assurance Group (NEPTS DAG) for the following dates:
07 Feb 2020 24 Apr 2020 12 May 2020 26 May 2020 09 Jun 2020 23 Jun 2020
Members RESOLVED to: APPROVE the confirmed minutes as above.
EASC FORWARD PLAN OF BUSINESS 20/62 The forward plan of business was received. Members discussed the arrangements for the Committee and agreed that the Chair and the Chief Ambulance Services Commissioner finalise outside of the meeting.
Following discussion, Members RESOLVED to: Chair and APPROVE that the Chair and the Chief Ambulance CASC Services Commissioner further review the Forward Plan.
Part 4. OTHER MATTERS ACTION
EASC ANY OTHER BUSINESS 20/63 There was one item – temporary amendments to the model Standing Orders.
EASC TEMPORARY AMENDMENTS TO MODEL STANDING 20/64 ORDERS, RESERVATION AND DELEGATION OF POWERS – LOCAL HEALTH BOARDS, NHS TRUSTS, WELSH HEALTH SPECIALISED SERVICES COMMITTEE, EMERGENCY AMBULANCE SERVICES COMMITTEE AND HEALTH EDUCATION AND IMPROVEMENT WALES
Gwenan Roberts presented the report which outlined the requirements of the Welsh Health Circular published on 9 July.
Members noted the temporary changes to the Standing Orders in relation to the tenure of the Chair and Vice Chair which would cease to have effect on 31 March 2021.
Members RESOLVED to: APPROVE the changes for ratification at all Health Board meetings before the end of July 2020.
Confirmed Minutes of the EAS Joint Meeting Page 11 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 DATE AND TIME OF NEXT MEETING
EASC A meeting of the Joint Committee would be held at 13:30 hrs, Committee 20/48 on Tuesday 8 September 2020 at the Welsh Health Secretary Specialised Services Committee (WHSSC), Unit G1, The Willowford, Main Ave, Treforest Industrial Estate, Pontypridd CF37 5YL.
Signed …………………………………………………… Christopher Turner (Chair)
Date ……………………………………………………
Confirmed Minutes of the EAS Joint Meeting Page 12 of 12 Emergency Ambulance Services Committee 14 July 2020 Meeting 8 September 2020 1 20.113.2b EASC confirmed minutes 12 May 2020.doc
EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE MEETING
‘CONFIRMED’ MINUTES OF THE MEETING HELD ON 12 MAY 2020 AT 130PM VIRTUALLY BY SKYPE
PRESENT Members: Chris Turner Independent Chair Stephen Harrhy Chief Ambulance Services Commissioner Judith Paget Chief Executive, Aneurin Bevan ABUHB Nick Lyons Medical Director, Cwm Taf Morgannwg CTMUHB Tracy Myhill Chief Executive, Swansea Bay SBUHB Steve Moore Chief Executive, Hywel Dda UHB Simon Dean Interim Chief Executive, Betsi Cadwaladr UHB Carol Shillabeer Chief Executive, Powys THB In Attendance: Jason Killens Chief Executive, Welsh Ambulance Services NHS Trust (WAST) Stuart Davies Director of Finance, Welsh Health Specialised Services Committee (WHSSC) and EASC Joint Committees James Rodaway Head of Commissioning & Performance Management Ross Whitehead Assistant Director of Quality and Patient Experience Rachel Marsh Director of Planning, Strategy and Performance, Welsh Ambulance Services NHS Trust Gwenan Roberts Assistant Director Corporate, National Collaborative Commissioning Unit (NCCU) (Committee Secretary)
Part 1. PRELIMINARY MATTERS ACTION EASC WELCOME AND INTRODUCTIONS 20/38 Chris Turner (Chair), welcomed Members to the first virtual meeting (using the Skype platform) of the Emergency Ambulance Services Committee.
Prior to the presentation of the provider report, the Chair formally thanked Jason Killens and all of the staff at WAST for their excellent response to the Covid 19 Pandemic.
The Chair also thanked the Chief Executives of health boards and their staff for their exceptional work and commitment in responding so well to the unprecedented situation.
‘Confirmed’ Minutes of the EAS Joint Meeting Page 1 of 9 Emergency Ambulance Services Committee 12 May 2020 Meeting 14 July 2020 Members expressed their sincere sympathies and condolences to the families, friends and colleagues at WAST and those in the wider health service who had died during the time of this pandemic.
EASC APOLOGIES FOR ABSENCE 20/39 Apologies for absence were received from Len Richards and Sharon Hopkins. Nick Lyons, Medical Director at Cwm Taf Morgannwg UHB was welcomed to his first meeting as the nominated deputy.
EASC DECLARATIONS OF INTERESTS Chair 20/40 There were no additional interests to those already declared.
Members noted that a new process was in development for Committee declarations in line with advice from Audit Wales and updated Secretary forms would be circulated shortly.
EASC MINUTES OF THE MEETING HELD ON 10 MARCH 2019 Chair 20/41 The minutes were confirmed as an accurate record of the Joint Committee meeting held on 10 March 2019.
EASC ACTION LOG 20/42 Members RECEIVED the action log and agreed that a log be Committee developed of pending actions delayed by the impact of the Secretary pandemic on normal business. Members NOTED specific progress as follows: Emergency Medical Retrieval Service (EMRTS) Gateway Review The Chair requested that this be added to the ‘pending’ log. CASC
EASC 19/08 & EASC 19/21 & EASC 19/23 Emergency Medical Retrieval Service (EMRTS) Refresh of the commissioning framework Members noted that the work to develop the framework was Head of almost complete and would be provided at the next meeting Commissioning (Added to the Forward Look). EASC 19/12 Risk Register It was agreed that this would be received by the EASC Committee Management Group and then by the Joint Committee in due Secretary course (On the Forward Look).
‘Confirmed’ Minutes of the EAS Joint Meeting Page 2 of 9 Emergency Ambulance Services Committee 12 May 2020 Meeting 14 July 2020 EASC 19/55 & 19/92 Mental Health It was agreed that this be added to the ‘pending log’. Deputy CASC EASC 19/78 Reference document on the WAST Relief Gap Emergency Ambulance Service It was agreed that this be added to the ‘pending log’ and would also form part of the work for the Ministerial Ambulance CEO WAST Availability Taskforce.
EASC 19/79 WAST Service Transformation It was agreed that this be added to the ‘pending log’. CEO WAST
EASC 19/97 Serious Adverse Incidents (SAIs) Members noted that SAIs had been included in the WAST Provider Report and a recent Quality and Delivery meeting with the CASC had discussed the approach in detail. Information would be included in every WAST Provider report going forward (Added to Action Log). CEO WAST
EASC 19/100 Emergency Department Quality and Delivery Framework It was agreed that this be added to the ‘pending log’. CASC
EASC 19/103 & EASC 20/16 Governance A report would be received at the next meeting which would Committee include the Annual Governance Statement, highlight reports Secretary from Sub Groups and the risk register.
EASC 20/12 Ministerial Ambulance Availability Taskforce Members noted that the work had been delayed and the Minister was aware. This would be added to the ‘pending log’. CASC
Emergency Medical Retrieval and Transfer Service A meeting had been planned to take place before the end of Chair and March with the Air Ambulance Charity. This would be CASC rearranged and this was added to the ‘pending log’.
EASC 20/15 Finance Report A Finance Report would be received at the next meeting and Director of would include the ‘A Healthier Wales’ allocation. Finance
‘Confirmed’ Minutes of the EAS Joint Meeting Page 3 of 9 Emergency Ambulance Services Committee 12 May 2020 Meeting 14 July 2020 Members RESOLVED to: CASC / NOTE the Action Log. Committee AGREED that a ‘matters pending log’ be developed as a Secretary result of the impact of the current pandemic.
EASC MATTERS ARISING 20/43 There were none.
EASC CHIEF AMBULANCE SERVICES COMMISSIONER’S 20/44 REPORT
The Chief Ambulance Services Commissioner’s (CASC) report was received. In presenting the report, Stephen Harrhy highlighted the following: Year End Accounts – Members noted that the draft year end accounts had been received and there were no problems or risks anticipated with finalising and submitting Director of to the Audit and Risk Committee at Cwm Taf Morgannwg Finance UHB in June 2020. Ministerial Ambulance Availability Task Force – Members noted that the plans for the Taskforce were currently on hold and the Minister had been informed. Consideration would be given when the work would formally recommence. Members noted that much of the work undertaken over the last few months in responding to the pandemic would be helpful in terms of the demand and capacity plan and would be particularly helpful to learn from the operational changes made at pace. Annual Governance Statement – Members noted that this was in the drafting stage and would be submitted to the Audit and Risk Committee at Cwm Taf Morgannwg in Committee June 2020. The draft once completed would be shared with Secretary Members for an opportunity to comment. Emergency Medical Retrieval and Transfer Service (EMRTS) – Members noted the work to develop the commissioning framework and the work to develop 24/7 working. The EMRTS Delivery Assurance Group would discuss and develop detailed operational plans for approval CASC at a future Committee meeting. EASC Integrated Medium Term Plan (IMTP) – Members noted that a letter of support had been received from the Welsh Government for the EASC IMTP although the planning processes were now on hold. A revised delivery plan would be developed and Members noted the CASC importance of responding to the updated operating framework process. A revised plan would be developed and presented to the Committee for consideration and approval in due course.
‘Confirmed’ Minutes of the EAS Joint Meeting Page 4 of 9 Emergency Ambulance Services Committee 12 May 2020 Meeting 14 July 2020 Co-Chair Task and Finish Group – Members were reminded that the CASC had been asked to work with the fire and rescue service; this work had been put on hold. CASC Further information would be shared when available. Ambulance Quality Indicators (AQIs) – Members noted that performance targets were on hold, although data continued to be collected; Stats Wales had paused the CASC publication of the AQIs. Meetings with WAST – Members noted that the CASC had a weekly meetings with the Chief Executive of WAST. A Quality and Delivery meeting was held last week and the CASC reported that progress was being made. EASC Management Group - Members noted that the Group would recommence shortly and would work on developing the ‘new normal’ in line with the requirements CASC of the operating framework. Covid response – Members noted that the CASC and the EASC teams had continued to work closely with WAST and commended the positive way in which the WAST Executive Team and all of the staff had responded to the pandemic. Members noted that in terms of the additional expenditure related to the pandemic response, this was being monitored and this would not be the responsibility of health boards to fund. Members noted that the importance of the revised financial plan and clarification of the additional expenditure incurred by WAST.
Members RESOLVED to: NOTE the Chief Ambulance Services Commissioner’s report.
EASC WELSH AMBULANCE SERVICES NHS TRUST (WAST) 20/45 PROVIDER REPORT
The update report from the Welsh Ambulance Services NHS Trust (WAST) was received and in presenting the report Jason Killens highlighted key areas which included:
Pandemic and response Members noted that the team at WAST had aimed to double their capacity across key operational areas. Areas highlighted included: - 111: Members noted that early on in the pandemic a 350% increase had been seen in the number of calls received for several weeks; additional call handlers and clinical staff had been recruited to assist and the online symptom checker was operational; as the activity reduced the team had been realigned.
‘Confirmed’ Minutes of the EAS Joint Meeting Page 5 of 9 Emergency Ambulance Services Committee 12 May 2020 Meeting 14 July 2020 - More call handling capacity had been developed in Swansea and Cwmbran (2) with the potential to open in North Wales if required. This approach allowed safe working practices, conforming to social distancing rules, to operate in call centres. - The surge in activity over the most recent weekend which saw the highest peak in activity over the last 3 months. - 999: capacity had been doubled. - Emergency Medical Services: the limiting factor was the availability of vehicles. - Workforce issues: weekly overtime had doubled, support had been received from the military and underlying sickness absence had reduced. - Performance: good outturn performance at over 65% across Wales in April and also expected in May. - Non-emergency patient transport services had been maintained for renal and oncology patients; shadow plans had been developed to increase capacity when required, although not this had not yet been deployed.
Activity and performance Amber performance had improved from the beginning of the financial year, activity reduced, production and lost hours had all contributed which was the best position for a number of years.
Demand and Capacity Review - Implementation progress Overview of the work to date was provided which included: Members noted that WAST had also retained this review as priority work during the Covid 19 pandemic response. Aim to recruit a net additional 136 WTE staff and the majority would be emergency medical technicians (EMT). Undertaken virtual recruitment events and virtual online training courses. Had already secured 40.28 WTE of the staff required and were also aiming to over-recruit the numbers of paramedics due to some slippage in the programme. Members noted that the Demand and Capacity Review was undertaken across NHS Wales and did not include the anticipated changes as a result of the Grange University Hospital opening. As a result Members noted that it was anticipated that a potential further 84 WTE staff would be required. Urgent discussions were underway to match the potential to open the new hospital in the Autumn as opposed to March 2021. Members noted that other developments and plans were on hold (apart from the work with the Grange Hospital).
‘Confirmed’ Minutes of the EAS Joint Meeting Page 6 of 9 Emergency Ambulance Services Committee 12 May 2020 Meeting 14 July 2020 Non-Emergency Patient Transport Service (NEPTS) Members noted that work was continuing to improve the national booking process. The Demand and Capacity Review of NEPTS had now been reconvened and was being managed through the NEPTS Delivery Assurance Group.
WAST Integrated Medium Term Plan (IMTP) Members noted that the WAST Board had approved the IMTP and a letter in support had been sent by the CASC although the planning processes had been put on hold by the Welsh Government. Members noted that WAST would respond to the new operating framework and intended to submit on 18 May. Members noted the intention to give the CASC sight of the final draft for comment by the end of the week.
Regional Escalation Members noted that this process had been disrupted due to the response required for the Covid 19 pandemic. The WAST team suggested that it would need to continue to refine plans for the previously agreed revised regional escalation process in the future to weave in learning and management of activity due to the impact of the pandemic.
In receiving and noting the WAST provider report Members highlighted: The excellent progress made with the recruitment of staff and asked whether health boards also searching for additional staff had impacted on WAST; Jason Killens suggested that he would welcome a further opportunity to discuss recruitment, for example of paramedics, across NHS Wales and the potential impact of this, although no issues had been experienced to date. Performance issues - in terms of the improving trend but also of the variation in performance across Wales. The Amber performance was positive. Further discussions would need to take place in relation to how the extra resources (136WTE staff) would be deployed and it was agreed that the EASC Management Group would lead on the work and report to a future Committee meeting (Added to Forward Look). The additional capacity in the transfer and discharge service and plans for the medium and long term which was encouraging. The impact on WAST staff during the pandemic and the challenges faced; Jason Killens explained that efforts were being made to capture the learning and not lose the agile way in which staff were responding.
‘Confirmed’ Minutes of the EAS Joint Meeting Page 7 of 9 Emergency Ambulance Services Committee 12 May 2020 Meeting 14 July 2020 It was felt that IT had been an enabler and the team were aiming to capture the learning from this. The WAST team were planning a Covid 19 Wave 1 debrief session to capture any learning and recovery actions. Work included an online digital version for front line staff to bring together in time for the WAST Board meeting in June. This information would be shared with Members (Added to Action Log). Generally, staff appeared to be coping well. Matters relating to personal protective equipment (PPE) and the impact in relation to the time taken to respond to incidents. The issue remained on aerosol generating procedures and cardiac arrest in relation to the type of PPE used. Additional information was sought regarding performance and the possibility that due to the reduction in demand coupled with increased production that this would impact more on red performance. Members noted that in responding to the pandemic the number of rapid response vehicles had been reduced and community first responders had not been utilised as previously, primarily to ensure the safety of the staff. However, this was changing and the performance was now on an improving trajectory. The evaluation of winter was raised and the work to do in planning for the next winter period alongside the Covid 19 impact. It was suggested and agreed that it would be helpful to undertake more planning than normal to ensure the NHS would be able to respond effectively. Members noted that WAST would increase the ambulance fleet by 100 new vehicles but would retain the older vehicles for an additional 12 months to ensure a contingency for the fleet. Additional staff were also trained and available such as the Fire and Rescue service staff. The impact of the winter in the Southern Hemisphere would also be monitored and WAST were keen to work closely with Health Boards in taking this work forward.
Members RESOLVED to: NOTE the provider report and the actions agreed.
EASC FORWARD PLAN OF BUSINESS 20/46 The forward plan of business was received. Members discussed the arrangements for the Committee and agreed that a pending log be developed and closely monitored to Gwenan ensure that necessary actions can be captured and completed Roberts in a timely way.
‘Confirmed’ Minutes of the EAS Joint Meeting Page 8 of 9 Emergency Ambulance Services Committee 12 May 2020 Meeting 14 July 2020 Following discussion, Members RESOLVED to: Chair and APPROVE that the Chair and the Chief Ambulance CASC Services Commissioner further review the Forward Plan for future meeting in line with the discussions held. EASC ANY OTHER BUSINESS 20/47 There was none
DATE AND TIME OF NEXT MEETING
EASC A meeting of the Joint Committee would be held at 09:30 hrs, Committee 20/48 on Tuesday 14 July 2020 at the Welsh Health Specialised Secretary Services Committee (WHSSC), Unit G1, The Willowford, Main Ave, Treforest Industrial Estate, Pontypridd CF37 5YL.
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Signed …………………………………………………… Christopher Turner (Chair)
Date ……………………………………………………
‘Confirmed’ Minutes of the EAS Joint Meeting Page 9 of 9 Emergency Ambulance Services Committee 12 May 2020 Meeting 14 July 2020 1 20.113.2c EASC Chair's Summary 8.9.20.docx
Reporting Committee Emergency Ambulance Services Committee Chaired by Chris Turner Lead Executive Directors Health Board Chief Executives Author and contact details. [email protected] Date of last meeting 8 September 2020 Summary of key matters including achievements and progress considered by the Committee and any related decisions made. An electronic link to the papers considered by the EAS Joint Committee is provided via the following link: http://www.wales.nhs.uk/easc/september2020
Chris Turner (Chair), welcomed Members to the virtual meeting (using the Microsoft Teams platform) of the Emergency Ambulance Services Committee.
CHIEF AMBULANCE SERVICES COMMISSIONER’S REPORT
Stephen Harrhy presented an update on the following areas: Ministerial Ambulance Availability Taskforce Members noted that arrangements were continuing to start the work related to the Taskforce. The proposed framework was being developed including the key output products identified. Stephen Harrhy agreed to share the draft work and asked for comments to shape the work as it develops. The aim was to use existing mechanisms where possible and an interim report was planned to be developed by the end of November.
Refreshing the Emergency Medical Services (EMS) Framework Members were aware of the plans to refresh the EMS Framework and it was suggested that this take place by April 2021. Detailed discussions would take place at the EASC Management Group and a report would be developed for the next EAS Committee meeting. The aim of the refresh would be to ensure that the Framework was streamlined and more reflective of the current position for EMS services.
Quality and Delivery (Q&D) Meeting with the Welsh Government (WG) Members noted a recent Q&D meeting had taken place and the areas discussed where the biggest concern, and the majority of the meeting’s focus, was on the current performance.
EASC allocation letters for Major Trauma Services and Critical Care Transfer Services Members noted that the allocation letters had been received by the CASC and were pleased to note that they were in line with the expectations of the financial plan within the Integrated Medium Term Plan (IMTP).
EASC Committee Chair’s report Page 1 of 6 8 September 2020 Progress on the Emergency Medical Services Demand and Capacity Implementation Plan Members were aware of the agreement at EASC to fund up to 90wte additional staff within the plan. The WAST team had previously discussed that a further 46wte staff could be recruited and trained within the financial year.
Members noted that a discussion had taken place at the EASC Management Group regarding the recruitment of the additional front line staff which had been supported, although the source of the funding was unclear. Stephen Harrhy suggested that this additional cost of £1.4m could be included as part of the process to bid for resources under the winter protection fund to ensure maximising front line staff. This suggestion was supported by Members.
The Chair thanked Stephen Harrhy for his report and Members discussed the following matters: Concerns were raised regarding the capacity of the system to meet all of the ongoing plans during the potential resurgence of the pandemic. In terms of the revision of the EMS Framework, Members felt that clinical outcomes would be important but there may be a wider requirement to filter the work of the Committee to business critical areas only. Members noted that the review of the IMTP would provide an opportunity to redefine the key areas of work and this would be discussed at the EASC Management Group and would be reported to the next EAS Committee meeting. Members noted the opportunity to align with the work already underway on seasonal planning and the potential opportunity to be more coordinated with the option of needing to work outside of the formal Committee arrangements if required. Members noted that good collective progress had been made on the arrangements to open the Grange University Hospital and a helpful recent meeting had taken place which had resolved some key outstanding issues.
The Chair summarised the discussion and Members RESOLVED to: NOTE the Chief Ambulance Services Commissioner’s report NOTE the need to identify a set of specific priorities NOTE the aim to link to seasonal priorities APPROVE the intention to seek £1.4m from the winter protection funding for the additional staff within the EMS Demand and Capacity Implementation plan.
PROVIDER ISSUES
The update report from the Welsh Ambulance Services NHS Trust (WAST) was received and in presenting the report Jason Killens highlighted key areas which included: Serious Adverse Incidents (SAIs) – a marked reduction in numbers over the recent months although now monitored weekly by the WAST Directors, reported to a WAST sub-committee and onto the WAST Board. The Chair asked if it would be possible to compare the levels of SAIs with other comparable areas as it was difficult to set in context the data presented. Jason Killens agree to try and benchmark with other areas and present the information in the next report. Health and Safety Executive (HSE) – two improvement notices had been received (sharps injury (disputed) and extended time spent in personal protective equipment).
EASC Committee Chair’s report Page 2 of 6 8 September 2020 A full response had been provided to the HSE and the policy position on personal protective equipment (PPE) had been updated. The importance of the turnaround of ambulances at emergency departments was discussed and that WAST staff wearing PPE were reliant on health board staff to comply with the guidance (added to the Action Log). Members noted that it was likely that the HSE would escalate this issue if further situations arose Performance position - RED position – for August was below 65%, however the number of calls responded to in 8 minutes was more than the previous August - 999 handling and 999 calls – good performance - Incidents – volumes increased from August 2019 - Production comparison August – more this year compared to previous years - EMS Abstractions – increase due to annual leave as staff were encouraged to take leave before winter - Overtime reductions – no incentivised overtime - Covid 19 abstractions now at 3% - More activity August 2020 compared with 2018 and 2019 - Emergency Ambulance Utilisation (3% tolerance) - Staffing – focus is on additionality and recruitment
Forecast - Production stronger in September – on or over 100% for emergency ambulances, more work required on rapid response vehicles - Amber performance and patients experiencing long waiting times - Anticipating further Covid19 surge - Modelling forecast for September - 66%.
Members were concerned about the deterioration in performance; it was noted that Powys had not met the target over the last 5 or 6 months although ongoing discussions were taking place. The performance was worse during 2020 and it was suggested that this could be attributed to the switch away from the deployment of rapid response vehicles (RRVs); it was hoped that the recommencement of RRVs would improve the performance in Powys and other health board areas.
Members asked regarding the impact of ‘consultant connect’ in terms of managing conveyance and whether any learning could be shared across the system. Members noted that the numbers to date were small and that there was a large variation in the uptake.
The CASC responded to the content of the presentation and highlighted: - Helpful to note that more front line staff available in August than previous year despite reduction in overtime and an increase in annual leave allocated; therefore, additional investment in demand and capacity plan is starting to become effective - Support the rebalancing of emergency vehicles and RRV as this will have a positive impact on red performance; however, WAST need to keep in mind any potential negative impact on amber performance
EASC Committee Chair’s report Page 3 of 6 8 September 2020 - Keen to work with health board colleagues re handover delays and what do their plans look like – it was agreed that the CASC to contact everyone for their plans (added to the Action Log) - Confirmed that a detailed analysis of the ambulance performance in August was being undertaken to supplement WAST improvement plan including variation in mobilisation times in South East Wales compared with other regions - Opportunities for learning across Wales including Cardiff and Vale UHBs CAV 24/7.
The Chair asked regarding the information on current and forecasted future performance and suggested that it would be helpful to have a coordinated plan from WAST to tackle the issues identified. It was felt this overview list would also be helpful for the work of the Ministerial Ambulance Availability Taskforce to coordinate the actions to be taken.
Members agreed that the EASC Management Group receive and discuss the overview list (Added to the Action Log). Members also noted the importance of the impact of cultural issues in terms of the ownership and professional responsibilities in working together and this would be key during the winter months.
Other matters highlighted from the WAST provider report included: the recruitment of the additional staff for the front line which was at 119.28wte to date which subject to additional resources could be increased although the additional work by the finance teams would provide clarity. Where health board service changes had been planned, Jason Killens thanked colleagues for including the WAST Team as early as possible to support service changes across NHS Wales.
Members RESOLVED to: NOTE the provider report and the actions agreed.
FOCUS ON – NON EMERGENCY PATIENT TRANSPORT SERVICE (NEPTS)
The report and presentation on the Non-Emergency Patient Transport Service (NEPTS) was received. In presenting the report, James Rodaway and Mark Harris explained that the report had been received at the NEPTS Delivery Assurance Group and also at the EASC Management Group.
Members noted: NEPTS Headline statistics The Collaborative approach undertaken at the NEPTS Delivery Assurance Group – this work included the team at WAST but also health board teams with a focus on continuous improvement Commissioning and Quality Assurance undertaken – the Framework was in place and robust processes were in operation. Step 1 and 2 were considered key in ensuring the transport solution is as good as possible NEPTS Service Development Enhanced Service Provision – renal, oncology and end of life service; renal patients account for 30% of all NEPTS journeys which was steadily increasing and more work ongoing to develop oncology services. It was noted that the End of Life Care Service
EASC Committee Chair’s report Page 4 of 6 8 September 2020 had won a Health Service Journal Award and the team were warmly congratulated on this achievement Performance/ Service Delivery Improvements Governance and Planning – this included a more joined up approach and particularly the tiered staff structure in health boards to support the local commissioning NEPTS Demand and Capacity Review now underway The Impact and Learning from Covid19 The NEPTS Delivery Assurance Group at the end of September would be discussing winter planning and discharge capacity matters and the impact of Covid19 on NEPTS activity.
Mark Harris provided detailed operational information regarding the different ways of working within the NEPT service during the pandemic which included support providers, people driving themselves to appointments, student paramedics and also the voluntary sector. The team were working to manage through the agreed script and were finding alternative ways of transporting patients.
The importance of the whole system approach to developing winter plans was discussed and particularly for this service. The longer term issues would also need to be considered including the resetting of plans for outpatients and other work.
The CASC emphasised the importance of the joined up approach and informed Members of the ongoing work with the procurement team to look at all spend on private providers as there may be an opportunity to realise savings and the further development of the NEPT service in line with the ‘Once for Wales’ ethos. Members were very supportive of the All Wales approach and the improvements being made within the NEPT service to date.
Members discussed the outstanding transfers to complete the ‘Once for Wales’ approach as agreed and asked about the timescales. Members noted that prior to the pandemic and lockdown all of the work required pre transfer had been completed for the ABUHB area. The aim was now to revisit the data and WAST had appointed a lead manager to oversee the work – ABUHB would be the next area to transfer. The Powys area had also provided data and would follow ABUHB before the end of the financial year.
The CASC explained that the detail would be developed and reported via the NEPTS DAG to the next Committee meeting. In terms of the timescales, it was expected that CTMUHB would transfer in the first half of 2021 and BCUHB by the end of the financial year 2021-22 (added to the Action Log).
The Chair, in summary, confirmed that effectively phase 1 had been achieved and further work was now required to transfer the other services as soon as possible. The WAST team were also congratulated by the Chair on their achievement of the Health Service Journal Award for their End of Life service.
Members RESOLVED to: NOTE the presentation and report.
EASC Committee Chair’s report Page 5 of 6 8 September 2020 Other reports received included: Outline Commissioning Intentions which included timescales Finance Report – no specific concerns to report Unscheduled Care Presentation EASC Integrated Medium Term Plan (IMTP) Revised Delivery Plan – to be developed Emergency Medical Retrieval And Transfer Service (EMRTS Cymru) Framework Agreement Final Draft EASC Risk Register
Key risks and issues/matters of concern and any mitigating actions Red performance Increasing handover delays Decreasing Amber performance Agreed timescales for roll out of transfer of work from health boards to WAST – ABUHB, followed by Powys this financial year; CTMUHB by the end of June in the new financial year and BCUHB by the end of the financial year
Matters requiring Board level consideration and/or approval None Forward Work Programme Considered and agreed by the Committee. Committee minutes submitted Yes √ No Date of next meeting 10 November 2020
EASC Committee Chair’s report Page 6 of 6 8 September 2020 1 20.113.2d EASC Chair's Summary from 14 July 2020.docx
Reporting Committee Emergency Ambulance Services Committee Chaired by Chris Turner Lead Executive Directors Health Board Chief Executives Author and contact details. [email protected] Date of last meeting 14 July 2020 Summary of key matters including achievements and progress considered by the Committee and any related decisions made. An electronic link to the papers considered by the EAS Joint Committee is provided via the following link: http://www.wales.nhs.uk/easc/july-2020
Chris Turner (Chair), welcomed Members to the virtual meeting (using the Microsoft Teams platform) of the Emergency Ambulance Services Committee.
CHAIRS REPORT
Members noted the meetings which the Chair had participated in since the last meeting of the Committee. The Chair also report that he had been invited and had accepted a further year’s appointment as Interim Chair of EASC until end October 2021.
CHIEF AMBULANCE SERVICES COMMISSIONER’S REPORT
Stephen Harrhy presented an update on the following areas: Year End Accounts and Annual Governance Statement – Members noted that the year-end accounts and Annual Governance Statement had been received and approved by the Audit and Risk Committee at Cwm Taf Morgannwg UHB in June 2020. Ministerial Ambulance Availability Task Force – Members noted that the plans for the Taskforce had been temporarily paused although plans were in place for recommencing the work. The work would need to be modified from the original direction and would involve critiquing work and proposals from sub groups with an aim to provide an interim report in the autumn to coincide with the commissioning cycle. Ambulance Service response times – generally these had been good during the first quarter although the performance in most rural areas was not at the level expected. Further work would take place by the WAST team to understand why this had occurred. Learning lessons from the pandemic – Members noted the desire to learn from the impact of the pandemic on the service and the aim to capture the positive changes for future service provision. Emergency Medical Services Framework Agreement – it was noted that this Agreement was due for review with the aim to modify to get a better balance between the service provision, patient safety/harm and staff experience. A new agreement would be presented at a future committee meeting.
Final Draft Annual Report EASC Page 1 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Grange University Hospital – Good progress was being made with the EAS Team, WAST and the team from Aneurin Bevan University Health Board working together to find a solution for the new transport arrangements required.
PROVIDER ISSUES
The update report from the Welsh Ambulance Services NHS Trust (WAST) was received and in presenting the report Jason Killens highlighted key areas which included:
Pandemic and response Members noted: An internal debriefing process in relation to the first wave was coming to a close and 500 staff had given their reflections on the work to date. Activity and performance Very few patients had experienced long waiting times for ambulances between April and June due to the reduced activity and additional capacity in the service The RED performance had been over 70% in the first quarter although not at the level expected in rural areas; members noted the impact of not using community first responders and the rapid response vehicles Emergency Departments Members discussed the ongoing work at WAST, Cardiff and Vale and Aneurin Bevan University Health Board in terms of managing access to emergency departments using the Consultant Connect app and analysing data to assist with early identification for surges in demand Health and Safety Executive A notification of a material breach of health and safety legislation had been received in relation to the use of personal protective equipment and evidence would be provided to the HSE
Members RESOLVED to: NOTE the provider report and the actions agreed.
FOCUS ON – THE EMERGENCY MEDICAL RETRIEVAL AND TRANSFER SERVICE (EMRTS)
Professor David Lockey provided a presentation based on his report on the EMRT service.
The following areas were highlighted: Phase 1 of the 24/7 went live from the Cardiff Heliport on 1 July 2020 Summary of EMRTS and activity improving service provision and service transfer Lots of the EMRTS work took place by road not air during the pandemic, particularly the twilight rapid response vehicle although it was anticipated that the service would soon be flying more again Activity levels The impact of the Covid 19 pandemic which included flying restrictions by the air operator (and reduction in the numbers of pilots available); curtains are in place on all aircraft; the EMRT service was maintained throughout Network work; noted to be time consuming in relation to teleconferencing and maintaining links
Final Draft Annual Report EASC Page 2 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Severe escalation plan in place; worked with the Critical Care Network and planned to mobilise key staff to any hospital overwhelmed with Covid 19 cases and would transfer patients to less affected areas for critical care treatment Support to wider NHS Community Monthly activity by base: rapid response vehicle usage was clear and in constant demand within the south East Wales region Twilight rapid response vehicle (RRV) originally resourced through winter funding; averaging 3.2 calls per shift; nature of calls include: cardiac arrest, road incidents, falls and unconscious patients RRV – useful project met unmet need this service enabled the move to 24/7 expansion 24/7 service expansion; noted the national shortage of pilots; the charity was working with the provider and aiming for an All Wales response; phase 2 for North Wales will be more difficult and will have a workload of 160 patients at night each year National Critical Care Transfer Service; working together with the Critical Care Network; separate to the core work and ring fenced; aiming for set up in 9-12 months time; recruitment of key staff, project manager and clinical lead – interviews next week.
In receiving and noting the report Members also asked Prof Lockey whether there might be an impact on the work of the major trauma network and whether it could overwhelm trauma centres. Prof Lockey explained that the vast majority of patients already attended the unit which would provide definitive care and therefore this would not change matters.
The requirement for capital funding for the EMRT Service and for the Critical Care Network was also discussed and further work would take place to ensure that the service.
FINANCE REPORT
The finance report was received. Members noted that over the next few months further work would take place with WAST to ensure that the new investment including the additional staff would be isolated in terms of the costs and a reconciliation exercise would provide clarity on the activity and the costs incurred.
EASC GOVERNANCE UPDATE
The EASC Governance Report was received.
Members RESOLVED to: NOTE the report APPROVE the EASC Committee Annual Report for 2019-2020 RATIFY the EASC Annual Governance Statement 2019-2020 APPROVE the EASC Management Group Annual Report for 2019-2020 and the Terms of Reference APPROVE the NEPTS DAG Annual Report for 2019-2020 and the Terms of Reference and NOTE the Internal Audit Report. RATIFY the EMRTS Hosted Bodies Annual Report for 2019-2020.
Final Draft Annual Report EASC Page 3 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 CONFIRMED MINUTES OF SUB GROUPS
Members received the confirmed minutes of the EASC Sub Groups as follows:
EASC Management Group - 21 February 2020.
Non-Emergency Patient Transport Service Delivery Assurance Group (NEPTS DAG) for the following dates: 07 Feb 2020 24 Apr 2020 12 May 2020 26 May 2020 09 Jun 2020 23 Jun 2020.
Members RESOLVED to: APPROVE the confirmed minutes as above.
FORWARD PLAN OF BUSINESS
Following discussion, Members RESOLVED to APPROVE that the Chair and the Chief Ambulance Services Commissioner further review the Forward Plan.
TEMPORARY AMENDMENTS TO MODEL STANDING ORDERS, RESERVATION AND DELEGATION OF POWERS – LOCAL HEALTH BOARDS, NHS TRUSTS, WELSH HEALTH SPECIALISED SERVICES COMMITTEE, EMERGENCY AMBULANCE SERVICES COMMITTEE AND HEALTH EDUCATION AND IMPROVEMENT WALES
Gwenan Roberts presented the report which outlined the requirements of the Welsh Health Circular published on 9 July. Members noted the temporary changes to the Standing Orders in relation to the tenure of the Chair and Vice Chair which would cease to have effect on 31 March 2021.
Members RESOLVED to: APPROVE the changes for ratification at all Health Board meetings before the end of July 2020.
Key risks and issues/matters of concern and any mitigating actions Performance in rural areas Capital funding for EMRTS and Critical Care Network. Matters requiring Board level consideration and/or approval EASC Governance Update Temporary Amendments to the Model Standing Orders. Forward Work Programme Considered and agreed by the Committee. Committee minutes submitted Yes √ No Date of next meeting 8 September 2020
Final Draft Annual Report EASC Page 4 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Final Draft Annual Report EASC Page 5 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 The Emergency Ambulance Services Committee
Annual Report 2019-2020
Final Draft Annual Report EASC Page 6 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 EMERGENCY AMBULANCE SERVICES COMMITTEE
ANNUAL REPORT 2019-2020 1. FOREWORD
As Chair of the EASC, I am pleased to commend this annual report, which has been prepared for the attention of the EAS Committee and reviews the work of this Committee for the financial year 2019 - 2020.
2. INTRODUCTION AND SCOPE OF RESPONSIBILITY
In accordance with the Emergency Ambulance Services Committee (Wales) Directions 2014 (2014 No.08), the Local Health Boards (LHBs) established a Joint Committee, which commenced on 1 April 2014, for the purpose of jointly exercising its Delegated Functions and providing the Relevant Services.
In establishing the Emergency Ambulance Services Joint Committee (EASC) to work on their behalf, the seven Local Health Boards (LHBs) recognised that the most efficient and effective way of planning these services was to work together to reduce duplication and ensure consistency.
The Emergency Ambulance Services Committee (EASC) (Wales) Regulations 2014 (SI 2014 No.566 (W.67)1 make provision for the constitution of the “Joint Committee” including its procedures and administrative arrangements. The Joint Committee is a statutory committee established under sections 11, 12(3), 13(2) (c) and (4) (c) and 203(9) and (10) of and paragraph 4 of Schedule 2 to the National Health Service (Wales) Act 2006(1). The LHBs are required to jointly exercise the Relevant Services.
In December 2015, the Welsh Ministers directed the Health Boards under the EASC (Wales) (Amendment) Directions 2016 No.8 (W.8)2 to be responsible for commissioning Non-Emergency Patient Transport (NEPT) services via the Emergency Ambulance Services Committee from April 2016. The Cwm Taf Morgannwg University Health Board (CTUHB) is the identified host organisation. It provides administrative functions for the running of EASC in line with the Directions and has established the Emergency Ambulance Services Committee Team (EASCT) and appointed the Chief Ambulance Services Commissioner as per Direction 8(4), 3 of the Emergency Ambulance Services Committee and related Regulations.
1 The Emergency Ambulance Services Committee (EASC) (Wales) Regulations 2014 (SI 2014 No.566 (W.67)1http://www.wales.nhs.uk/sitesplus/documents/1134/Welsh%20Statutory%20Instrument%20f or%20EASC%202014%20No%20566%20%28w67%29.pdf 2 the EASC (Wales) (Amendment) Directions 2016 No.8 (W.8) http://www.wales.nhs.uk/sitesplus/documents/1134/2016%20No%208%20%28W8%29%20The%20 EASC%20%28Wales%29%20%28Amendment%29%20Directions%202016.pdf
Final Draft Annual Report EASC Page 7 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 The Emergency Medical Retrieval and Transfer Service went live on the 27 April 2015. The service was commissioned “to provide advanced decision making & critical care for life or limb threatening emergencies that require transfer for time critical specialist treatment at an appropriate facility.” The service represents a joint partnership between NHS Wales, The Wales Air Ambulance Charity Trust (WAACT) and Welsh Government. The service was initially commissioned by the Welsh Health Specialised Services Committee; however, this function transferred to the Emergency Ambulance Services Committee on the 1 April 2016.
3. PURPOSE
The Joint Committee has been established for the purpose of jointly exercising those functions relating to the commissioning of emergency ambulance services (EMS), non-emergency patient transport services (NEPTS) and the emergency medical retrieval and transfer services (EMRTS) on a national all-Wales basis, on behalf of each of the seven LHBs in Wales.
LHBs are responsible for those people who are resident in their areas. Whilst the Joint Committee acts on behalf of the seven LHBs in undertaking its functions, the duty on individual LHBs remains, and they are ultimately accountable to citizens and other stakeholders for the provision of emergency ambulance services (EMS), non- emergency patient transport services (NEPTS) and the emergency medical retrieval and transfer services (EMRTS) for residents within their area.
The Joint Committee’s role is to: Determine a long-term strategic plan for the development of emergency ambulance services and non-emergency patient transport services in Wales, in conjunction with the Welsh Ministers Identify and evaluate existing, new and emerging ways of working and commission the best quality emergency ambulance services (EMS), non-emergency patient transport services (NEPTS) and the emergency medical retrieval and transfer services (EMRTS). Produce an Integrated Medium Term Plan, including the balanced Medium Term Financial Plan for agreement by the Committee following the publication of the individual LHBs Integrated Medium Term Plans Agree the appropriate level of funding for the provision of emergency ambulance services, non-emergency patient transport services and emergency medical retrieval and transfer services at a national level, and determining the contribution from each LHB for those services (which will include the running costs of the Joint Committee and the EAS
Final Draft Annual Report EASC Page 8 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Team) in accordance with any specific directions set by the Welsh Ministers Establish mechanisms for managing the commissioning risks
Establish mechanisms to monitor, evaluate and publish the outcomes of emergency ambulance services, non-emergency patient transport services and emergency medical retrieval and transfer services and take appropriate action.
In March 2014, the Joint Committee approved the revised Governance and Accountability Framework including the Standing Orders. These were reviewed and updated in November 2018 which included the Memorandum of Understanding and the Hosting agreement.
In November 2019, the Committee received and endorsed the use of the first Model Standing Orders for EASC provided by the Welsh Government. In accordance with related Regulations and Directions, each Local Health Board (‘LHB’) in Wales must then agree the Model Standing Orders (SOs) for the regulation of the Emergency Ambulance Services Committee (“Joint Committee”) proceedings and business.
These Joint Committee Standing Orders (Joint Committee SOs) form a schedule to each LHB’s own Standing Orders, and have effect as if incorporated within them.
Together with the adoption of a scheme of decisions reserved to the Joint Committee; a scheme of delegations to officers and others; and Standing Financial Instructions (SFIs), they provide the regulatory framework for the business conduct of the Joint Committee. The Standing Financial Instructions are in the process of development and should be available during 2020-2021.
These documents, together with a Memorandum of Agreement setting out the governance arrangements for the seven LHBs and a hosting agreement between the Joint Committee and Cwm Taf Morgannwg University Health Board UHB (“the Host LHB”), form the basis upon which the Joint Committee’s governance and accountability framework is developed. Together with the adoption of a Values and Standards of Behaviour framework this is designed to ensure the achievement of the standards of good governance set for the NHS in Wales.
A hosting agreement also exists between the Joint Committee and the host LHB (Cwm Taf Morgannwg) in relation to the provision of administrative and any other services to be provided to the Joint Committee.
Final Draft Annual Report EASC Page 9 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 4. MEMBERSHIP
The membership of the EASC in line with the Standing Orders comprises Chief Executives (or nominated deputies) from all health boards enabling the group to provide appropriate opportunities to make arrangements to fulfil the functions highlighted above. The Chief Executives of NHS Trusts in Wales are associate members of the Committee.
Chris Turner has been the Chair of the Committee for 2019-2020 and Members noted at the meeting held on 12 November 2019 that he had been appointed for a further year. Steve Moore, Chief Executive of Hywel Dda University Health Board has been the Vice Chair since February 2019, a two year appointment initially with an option to extend for a further two years (in line with the Standing Orders).
The Membership is attached as Appendix 1.
5. ATTENDANCE AT MEETINGS
The attendance of members and their nominated deputies has been good at Committee meetings with all meetings being quorate. However, for the second year, two associate members of the Committee have not attended a single meeting. The Members attendance is attached at Appendix 2.
6. MAIN AREAS AND REPORTING LINES FOR EASC
An agreed standard agenda format is used at meetings and the reporting mechanism to health boards includes forwarding the confirmed minutes to all health boards as well as a Chair’s summary of the latest meeting. CTM, as the host organisation, is the board where the formal endorsement of the confirmed minutes takes place. The Chair and Chief Ambulance Services Commissioner also attend all health board meetings on an annual basis to share the work of the Committee directly with board members.
The agenda and reports to all meetings can be found on the EASC Website: http://www.wales.nhs.uk/easc/meetings.
The standard agenda included:
Welcome and introduction Apologies for absence Declaration of interests Receive the unconfirmed minutes of the previous Committee meeting Action log Matters arising Chair’s Report
Final Draft Annual Report EASC Page 10 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Chief Ambulance Services Commissioner Report Finance Report Provider issues by exception Forward Plan of business
A summary of specific items received by the Committee are as follows:
14 May 2019 The Chief Ambulance Services Commissioner’s (CASC) Report included a letter relating to the performance at the Welsh Ambulance Services NHS Trust (WAST) Ambulance Quality Indicators EASC Governance Update including the Annual Governance Statement, Internal Audit report on EASC Governance
23 July 2019 CASC Report included - Update on Emergency Medical Retrieval and Transfer Service (EMRTS) Gateway Review - Update on Management Group Meeting - RED Performance - Mental Health Demand and Capacity Review of Emergency Medical Services at the Welsh Ambulance Services NHS Trust (WAST) Update on the Amber Review Update on Quarter 1 IMTP and return to the Welsh Government Regional Escalation ‘A Healthier Wales’ 1% Allocation for approval EASC Governance Update to endorse the Chair’s action The Clinical Risk Review Final Report for approval
10 September 2019 CASC Report included: - Amber Review Implementation Programme - Update on EASC Management Group - Risk Register development - EMRTS Gateway Review WAST Relief Gap for Emergency Ambulance Services – Reference Document WAST Report included Demand and Capacity Review Alternative pathways / Emergency Services map Ambulance Quality Indicators Regional Escalation ‘A Healthier Wales’ 1% allocation
Final Draft Annual Report EASC Page 11 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Establishment of the South, Mid and West Wales Trauma Network – Welsh Ambulance Services NHS Trust Business Case
12 November 2019 CASC Report included - AMBER Review - Emergency Medical Retrieval and Transfer Service (EMRTS) update - Update on Mental Health Staff Clinical Desk Non-Emergency Patient Transport Progress Report Handover Delays and Escalation - Emergency Departments Quality Delivery Framework (EDQDF) Regional Escalation Ambulance Quality Indicators EASC Governance update to include approving the model Standing Orders and the risk register EASC Integrated Medium Term Plan (IMTP) Update and Commissioning Intentions
28 January 2019 CASC Report included National Transfer Service for Critically Ill Adults - Ministerial Ambulance Availability Task Force - AQIs - Escalation - Performance dashboard - EMRTS: Gateway Review and progress on review of commissioning framework - Mental Health update EASC IMTP for approval Final Demand and Capacity Review for approval Letter of support for the WAST IMTP WAST Response to commissioning intentions Non-emergency patient transport service progress report EASC governance update to include the risk register and the plan for the sub groups to report to the Committee
10 March 2019 CASC Report included: - National Transfer Services including Critical Care - Ministerial Ambulance Availability Taskforce - Regional Escalation - EMRTS Expansion - Urgent Mental Health Access and Conveyance Review - Co-Chairing a task and finish group to explore opportunities to work closely with the Fire and Rescue Services Confirmed action notes from the EASC Sub Groups Strategic Commissioning Intentions EASC Governance Update Performance Report
Final Draft Annual Report EASC Page 12 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Focus on – Ambulance Quality Indicators
7. ACTION LOG
In order to monitor progress and any necessary follow up action, the Committee has developed an Action Log that captures all agreed actions. This is an essential element of assurance to the EAS Committee and the Health Boards across NHS Wales.
8. SUB GROUPS
The Emergency Ambulance Services Committee has three sub groups: 1. EASC Management Group (first meeting in July 2019) 2. Emergency Medical Retrieval and Transfer Service Delivery Assurance Group 3. Non-Emergency Patient Transport Service Delivery Assurance Group
EASC Management Emergency Medical Non-Emergency Group Retrieval and Patient Transport Transfer Service Service Delivery Assurance Delivery Assurance Group Group The overall purpose of EMRTS DAG NEPTS DAG the Management Established to support Established to support Group is to provide the production, the production, advice and make ongoing development ongoing development recommendations to and maintenance of and maintenance of EASC and to ensure the interim the interim that the seven LHBs in Framework. Framework. Wales will work jointly to exercise functions Responsible for the Responsible for the relating to the planning delivery, direction and implementation of the and securing of performance of the NEPTS work emergency ambulance EMRTS. programmes that services. deliver WHC 2007 (005) and the 2015 Ensure equitable business case ‘The access to safe, Future of NEPTS in effective, sustainable Wales’. and acceptable services for the people of Wales in line with agreed commissioning intentions and the EASC IMTP. Members include: Members include: Members include: Chaired by CASC Chaired by CASC Chaired by a representatives representatives member of the from Host Body from Host Body EASC Team EASC Team
Final Draft Annual Report EASC Page 13 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 membership from membership from NEPT Champion health boards health boards from every Health Welsh Government Welsh Government Board and representative representative Velindre NHS Trust EASC Team EASC Team Director of Finance WAST Chief EMRTS National WHSSC Executive director and service representative Representatives manager from Welsh Renal from WAST WAST Clinical Network Clinical Contract and and representatives Performance lead. Welsh welcomed from Government. health boards. It should be noted that the sub-group structure changed in 2019/20 with the amalgamation of two former sub groups, the Planning, Development and Evaluation Group (PDEG) and the Joint Management Advisory Group (JMAG) into the single EASC Management Group reporting to the EASC Joint Committee.
All Sub Groups have developed an annual report for submission to the Committee for approval which in line with this report summarises the required functions and captures the work undertaken in 2019- 2020.
9. OTHER GOVERNANCE
Chief Ambulance Services Commissioner Quality and Delivery Meetings with the Welsh Ambulance Services NHS Trust
Members will recall that that the Chief Ambulance Services Commissioner was asked by Welsh Government officials in December 2019 to hold the Quality and Delivery meetings with the Welsh Ambulance Services NHS Trust on their behalf. This change was made in line with the recommendations featured in the McClelland ‘Strategic Review of Emergency Ambulance Services’, and the Welsh Government were aiming to re-emphasise the need for simple governance and accountability for planning and delivery of emergency ambulance services.
EASC Quality and Delivery Meeting
Members will be aware that the CASC and the EASC Team have bimonthly Quality and Delivery meetings with Welsh Government officials. Any issues arising from the WAST Quality and Delivery meeting are discussed with officials and EASC performance is reviewed. Updates from these meetings will be included in the CASC report to the EAS Joint Committee.
10. REVIEW OF THE GROUP’S EFFECTIVENESS
Final Draft Annual Report EASC Page 14 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 The EAS Joint Committee aims to meet six times during the year with additional meetings being held as required. The role of the secretariat to the Committee is crucial to the ongoing development and maintenance of a strong governance framework for the EAS Committee.
The purpose of an effectiveness survey is to comply with the EASC Standing Orders and evaluate the performance and effectiveness of: the Committee the quality of the reports presented to the Committee the committee secretariat
Members of the Group need to consider the above by completion of a self-assessment questionnaire (Appendix 3) based the year 2019- 2020.
Chris Turner Stephen Harrhy
Chair of the Emergency Chief Ambulance Services Ambulance Services Joint Commissioner Committee
Date: 6 July 2020
Final Draft Annual Report EASC Page 15 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Appendix 1 Emergency Ambulance Services Committee Members and Nominated Deputies March 2020 Name Role Chris Turner Chair Stephen Harrhy Chief Ambulance Services Commissioner Member Health Board Nominated Deputy Judith Paget Aneurin Bevan University Health Glyn Jones Board (ABUHB) Director of Finance Simon Dean Betsi Cadwaladr University Health Gill Harris Board (BCUHB) Director of Nursing Len Richards Cardiff and Vale University Health Steve Curry Board (CVUHB) Chief Operating Officer Sharon Hopkins Cwm Taf Morgannwg University Nick Lyons Health Board (CTMUHB) Medical Director Steve Moore Hywel Dda University Health Board Karen Miles Vice Chair (Feb 19) (HDdUHB) Director of Planning Carol Shillabeer Powys Teaching Health Board Jamie Marchant (PtHB) Director of Primary Community and Mental Health Tracy Myhill Swansea Bay University Health Sian Harrop-Griffiths Board (SBUHB) Director of Planning Associate Members Jason Killens Chief Executive Welsh Ambulance Services NHS Trust Steve Ham Chief Executive Velindre NHS Trust Tracey Cooper Chief Executive Public Health Wales
Final Draft Annual Report EASC Page 16 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Appendix 2 Annual Attendance Register - Joint Committee Meeting Organisation Name May Jul Sep Nov Jan Mar Voting Members EASC Chris Turner (Chair) √ √ √ √ √ √ 6/6 Stephen Harrhy Chief Ambulance Services √ √ √ √ √ X 5/6 Commissioner (CASC) Cwm Taf Allison Williams Chief Executive √ 1/1 Morgannwg UHB Sharon Hopkins Interim Chief Executive √ √ √ √ √ 5/5 Cardiff and Vale Len Richards Chief Executive X √ √ X √ X 3/6 UHB Lee Davies (non voting) √ Steve Curry Chief Operating Officer (Nominated √ Deputy) Betsi Cadwaladr Gary Doherty Chief Executive √ VC √ √ VC √ VC √ 5/5 UHB Simon Dean Interim Chief Executive X 0/1 Gill Harris Director of Nursing (Nominated Deputy) Hywel Dda UHB Steve Moore Chief Executive (Vice Chair) √ X √ VC √ √ X 4/6 Karen Miles Director of Planning √ (Nominated Deputy) Aneurin Bevan Judith Paget Chief Executive √ √ 2/6 UHB Glyn Jones Deputy Chief Executive √ √ √ (Nominated Deputy) Nicola Prygodicz Director of Planning (non voting) √ Swansea Bay UHB Tracy Myhill Chief Executive √ √ √ √ 4/6 Sian Harrop Griffiths Director of Planning √ √ (Nominated Deputy) Powys tHB Carol Shillabeer Chief Executive √ √ √ √ X 4/6 Jamie Marchant, Director of Primary Community √ and Mental Health (Nominated Deputy)
Final Draft Annual Report EASC Page 17 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Organisation Name May Jul Sep Nov Jan Mar Associate Members Public Health Tracey Cooper Chief Executive X X X X X X 0/6 Wales Velindre NHS Steve Ham Chief Executive X X X X X X 0/6 Trust Welsh Ambulance Jason Killens Chief Executive √ √ √ √ VC √ √ 6/6 Services NHS Trust In attendance EAS Team Robert Williams Committee Secretary √ 1/1 Hosted by Cwm Stuart Davies Director of Finance √ √ √ √ √ √ 6/6 Taf UHB Shane Mills Deputy CASC √ √ X √ X √ 4/6 Ross Whitehead, Assistant CASC √ √ √ √ √ √ 6/6 James Rodaway, Head of Commissioning √ √ √ √ √ √ 6/6 Julian Baker, Director NCCU √ X √ √ √ X 4/6 Gwenan Roberts Secretariat √ √ √ √ √ 5/5 Welsh Ambulance Rachel Marsh Director of Planning √ X √ √ √ √ Services NHS Lee Brooks Chief Operating Officer √ Trust Brendan Lloyd Medical Director √
Quorum At least 4 voting members 8 9 8 9 9 4
Final Draft Annual Report EASC Page 18 of 57 EAS Committee Meeting 2019 -2020 14 July 2020 Appendix 3
EFFECTIVENESS SURVEY
EAS JOINT COMMITTEE
The primary purpose of this annual self-assessment survey is to consider the effectiveness of the Committee. The survey is based on a committee effectiveness survey template used for all Board Sub-Committees and members are requested to answer all questions.
Please read the question fully and add a “√” in the relevant box to confirm your response.
Part A (The Committee) Composition and Establishment Yes No Don’t Comments (√) (√) Know (√) 1. Does the Committee have written terms of √ EASC Directions 2014 reference that adequately and accurately EASC Regulations 2014 define its role, purpose and accountabilities? Explanatory memorandum for EASC Directions 2. Have the terms of reference been adopted by √ Not applicable the Committee? 3. Are the terms of reference reviewed annually √ to ensure they remain fit for purpose? 4. Does the Committee have an annual work plan √ Forward plan in place? At each meeting If yes, is it reviewed regularly? 5. Has the Committee been provided with sufficient membership, authority and resources to perform its role effectively and objectively? 6. Does the Committee monitor its attendance? √ Within the Annual Report 7. Is the Committee membership appropriate, in terms of available skills, expertise? If no, please elaborate within comments section. Effective Functioning – Committee Yes No Don’t Comments (√) (√) Know (√) 8. Is there effective challenge, scrutiny and learning lessons from all Members? 9. Do the Health Boards review the progress and outputs of the Committee? 10. Does the Committee report regularly to health √ All confirmed minutes and a boards and through action notes and make Chair’s summary are sent to all clear recommendations when necessary? health boards following Committee meetings 11. Does the Committee periodically assess its own effectiveness? 12. Can members give appropriate feedback on the effectiveness of the Chair and the Secretariat?
EASC Annual Governance Page 19 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed Yes No Don’t Comments (√) (√) Know (√) 13. Has the Committee determined the appropriate level of detail it wishes to receive from reports? 14. Does the Committee receive the appropriate level of timely and accurate information to allow it to fulfil its role? 15. Does the Committee have sufficient time to cover its business? 16. Does the Committee effectively monitor – or ensure monitoring of - agreed actions? 17. Are members particularly those new to the √ Committee, provided with training? 18. Has the Committee formally considered how it √ integrates with other groups and meetings? 19. Where they exist, does the Committee receive timely and appropriate feedback from its sub- groups ? 20. Does the Committee provide clear direction to its sub-groups? 21. Does the Committee produce an Annual Report √ This is the first one of its work? 22. If yes (to Q 22) - Do all members contribute to √ and review the Groups Annual Report? Compliance with the law and regulations governing the NHS Yes No Don’t Comments (√) (√) Know (√) 23. Does the Committee have a mechanism to keep it aware of topical issues? 24. Does the Committee have a mechanism to keep it aware of any related legal / regulatory guidance? Assurance Yes No Don’t Comments (√) (√) Know (√) 25. Does the Committee receive timely exception reports about the work of external regulatory and inspection bodies? 26. Does the Committee receive timely information on performance concerns? 27. Are all reports clear, concise, and readily understood? 28. Is the Committee able to refer matters outside its own jurisdiction and if yes, is any feedback reviewed on such matters? 29. If considered appropriate, does the Committee know the process to be followed should it need to escalate matters? 30. In relation to the Risk Register, does the Committee appropriately review the risks assigned to it? Other Issues Yes No Don’t Comments (√) (√) Know (√) 31. Does the Committee meet the appropriate 6 times a year number of times to deal with planned matters, development and liaison? 32. Are arrangements in place to call ad hoc meetings when necessary?
EASC Annual Governance Page 20 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed Yes No Don’t Comments (√) (√) Know (√) 33. Are Committee members notified of urgent matters when appropriate? 34. Does the Committee make the EASC Team aware of issues of staff capacity and skills that impact on the running of the committee?
Administrative arrangements Yes No Don’t Comments (√) (√) Know (√) 35. Are the Committee’s costs appropriate to the perceived risks and benefits? 36. Are papers circulated in good time and are minutes and agreed actions, received as soon as possible after meetings? Questions for Consideration & Discussion Yes No Don’t Comments (√) (√) Know (√) 37. Does the Committee ensure that its work is fully conveyed to wider organisations? 38. Is the work of the Committee’s duplicated elsewhere? if yes, please elaborate. 39. Do you consider the Committee to be effective in discharging its duties in line with the legislation? 40. Do you have any suggestions on how the work of the Committee could be improved or strengthened? PART B - Effective Functioning - individual members Yes No Don’t Comments (√) (√) Know (√) 41. What is your role on the Group? a. Member b. Designated deputy for the health board c. WAST CEO d. Representative from WAST e. Representative of other NHS Trust f. EASC Team Other 42. Do I have sufficient understanding and knowledge of the issues covered within the legal directors of the Committee? 43. Do I appropriately challenge the Chair and other members of the group particularly on critical and sensitive matters?
Thank you for taking the time to complete this questionnaire. Please return completed forms to Gwenan Roberts [email protected]
EASC Annual Governance Page 21 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed EMERGENCY AMBULANCE SERVICES COMMITTEE ANNUAL GOVERNANCE STATEMENT 2019-2020
To: Chris Turner, Emergency Ambulance Services Committee Chair Cwm Taf Morgannwg University Health Board (UHB) cc: Emergency Ambulance Services Committee (EASC) Members
EASC Annual Governance Page 22 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed Contents PAGE 1. SCOPE OF RESPONSIBILITY 3
2. GOVERNANCE FRAMEWORK 4
3. THE PURPOSE OF INTERNAL CONTROL 19
4. CAPACITY TO HANDLE RISK 22
5. THE RISK AND CONTROL FRAMEWORK 23
6. MANDATORY DISCLOSURES 26
7. CHIEF AMBULANCE SERVICES COMMISSIONER OVERALL 29 REVIEW OF EFFECTIVENESS
8. LOOKING AHEAD 31
9. COVID 19 PANDEMIC 32
10. SIGNIFICANT GOVERNANCE ISSUES 33
11. CONCLUSION 33
EASC Annual Governance Page 23 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed 1. SCOPE OF RESPONSIBILITY
In accordance with the Emergency Ambulance Services Committee (Wales) Directions 2014 (2014 No.08), the Local Health Boards (LHBs) established a Joint Committee, which commenced on 1 April 2014, for the purpose of jointly exercising its Delegated Functions and providing the Relevant Services.
In establishing the Emergency Ambulance Services Joint Committee (EASC) to work on their behalf, the seven Local Health Boards (LHBs) recognised that the most efficient and effective way of planning these services was to work together to reduce duplication and ensure consistency.
The Emergency Ambulance Services Committee (EASC) (Wales) Regulations 2014 (SI 2014 No.566 (W.67)3 make provision for the constitution of the “Joint Committee” including its procedures and administrative arrangements. The Joint Committee is a statutory committee established under sections 11, 12(3), 13(2) (c) and (4) (c) and 203(9) and (10) of and paragraph 4 of Schedule 2 to the National Health Service (Wales) Act 2006(1). The LHBs are required to jointly exercise the Relevant Services.
In December 2015, the Welsh Ministers directed the Health Boards under the EASC (Wales) (Amendment) Directions 2016 No.8 (W.8)4 to be responsible for commissioning Non-Emergency Patient Transport (NEPT) services via the Emergency Ambulance Services Committee from April 2016.
The Cwm Taf Morgannwg University Health Board (CTUHB) is the identified host organisation. It provides administrative functions for the running of EASC in line with the Directions and has established the Emergency Ambulance Services Committee Team (EASCT) and appointed the Chief Ambulance Services Commissioner as per Direction 8(4), 3 of the Emergency Ambulance Services Committee and related Regulations.
At the time of preparing this Annual Governance Statement (AGS), the EAS Committee and the NHS in Wales is facing unprecedented and increasing pressure in commissioning services to meet the
3 The Emergency Ambulance Services Committee (EASC) (Wales) Regulations 2014 (SI 2014 No.566 (W.67)3http://www.wales.nhs.uk/sitesplus/documents/1134/Welsh%20Statutory%20Instrument%20f or%20EASC%202014%20No%20566%20%28w67%29.pdf 4 the EASC (Wales) (Amendment) Directions 2016 No.8 (W.8) http://www.wales.nhs.uk/sitesplus/documents/1134/2016%20No%208%20%28W8%29%20The%20 EASC%20%28Wales%29%20%28Amendment%29%20Directions%202016.pdf
EASC Annual Governance Page 24 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed needs of those who are affected by the Covid 19 Coronavirus pandemic.
The response required to the pandemic has meant that the Committee and the supporting team has needed to work very differently both internally with staff, partners and stakeholders and has been necessary to revise the way the governance framework has been discharged. Where relevant this has been explained within this AGS.
It is acknowledged that in these unprecedented times there are limitations on the Joint Committee and its sub groups being able to physically meet where this is not necessary and can be achieved by other means. The Joint Committee complies with the host body arrangements in line with the Public Bodies (Admissions to Meetings) Act 1960 to hold meetings in public. As a result of the public health risk linked to the pandemic Welsh Government (and UK Government) stopped public gatherings of more than two people and therefore it was not possible to allow the public to attend meetings of the Joint Committee from the start of the pandemic in March 2020. To ensure business was conducted in as open and transparent manner as possible during this time the following actions were continued – information was posted on the website in advance of the Joint Committee meeting. An assessment was also made to ensure that decisions where time critical and could not be held over until it was possible to allow members of the public to attend meetings. As the duration of the pandemic and the measures required subsequently are not yet known this will be kept under review in line with the host body arrangements. The Sub Groups were postponed during March and arrangements are being made to restart the groups using virtual platforms.
2. GOVERNANCE FRAMEWORK
In March 2014, the Joint Committee approved the revised Governance and Accountability Framework including the Standing Orders. These were reviewed and updated in November 2018 which included the Memorandum of Understanding and the Hosting agreement.
In November 2019, the Committee received and endorsed the use of the first Model Standing Orders for EASC provided by the Welsh Government. In accordance with related Regulations and Directions, each Local Health Board (‘LHB’) in Wales must then agree the Model Standing Orders (SOs) for the regulation of the
EASC Annual Governance Page 25 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed Emergency Ambulance Services Committee (“Joint Committee”) proceedings and business. These Joint Committee Standing Orders (Joint Committee SOs) form a schedule to each LHB’s own Standing Orders, and have effect as if incorporated within them.
Together with the adoption of a scheme of decisions reserved to the Joint Committee; a scheme of delegations to officers and others; and Standing Financial Instructions (SFIs), they provide the regulatory framework for the business conduct of the Joint Committee. The Standing Financial Instructions are in the process of development and should be available during 2020-2021.
These documents, together with a Memorandum of Agreement setting out the governance arrangements for the seven LHBs and a hosting agreement between the Joint Committee and Cwm Taf Morgannwg University Health Board UHB (“the Host LHB”), form the basis upon which the Joint Committee’s governance and accountability framework is developed. Together with the adoption of a Values and Standards of Behaviour framework this is designed to ensure the achievement of the standards of good governance set for the NHS in Wales.
2.1 Quality & Delivery Framework Agreements The Emergency Ambulance Services Committee (EASC) at its inaugural meeting in April 2014 sponsored the use of CAREMORE® and the creation of National Collaborative Commissioning, Quality & Delivery Frameworks (‘Framework Agreement’) to commission services. Currently EASC commissions the following services: Emergency Ambulance Services Non-Emergency Patient Transport Services Emergency Medical Retrieval Transfer Services.
Emergency Ambulance Services The Framework Agreement for Emergency Ambulance Services operational from 2015/16 is structured to support the following scope of services: a) responses to emergency calls via 999 b) urgent hospital admission requests from general practitioners c) high dependency and inter-hospital transfers d) major incident response and urgent patient triage by telephone e) NHS Direct Wales Services. This is in line with the Emergency Ambulance Services Committee (Wales) Regulations 2014 (2014 No.566 (w.67)), 10 March 2014.
EASC Annual Governance Page 26 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed Non-Emergency Patient Transport Services In line with the recommendations of the 2013 A Strategic Review of Welsh Ambulance Services and a Framework Agreement was developed to commissioning Non-Emergency Patient Transport Services. The scope of services covered by this Quality and Delivery Framework (operational from 2019/20) is commissioning arrangements for non-emergency patient transport services (NEPTS), including: a) all non-emergency patient transport provided by the Welsh Ambulance Services NHS Trust b) all non-emergency patient transport commissioned by Health Boards and NHS Trusts c) all non-emergency patient transport commissioned by the Welsh Health Specialised Services Committee (WHSCC) for the Welsh Renal Clinical Network.
Emergency Medical Retrieval Transfer Services The Framework Agreement for Emergency Medical Retrieval Transfer Services operational from 2020/21. The scope of services covered by this Quality and Delivery Framework is commissioning arrangements for Emergency Medical Retrieval & Transfer Service (EMRTS), including: a) all Emergency Medical Retrieval & Transfer Services provided by EMRTS; b) all Emergency Medical Retrieval & Transfer Services commissioned by Health Boards from EMRTS
CAREMORE® One of the main ambitions of EASC is to encourage and enable patients to access services through other, more appropriate means before their needs become urgent and/or life-threatening, and require a response from the emergency ambulance service. In 2015, EASC developed a new, citizen-centred pathway which describes a five-step process that supports the delivery of emergency ambulance services within Wales. Every service commissioned using the CAREMORE® methodology describes the five step model of care and service delivery.
The Ambulance Patient Care Pathway (referred to as the five-step model) is set out in Figure 1 below:
EASC Annual Governance Page 27 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed Figure 1 - CAREMORE® Emergency Ambulance Services 5 Step
Model
The CAREMORE® model defines the expected care standards to be met for each of the five steps of the Ambulance Patient Care Pathway; as well as setting out activity, performance and resource management information available for each of the steps of the pathway.
It also details the outcomes required in pursuit of improving patient experience; improving patient’s clinical outcomes and demonstrating value for money. The principles of the CAREMORE® model are set out in Figure 2 below:
Figure 2 – Principles of the CAREMORE®
EASC Annual Governance Page 28 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed 2.2 The Joint Committee The Joint Committee has been established in accordance with the Directions and Regulations to enable the seven LHBs in NHS Wales to make collective decisions on the review, planning, procurement and performance monitoring of Emergency Ambulance Services (relevant services), Emergency Medical Retrieval & Transfer Service (EMRTS) and Non-Emergency Patient Transport Service (NEPTS) and in accordance with their defined delegated functions.
1.0.1 Whilst the Joint Committee acts on behalf of the seven LHBs in undertaking its functions, the responsibility of individual LHBs for their residents remains and they are therefore accountable to citizens and other stakeholders for the provision of Emergency Ambulance Services; Emergency Medical Retrieval & Transfer Service and Non-Emergency Patient Transport Services. The Joint Committee is accountable for internal control. As Chief Ambulance Services Commissioner NHS Wales, I have the responsibility for maintaining a sound system of internal control that supports achievement of the Joint Committee’s policies, aims and objectives and to report the adequacy of these arrangements to the Chief Executive of Cwm Taf Morgannwg University Health Board (CTMUHB).
Health Boards and NHS Trusts in Wales have collaborated over the operational arrangements for the provision of the emergency ambulance services and have agreed the terms of a Memorandum
EASC Annual Governance Page 29 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed of Understanding to ensure that the arrangements are introduced and operate effectively by collective decision making, in accordance with the policy and strategy set out above determined by the EASC.
Whilst the EASC acts on behalf of the Health Boards and NHS Trusts in undertaking its functions, the responsibility for the exercise of the emergency ambulance functions is a shared responsibility of all NHS bodies in Wales.
Under the terms of the establishment arrangements, Cwm Taf Morgannwg University Health Board (UHB) is deemed to be held harmless and have no additional financial liabilities beyond for their own resident population.
The Joint Committee is supported by a Committee Secretary, who acts as the guardian of good governance within the Joint Committee.
The Governance framework for the operation of EASC is presented in Figures 3 and a flowchart outlining the current supporting sub groups is outlined in Figure 4.
EASC Annual Governance Page 30 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed Figure 3 - Governance Framework for EASC
HEALTH BOARDS
Cwm Taf Morgannwg Corporate and Clinical Risk Management Emergency Ambulance Services Joint University Health Board Committee Audit and Risk Committee
EASC Emergency Medical Non-Emergency Cwm Taf Morgannwg Management Group Retrieval and Patient Transport University Health Transfer Service Service Board Quality and Delivery Assurance Delivery Assurance Safety Committee Group Group Quality, Standards Patient and Staff Quality, Standards and Safety Types of Internal and External Assurance
Community Health Councils, Statutory Inspections Regulatory Bodies Collaborative quality Internal & External Audit Patient Groups (Health and Safety (Healthcare Inspectorate Wales initiatives NHS Wales Share Services Executive) Care Quality Commission) Improvement Cymru Partnership / Audit Wales
EASC Annual Governance Page 31 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed It should be noted that the sub-group structure changed in 2019/20 with the amalgamation of two former sub groups, the Planning, Development and Evaluation Group (PDEG) and the Joint Management Advisory Group (JMAG) into the single EASC Management Group reporting to the EASC Joint Committee.
Figure 4 – Sub Groups of the EASC
Emergency Ambulance Services Committee (EASC) Sub groups
EASC Management Group Emergency Medical Retrieval and Transfer Service Non-Emergency Patient Transport Service Delivery Assurance Group Delivery Assurance Group
The overall purpose of the Management Group is to provide EMRTS DAG NEPTS DAG advice and make recommendations to EASC and to ensure Established to support the production, ongoing development Established to support the production, ongoing development that the seven LHBs in Wales will work jointly to exercise and maintenance of the interim Framework. and maintenance of the interim Framework. functions relating to the planning and securing of emergency ambulance services, non-emergency patient transport Responsible for the delivery, direction and performance of the Responsible for the implementation of the NEPTS work services and Emergency Medical Retrieval & Transfer EMRTS. programmes that deliver WHC 2007 (005) and the 2015 Service. business case ‘The Future of NEPTS in Wales’. Ensure equitable access to safe, effective, sustainable and acceptable services for the people of Wales in line with agreed commissioning intentions and the EASC IMTP.
Members include: Chaired by CASC; representatives from Members include: Chaired by CASC; representatives from Members include: Chaired by CASC; EASC Team; NEPT Host Body, membership from health boards; Welsh Host Body, membership from health boards; Welsh Champion from every Health Board and Velindre NHS Trust; Government representative; EASC Team; WAST Chief Government representative; EASC Team; EMRTS National Director of Finance WHSSC; representative from Welsh Renal Executive; Representatives from WAST; Clinical director and service manager; WAST; Contract and Clinical Network and from the Welsh Government. representatives welcomed from health boards. Performance lead.
EASC Annual Governance Page 32 of 57 Audit and Risk Committee Statement 2019-2020 Meeting To be confirmed Emergency Ambulance Services Joint Committee – Governance Framework The EASC has in place a robust Governance and Accountability Framework including: Standing Orders A Hosting Agreement Memorandum of Understanding
The above documents set out the governance arrangements for the NHS Wales organisations and form the basis upon which the Joint Committee’s Governance and Accountability Framework is developed. Together with the Cwm Taf Morgannwg University Health Board “Values and Standards of Behaviour framework” this is designed to ensure the achievement of the standards of good governance set for the NHS in Wales.
The table in Figure 5 below outlines the Composition of the Joint Committee during the financial year 2019-2020.
Figure 5 – Composition of the EASC Committee 2019-2020 Organisation University Health Board Name Role (UHB) Emergency Ambulance Chris Turner Chair (Nov 2018) Services Committee Emergency Ambulance Chief Ambulance Stephen Harrhy Services Committee Services Commissioner Chief Executive, Judith Paget Member Aneurin Bevan UHB Gary Doherty Member (to Feb 2020) Chief Executive, Betsi Cadwaladr UHB Simon Dean Member (from March (Interim CEO) 2020) Chief Executive, Len Richards Member Cardiff & Vale UHB Member (to August Allison Williams Chief Executive, 2019) Cwm Taf Morgannwg Sharon Hopkins Member (from Sept UHB (Interim CEO) 2019) Chief Executive, Steve Moore Member (Vice Chair) Hywel Dda UHB Chief Executive, Carol Shillabeer Member Powys Teaching HB Chief Executive, Tracy Myhill Member Swansea Bay UHB Chief Executive, Welsh Ambulance Services NHS Jason Killens Associate Member Trust Chief Executive, Public Tracey Cooper Associate Member Health Wales NHS Trust Chief Executive, Steve Ham Associate Member Velindre NHS Trust 1.0.2
EASC Committee Chair’s report Page 33 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework 1.0.3 In accordance with the EASC Standing Orders, the Joint Committee may and, where directed by the LHBs jointly or the Welsh Ministers must, appoint joint sub-Committees of the Joint Committee either to undertake specific functions on the Joint Committee’s behalf or to provide advice and assurance to others (whether directly to the Joint Committee, or on behalf of the Joint Committee to each LHB Board and/or its other committees). 1.0.4 1.0.5 The purpose of the Joint Committee is to jointly exercise those functions relating to the commissioning of emergency ambulance services on a national all-Wales basis, on behalf of each of the seven LHBs in Wales. 1.0.6 1.0.7 LHBs are responsible for those people who are resident in their areas. Whilst the Joint Committee acts on behalf of the seven LHBs in undertaking its functions, the duty on individual LHBs remains, and they are ultimately accountable to citizens and other stakeholders for the provision of emergency ambulance services for residents within their area. 1.0.8 1.0.9 The Joint Committee’s role is to: Determine a long-term strategic plan for the development of emergency ambulance non-emergency patient transport services and Emergency Medical Retrieval and Transfer Services in Wales, in conjunction with the Welsh Ministers Identify and evaluate existing, new and emerging ways of working and commission the best quality emergency ambulance service Produce an Integrated Medium Term Plan (IMTP), including a balanced Medium Term Financial Plan for agreement by the Committee following the publication of individual LHBs Integrated Medium Term Plans (IMTPs), which should also make reference to the EASC commissioning intentions Agree the appropriate level of funding for the provision of emergency ambulance and non-emergency patient transport services at a national level, and determining the contribution from each LHB for those services (which will include the running costs of the Joint Committee and the EASC Team) in accordance with any specific directions set by the Welsh Ministers Establish mechanisms for managing the commissioning risks Establish mechanisms to monitor, evaluate and publish the outcomes of emergency ambulance, non-emergency patient transport services and Emergency Medical Retrieval and Transfer Services and take appropriate action.
The EASC monitors performance on a quarterly basis against the key performance indicators. For any indicators assessed as being below target, reasons for current performance are identified and
EASC Committee Chair’s report Page 34 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework included in the report along with any remedial actions to improve performance.
The Joint Committee ensures that the principles of good governance applicable to NHS organisations are followed consistently, including the oversight and development of systems and processes for financial control, organisational control, governance and risk management. The EASC assesses strategic and corporate risks through the Risk Register.
2.2.1 Joint Committee Meetings The table in Figure 6 outlines dates of Joint Committee meetings held during 2019-2020 and attendance by Members. All meetings held were quorate. The Committee met 6 times and all agenda and reports are available here: http://www.wales.nhs.uk/easc/committee.
Figure 6 – EASC Committee Attendance 2019-2020
University Health May Jul Sept Nov Jan Mar Board (UHB) Committee Members Chair √ √ √ √ √ √ CASC √ √ √ √ √ X Aneurin Bevan UHB √* √* √** √ √ √* Swansea Bay UHB √ √* √ √* √ √ Betsi Cadwaladr UHB √(VC) √ √(VC) √(VC) √ X Cardiff & Vale UHB √** √ √ √* √ X Cwm Taf Morgannwg √ √ √ √ √ √ UHB Hywel Dda UHB √ √* √(VC) √ √ X Powys Teaching HB √ √ √ √* √ X Associate Committee Members WAST √ √ √ √ √ √ Public Health Wales X X X X X X Velindre NHS Trust X X X X X X
X * denotes CEO not present but the nominated Executive Director present X ** denotes CEO not present but sent a representative (not nominated deputy) (VC) denotes by Video Conference
The Chair of the Committee routinely emphasises the importance of attendance at the Joint Committee and escalates any matters of member non-attendance, as appropriate, with Members and/or Chairs of NHS organisations. The issue of non-attendance of organisation representatives at sub-group meetings has also been raised by the Chair and the CASC and discussed with Members at Joint Committee meetings. Dr Andrew Goodall, Director General / Chief
EASC Committee Chair’s report Page 35 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework Executive NHS Wales has also written out to Chief Executive Officers to remind them of their responsibilities in this regard.
2.2.2 Joint Committee Performance and Self-Assessment
1.0.10 During 2019-2020 the Emergency Ambulance Services Committee approved an annual forward plan of business, including: 1.0.11 1.0.12 Standing items Chair’s report Chief Ambulance Services Commissioner (CASC) report Finance Report Provider issues by exception Forward Plan of Business Implementation of the AMBER Review 1.0.13 Planned items received on a regular basis Ambulance Quality Indicators Report (in line with quarterly reporting) AMBER Review EASC Governance Updates including risk register reporting Emergency Medical Retrieval and Transfer Services (EMRTS) including the business case EASC Integrated Medium Term Plan (IMTP) Quarterly reports Regional Escalation A Healthier Wales Allocation (1%) Demand and Capacity Review at the Welsh Ambulance Services NHS Trust Non-emergency patient transport progress report 1.0.14 Other items included: Clinical Risk Review - Final Report WAST Relief Gap for Emergency Ambulance Services – Reference document Establishment of the South, Mid and West Wales Trauma network – WAST Business Case Outline WAST IMTP RED Improvement Plan Handover delays and escalation – emergency department quality delivery framework EASC Integrated Medium Term Plan (IMTP) and Commissioning Intentions Letter of support for the WAST IMTP WAST response to commissioning intentions Strategic Commissioning Intentions Performance Report 1.0.15 Reports from EASC Sub Groups Emergency Medical Retrieval and Transfer Service Delivery Assurance Group (EMRTS DAG) Non-Emergency Patient Transport Services Delivery Assurance
EASC Committee Chair’s report Page 36 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework Group (NEPTS DAG) EASC Management Group. 1.0.16 2.3 Sub Committees
2.3.1 The Audit and Risk Committee of the Cwm Taf Morgannwg University Health Board The primary role of the Cwm Taf Morgannwg University Health Board Audit and Risk Committee (formerly known as Audit Committee) is to review and report upon the adequacy and effective operation of EASC’s overall governance and internal control system. This includes risk management, operational and compliance controls, together with the related assurances that underpin the delivery of EASC’s objectives. This role is set out clearly in the Audit and Risk Committee’s terms of reference which were revised in 2017 to ensure these key functions were embedded within the standing orders and governance arrangements.
The Audit and Risk Committee reviews the effective local operation of internal and external audit, as well as the Counter Fraud Service. In addition, it ensures that a professional relationship is maintained between the external and internal auditors so that reporting lines can be effectively used.
The Audit and Risk Committee supports the Joint Committee in discharging its accountabilities for securing the achievement of the EASC objectives in accordance with the standards of good governance determined for the NHS in Wales.
The Cwm Taf Morgannwg University Health Board Audit and Risk Committee attendees during 2019-2020 comprised of Independent Members supported by representatives of both Internal and External Audit and Senior Officers of Cwm Taf Morgannwg University Health UHB. Where necessary, relevant officers are in attendance for the EASC components of the Cwm Taf Morgannwg University Health Board Audit and Risk Committee, and it is recognised that as the EASC continues to evolve and mature as a Joint Committee, there will be an increasing level of audit related activity.
2.3.2 EASC Management Group The overall purpose of the EASC Management Group is to provide advice and make recommendations to EASC and to ensure that the seven LHBs in Wales will work jointly to exercise functions relating to the planning and securing of emergency ambulance services,
EASC Committee Chair’s report Page 37 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework non-emergency patient transport services and Emergency Medical Retrieval & Transfer Service.
The Group will underpin the commissioning responsibilities of EASC to ensure equitable access to safe, effective, sustainable and acceptable services for the people of Wales in line with agreed commissioning intentions and the EASC IMTP.
The Group will be responsible to EASC for undertaking the following functions: To agree, make recommendations and monitor the EASC IMTP and the commissioning framework To receive recommendations from sub groups and to make recommendations to the EASC regarding service improvements including investments, disinvestments and other service changes To monitor the delivery of the quality and delivery commissioning frameworks for EASC Commissioned Services To receive regular reports on performance monitoring and management and the main actions to address performance issues To undertake the role of Programme Board for specific work streams and monitor their implementation To consider consultation outcomes and recommended pathway or services changes / developments before consideration by EASC members To ensure the development and maintenance of the needs assessment across Wales for Ambulance Services in accordance with the requirements of the Future Generations Act To consider, agree and recommend commissioning/service issues to the EASC which are to be considered as part of the EASC IMTP. This will include issues which will have an impact on the plan raised by other sub groups/advisory groups, the WAST IMTP and EASC’s strategic commissioning intentions.
The EASC standing orders have been reviewed and the updated terms of reference for the EASC Management Group have been included in the document.
2.3.3 Emergency Medical Retrieval & Transfer Service (EMRTS) The EMRTS is commissioned by the Emergency Ambulance Service Committee (EASC) and is hosted by Swansea Bay University Health Board (SBUHB). The organisational governance structure consists of an EMRTS Delivery Assurance Group (DAG) which reports to the Chief Ambulance Service Commissioner and through to the EASC Joint Committee. The EASC Joint Committee delegates responsibility to the DAG for the delivery, direction and performance of the EMRTS. The Chief Ambulance Services Commissioner is a member of the SBUHB EMRTS Clinical Governance sub group.
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The National Director is accountable to the EMRTS DAG for the delivery and performance of the EMRTS and to the SBUHB Chief Executive for organisational and clinical governance. There are a number of supporting agreed documents which underpin the organisational governance of the service as follows: 1. Memorandum of Agreement between SBUHB and EASC. 2. Terms of reference for the EMRTS Delivery Assurance Group 3. Collaborative agreement between AB SBUHB, the Wales Air Ambulance Charity Trust (WAACT) and the Welsh Ambulance Service Trust (WAST) 4. Memorandum of Understanding between SBUHB and other Welsh LHBs/NHS Trusts 5. Service level agreement between EMRTS and SBUHB for accessing supporting services 6. Terms of Reference for the EMRTS Clinical and Operational Board.
The Emergency Medical Retrieval and Transfer Service went live on the 27 April 2015. The service was commissioned “to provide advanced decision making & critical care for life or limb threatening emergencies that require transfer for time critical specialist treatment at an appropriate facility.” The service represents a joint partnership between NHS Wales, The Wales Air Ambulance Charity Trust (WAACT) and Welsh Government. The service was initially commissioned by the Welsh Health Specialised Services Committee; however, this function transferred to the Emergency Ambulance Services Committee on the 1 April 2016.
The EASC standing orders have been reviewed and the updated terms of reference for the EMRTS DAG have been included in the document.
2.3.4 Non-Emergency Patient Transport Service (NEPTS) The Non-Emergency Patient Transport Services Delivery Assurance Group is the mechanism through which the Health Boards and WAST will jointly plan and take collective action to deliver the NEPTS Commissioning Intentions and 2015 business case ‘The Future of NEPTS in Wales’. Ensuring a robust and collaborative approach is taken to develop and implement the key outcomes from the task and finish group.
The NEPTS Delivery Assurance Group will provide advice and make recommendations to EASC Management Group and to ensure that the seven LHBs in Wales will work jointly to exercise
EASC Committee Chair’s report Page 39 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework functions relating to the planning and securing non-emergency patient transport services.
The Group will underpin the commissioning responsibilities of EASC to ensure equitable access to safe, effective, sustainable and acceptable services for the people of Wales in line with agreed commissioning intentions and the EASC Integrated Medium Term Plan (IMTP).
The Group will be responsible to EASC Management Group for undertaking the following functions: To receive recommendations and to make recommendations to the EASC Management Group regarding service improvements including investments, disinvestments and other service changes. To develop, establish and manage performance arrangements including a team with relevant expertise, which: o gives assurances on the adherence to agreed Care standards o reviews and reports on performance improvements o reviews and reports upon activity information o reviews and reports on resource utilisation and effectiveness o reviews delivery of agreed service change initiatives in line with agreed milestones o provides assurance that Framework Agreement is operating effectively between all parties i.e. health boards & NEPTS o evaluate patient outcomes, patient experience and cost impact - to inform learning & continuous improvement, plus, ongoing development of the Framework Agreement. To monitor the delivery of the quality and delivery commissioning frameworks for NEPTS To receive regular reports on performance monitoring and management and the main actions to address performance issues To consider consultation outcomes and recommended pathway or services changes / developments before consideration by EASC members.
The EASC standing orders have been reviewed and the updated terms of reference for the NEPTS DAG have been included in the document.
2.4 Reviewing the Effectiveness of EASC The Audit and Risk Committee of Cwm Taf Morgannwg University Health Board advises and assures the Joint Committee on the effectiveness of its risk management arrangements, by reviewing its risk register and approach to risk management at each of its meetings. This was formerly undertaken by the Quality Safety and
EASC Committee Chair’s report Page 40 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework Risk Committee) (host body). It is also important to note that the risk register is aimed to be a routine feature of the business of the Joint Committee.
The Committee agreed to review the format of the risk register and that this should be discussed initially at a development session. A set of context perspectives for each risk was discussed and agreed at the meeting in January 2020. However, this work has not been progressed due to the impact of Covid 19 pandemic. Work is underway to review the risk register to report in July 2020. In the interim, key risks and issues have been included within the Chief Ambulance Services Commissioner report which is presented at each committee meeting.
The Quality and Safety Committee of the Cwm Taf Morgannwg University Health Board as host organisation advises and assures the Joint Committee on the provision of workplace health and safety for the EASC Team.
2.5 Standards of Behaviour The Welsh Government's Citizen-Centred Governance Principles apply to all public bodies in Wales. These principles integrate all aspects of governance and embody the values and standards of behaviour expected at all levels of public services in Wales.
“Public service values and associated behaviours are and must be at the heart of the NHS in Wales”
The Joint Committee is strongly committed to EASC being value- driven, rooted in the Nolan principles and high standards of public life and behaviour, including openness, customer service standards, diversity and engaged leadership.
The Joint Committee expects all Members and employees to practice high standards of corporate and personal conduct, based on the recognition that the needs of service users must come first.
The “Seven Principles of Public Life”, or the “Nolan Principles” form the basis of the Standards of Behaviour requirements for the EASC team.
The Cwm Taf Morgannwg Standards of Behaviour Policy, incorporating Declarations of Interest, Gifts, Hospitality and Sponsorship, aims to ensure that arrangements are in place to
EASC Committee Chair’s report Page 41 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework support employees to act in a manner that upholds the Standards of Behaviour Framework as well as setting out specific arrangements for the appropriate declarations of interests and acceptance / refusal and record of offers of Gifts, Hospitality or Sponsorship. The Policy also aims to capture public acceptability of behaviours of those working in the public sector so that EASC can be seen to have exemplary practice in this regard.
All Members and Senior Managers and their close family members have declared any pecuniary interests and positions of authority which may result in a conflict with their responsibilities. No material interests have been declared during 2019-20, a full register of interests for 2019-20 is available upon request from the Committee Secretary. A register of interests is maintained and is available on request in line with the host body arrangements.
3. THE PURPOSE OF THE SYSTEM OF INTERNAL CONTROL
The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risks; it can therefore only provide reasonable and not absolute assurances of effectiveness.
The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place for the year ended 31 March 2020 and up to the date of approval of the annual report and accounts.
3.1 External Audit During 2019-2020 there were no specific reports from external auditors.
As a hosted organisation under Cwm Taf Morgannwg University Health Board, the work of external audit is monitored by the Cwm Taf Morgannwg University Health Board Audit and Risk Committee through regular progress reports. Their work is both timely and professional. The recommendations made are relevant and helpful in our overall assurance and governance arrangements and our work on minimising risk. There are clear and open relationships with
EASC Committee Chair’s report Page 42 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework officers and the reports produced are comprehensive and well presented. In addition to EASC matters, the Cwm Taf Morgannwg University Health Board Audit and Risk Committee has been kept apprised by its external auditors of developments across NHS Wales and elsewhere in the public service. These discussions have been helpful in extending the Audit and Risk Committee’s awareness of the wider context of the work.
3.2 Internal Audit The Cwm Taf Morgannwg University Health Board Audit and Risk Committee regularly review and consider the work and findings of the internal audit team. The Director of Audit and Assurance and the relevant Heads of Internal Audit have attended each meeting to discuss their work and present their findings. The Audit and Risk Committee are satisfied with the liaison and coordination between the external and internal auditors.
During the reporting period 2019-2020 the EASC were audited on: EASC Governance - Reasonable Assurance received by the Host Body’s Audit and Risk Committee on 13 May 2019. The purpose of the review was to establish if appropriate governance and performance management arrangements are in place to ensure that EASC operates effectively and WAST performance is effectively monitored and managed. Internal Audit Report on Handover of Care at Emergency Departments Follow-up Health Board Related Recommendations - The Internal Audit Report was received at the host body Audit NS Risk Committee on 15 July 2019; the report was reported to the Welsh Ambulance Services NHS Trust (WAST) Board. No reports received a “limited assurance” assessment rating.
3.3 Counter Fraud Counter Fraud support is incorporated within the hosting agreement with Cwm Taf Morgannwg University Health Board. Local Counter Fraud Plans relating to the role of the Host body, including matters relating to EASC, are considered via the Cwm Taf Morgannwg University Health Board Audit and Risk Committee.
3.4 Integrated Governance The Cwm Taf Morgannwg University Health Board Audit and Risk Committee is responsible for the maintenance and effective system of integrated governance. It has maintained oversight of the whole process by seeking specific reports on assurance, which include:
EASC Committee Chair’s report Page 43 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework Tracking of Audit Recommendations EASC Risk Register.
During 2019-2020, the Cwm Taf Morgannwg University Health Board Quality and Safety and the Audit and Risk Committee played a proactive role in communicating suggested amendments to governance procedures and the corporate risk register.
3.5 Quality
3.5.1 Ambulance Quality Indicators To support the measurement of the new Clinical Model a comprehensive suite of Ambulance Quality Indicators (AQIs) were developed in collaboration with Welsh Ambulance Services Trust and Welsh Government. The new AQIs were first published as part of a pilot in January 2016, and thereafter quarterly reports were presented to each EASC meeting.
The AQI reports for the 2019-2020 reporting period can be viewed on the link below: http://www.wales.nhs.uk/easc/ambulance-quality-indicators
Due to the ongoing impact of the COVID-19 pandemic, data gathering and release practices have been changed. The Ambulance Quality Indicators will not be published at this time. Releases of official statistics and research on Wales can be found at the following link: https://gov.wales/statistics-and-research.
3.5.2 Quality and Patient Experience During 2019-2020, the Joint Committee has continued its commitment to assuring the quality of services by including a section on “Quality, Safety and Patient Experience” as one of the core considerations in the commissioning frameworks and also on the updated committee report template which directs the report author to consider the implications when drafting reports for EASC meetings. The Chief Ambulance Services Commissioner (CASC) undertakes a monthly Quality and Delivery meeting with the Welsh Ambulance Services NHS Trust which is reported within the CASC report to the EASC Committee.
4. CAPACITY TO HANDLE RISK
As the Chief Ambulance Services Commissioner for NHS Wales, I have responsibility for maintaining a sound system of internal
EASC Committee Chair’s report Page 44 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework control that supports the achievement of EASCs policies, aims and objectives and need to be satisfied that appropriate policies and strategies are in place and that systems are functioning effectively, through the development implementation and review of Collaborative Commissioning Framework Agreements. The Joint Committee’s Sub Groups have assisted in providing these assurances and I am supported by the Head of Internal Audit’s related work, report and opinion on the effectiveness of our system of internal control.
As previously highlighted the need to plan and respond to the Covid 19 pandemic presented a number of challenges to the EASC Team. The business continuity arrangements of the host body as well as a plan for the EASC team has allowed for safe working. There does remain a level of uncertainty about the overall impact this will have on the immediate and longer term commissioning for the Committee although I am confident that all appropriate action has been taken.
The Joint Committee aims to review the EASC Risk Register at each meeting and the key risks identified are aligned to delivery and are considered and scrutinised by the Cwm Taf Morgannwg University Health Board Audit & Risk Committee as a whole. It must be noted that responsibility for the commissioning of Emergency Ambulance Services, Emergency Medical Retrieval & Transfer Services and Non-Emergency Patient Transport Services remains that of individual health boards, discharged collaboratively through the Emergency Ambulance Services Joint Committee (EASC).
The joint Memorandum of Understanding (MoU) between the EASC; Welsh Government and the Chief Ambulance Services Commissioner was endorsed by the Joint Committee in March 2016 and was reviewed at the meeting in November 2018. The Model Standing Orders and the Hosting Agreement with the host body (Cwm Taf Morgannwg University Health Board) were endorsed in November 2019 for approval at all health board meetings to meet the requirements of the Welsh Health Circular WHC 2019/027 (Model Standing Orders, Reservation and Delegation of Powers – Local Heath Boards, NHS Trusts, Welsh Health Specialised Services Committee and the issuing of Model Standing Orders for the Emergency Ambulance Services Committee).
5. THE RISK AND CONTROL FRAMEWORK
EASC Committee Chair’s report Page 45 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework Under the hosting agreement with Cwm Taf Morgannwg University Health Board, the EASC complies with the Risk Management Strategy, the Risk Management Policy and the Risk Assessment Procedure.
The aim of the Risk Management Policy is to: Ensure that the culture of risk management is effectively promoted to staff ensuring that they understand that the ‘risk taker is the risk manager’ and that risks are owned and managed appropriately Utilise the agreed approach to risk when developing and reviewing the Resource and Operational Plan Embed both the principles and mechanisms of risk management into the organisation Involve staff at all levels in the process Revitalise its approach to risk management, including health and safety.
Risk management relating to the activities of EASC has matured throughout the year and arrangements for reporting risks agreed and developed.
The Committee Risk Register forms part of the process in terms of the identification and management of strategic risks in relation to the commissioning of Emergency Ambulance Services and during this year has been on hold to comply with the new arrangements of the host body.
The Risk Register continues to evolve and is a ‘living’ document and should be in a state of constant change to reflect increases, decreases and the elimination of risks The Risk Register will be subject to continuous review by the Chief Ambulance Services Commissioner and the work of the Joint Committee Sub Groups It is for the Joint Committee to determine whether there is sufficient assurance in the rigour of internal systems to be confident that there are adequate controls over the management of principal risks to the strategic objectives. The Committee agreed to review the format of the risk register and that this should be discussed initially at a development session. A set of context perspectives for each risk was discussed and agreed at the meeting in January 2020
EASC Committee Chair’s report Page 46 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework
5.1 Joint Committee Risk Register As at 28 January 2020, there were 3 risks categorised as Extreme / High these being:
Risk Description of risk Initial Current Mitigating Actions Reference identified Score Score Demand and Capacity Failure to progress WAST Report approved staffing roster changes across To agree EASC 07 Wales in alignment with demand 15 15 patterns identified within the implementation plan ORH report.
EASC to coordinate from Jan 2020 Agreed by Chairs of Failure to provide alternative HBs EASC 08 12 15 services Letter sent to Andrew Goodall Included in Taskforce terms of reference Further investment in Failure to ensure the Clinical desk EASC 13 commissioning of emergency Lessons learned from (added July ambulance services is 15 15 previous work on red 2018) appropriately clinically category categorised Implementation of Amber Review
5.2 Policies and Procedures The EASC follows the policies and procedures of Cwm Taf Morgannwg University Health Board, as the host organisation.
5.3 Information Governance The EASC has established arrangements for Information Governance to ensure that information is managed in line with the relevant ethical law and legislation, applicable regulations and takes guidance, where required from the Information Commissioner’s Office (ICO). This includes legislation such as the Data Protection Act (2018) and the Caldicott Report (1997/2013) that covers the data that we collect and the processing of this to ensure that we only use it for compatible purposes and it remains secure and confidential whilst in our custody.
The EASC receive information governance support from Cwm Taf Morgannwg University Health Board on areas such as the Freedom of Information Act, Information Asset Ownership, Information
EASC Committee Chair’s report Page 47 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework Governance Breaches, Records Management, new guidance documentation and training materials, areas of concern and latest new information and law including the implementation of the General Data Protection Regulation (GDPR).
The Director of Corporate Services & Governance / Board Secretary at Cwm Taf Morgannwg University Health Board is the designated Senior Information Risk Owner (SIRO) in relation to Information Governance for the EASC and, due to our hosted status; the Caldicott Guardian for Cwm Taf Morgannwg University Health Board is the Executive Medical Director.
5.4 Integrated Medium Term Plan (IMTP) The basis for the EASC’s planning has been the original national collaborative commissioning quality and delivery framework which all seven Health Boards have signed up to. The framework provides the mechanism to support the recommendations of Professor Siobhan McClelland in the “A Strategic Review of Welsh Ambulance Services” published in 2013. The framework puts in place a structure which is clear and directly aligned to the delivery of better care. The framework introduces clear accountability for the provision of emergency ambulance services and sees the Chief Ambulance Services Commissioner (CASC) and the Emergency Ambulance Services Committee (EASC) acting on behalf of health boards and holding WAST to account as the provider of emergency ambulance services. Each Health Board is required to demonstrate their ambition of the framework through making reference to the collaborative work of the EASC within individual Health Board IMTPs.
The EASC prepared and submitted a Board Approved Integrated Medium Term Plan (IMTP) for 2019-20 – 2021-22, which was approved by Welsh Government officials. The Committee received EASC Integrated Medium Term Plan (IMTP) Quarterly reports during 2019-20 and progress was been made in line with the plan. A letter was received on 19 March 2020 to confirm that the plan had been taken through a rigorous assessment by Welsh Government. Whilst it was not a statutory requirement for EASC under the NHS Finance (Wales) Act 2014 and therefore the plan does not require Ministerial approval, officials confirmed that it was satisfactory and consistent with the requirements of the NHS Planning Framework 2019-2022. However, in light of the challenges posed by the Covid 19 pandemic noted that a decision had been made to pause the
EASC Committee Chair’s report Page 48 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework IMTP processes and allow all resources to be redirected to sustaining and supporting key services. The EASC Team were redirected to assist and support services across NHS Wales.
5.5 Health and Care Standards for NHS Wales The Welsh Government’s “Health and Care Standards for NHS Wales5” provide a framework for consistent standards of practice and delivery across the NHS in Wales, and for continuous improvement.
In 2017-18 a revised set of Health and Care Standards were issued to NHS Wales. In particular, a new standard for Governance, leadership and Accountability was introduced. The EASC Team have considered that the following criteria has been met: Health services demonstrate effective leadership by setting direction, igniting passion, pace and drive, and developing people. Strategy is set with a focus on outcomes, and choices based on evidence and people insight. The approach is through collaboration building on common purpose. Health services innovate and improve delivery, plan resource and prioritise, develop clear roles, responsibilities and delivery models, and manage performance and value for money. Health services foster a culture of learning and self-awareness, and personal and professional integrity. The work of EASC is also included within the annual self- assessment that Cwm Taf Morgannwg University Health Board. At the time this report was being prepared, the Internal Audit review and Annual Health & Care Standard report had not been completed. COVID-19 has inevitably had an impact on the ability to compete the activity within the original timeframe.
5.6 Governance & Accountability Assessment The Governance & Accountability Assessment is more relevant to the host body, Cwm Taf Morgannwg University Health Board although the EASC will be cognisant of complying with any requirements.
5.7 Appointment of Independent Chair Dr Chris Turner received, and accepted, an invitation to stay on as Interim Chair for the Committee for a further year in November 2019.
6. MANDATORY DISCLOSURES
5Welsh Government’s Health and Care Standards Framework, April 2015 http://www.wales.nhs.uk/governance-emanual/health-and-care-standards
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The EASC is also required to report that arrangements are in place to manage and respond to the following governance issues:
6.1 Equality, Diversity and Human Rights Control measures are in place to ensure that the EASC’s obligations under equality, diversity and human rights legislation are complied with. The EASC follows the policies and procedures of the Cwm Taf Morgannwg University Health Board as the host organisation.
As a non-statutory hosted organisation under Cwm Taf Morgannwg University Health Board, EASC is required to adhere to the Cwm Taf Morgannwg University Health Board Equality and Diversity policy which sets out the UHB’s commitment to equality and diversity and the legal setting for doing so.
As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.
6.2 Welsh Language The EASC is committed to ensuring that the Welsh and English languages are treated on the basis of equality in the services we provide to the public and other NHS partner organisations in Wales. This is in accordance with the Cwm Taf Morgannwg University Health Board Welsh Language Scheme, Welsh Language Act 1993 the Welsh Language Measure (Wales) 2011 and the Welsh Language Standards (Health Sector) Regulations once approved by the National Assembly for Wales.
The work of the EASC in relation to Welsh language is included within the Cwm Taf Morgannwg University Health Board approved Welsh language scheme and their Annual Welsh Language Monitoring report to the Welsh Language Commissioner.
6.3 Handling of Concerns The EASC is committed to ensuring a professional and customer focussed service through the work of the Joint Committee and as a hosted organisation under Cwm Taf Morgannwg University Health Board adheres to its Concerns policy.
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During 2019-2020 no formal complaints were received concerning the work of the EASC.
6.4 Freedom of Information Requests The Freedom of Information Act (FOIA) 2000 give the public right of access to a variety of records and information held by public bodies and provides commitment to greater openness and transparency in the public sector.
During 2019-2020, the EASC received one request for information under the provision of the Freedom of Information Act (FOIA).
6.5 Data Security The EASC is committed to ensuring that there are effective measures in place to safeguard information and as a hosted organisation under Cwm Taf Morgannwg University Health Board adheres to its Information Governance policies.
All information governance incidents involving data security are reviewed by the Information Governance team within Cwm Taf Morgannwg University Health Board.
During 2019-2020 no Information Governance breaches were reported for the EASC.
6.6 ISO14001 – Sustainability and Carbon Reduction Delivery Plan The Welsh Government have an ambition for the public sector to be carbon neutral by 2030. This ambition sits alongside the Environment (Wales) Act 2016 and Wellbeing of Future Generations (Wales) Act 2015 as legislative drivers for decarbonisation of the Public Sector in Wales. As a hosted organisation under Cwm Taf Morgannwg University Health Board the EASC is committed to managing its environmental impact, the organisation's carbon footprint and increasing its sustainability. Cwm Taf Morgannwg has undertaken risk assessments and Carbon Reduction Delivery Plans are in place in accordance with emergency preparedness and civil contingency requirements as based on UKCIP 2009 weather projections to ensure that the organisation’s obligation under the Climate Change Act and the Adaptation Reporting requirements are complied with.
6.7 Business Continuity Planning/Emergency Preparedness
EASC Committee Chair’s report Page 51 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework The EASC is cognisant of the need to review the capability of the different organisations within NHS Wales to continue to deliver products or services at acceptable predefined levels following a disruptive incident. We recognise our contribution in supporting NHS Wales to be able to plan for and respond to a wide range of incidents and emergencies that could affect health or patient care, in accordance with requirement for NHS bodies to be classed as a category 1 responder deemed as being at the core of the response to most emergencies under the Civil Contingencies Act (2004).
The Joint Committee reviews the arrangements in place for cross border and cross boundary resource flows and that there are effective strategies in place for: People – the loss of personnel due to sickness or pandemic Premises – denial of access to normal places of work Information Management and Technology (IM & IT) and communications/ICT equipment issues Suppliers internal and external to the organisation.
The EASC is committed to ensuring that it meets all legal and regulatory requirements and has processes in place to identify, assess and implement applicable legislation and regulation requirements related to the continuity of operations, services as well as the interests of interested parties.
6.8 UK Corporate Governance Code The EASC operates within the scope of the governance arrangements for the Cwm Taf Morgannwg University Health Board. The Cwm Taf Morgannwg University Health Board has provided disclosure statements within their Annual Governance Statement as follows:
Whilst there is no requirement to comply with all elements of the Corporate Governance Code for Central Government Departments, the Health Board considers that it is complying with the main principles of the Code where applicable, and follows the spirit of the Code to good effect and is conducting its business openly and in line with the Code. This has been informed by the Deloitte review undertaken during the period.
There have been no reported/identified departures from the Corporate Governance Code during the year. A detailed assessment will be undertaken against the code, however, this has
EASC Committee Chair’s report Page 52 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework been delayed due to the impact of the COVID-19 response. A full assessment against the Code utilising the framework developed by the Deputy Board Secretary Peer Group will be undertaken by December 2020.
6.9 Ministerial Directions 2019-2020 Whilst Ministerial Directions are received by NHS Wales organisations, these are not always applicable to EASC. Ministerial Directions issued throughout the year are listed on the Welsh Government website. During 2019-20 one only Direction was issued and this was not directly relevant to the EASC. Information on Ministerial Directions can be found on the Welsh Government website: https://gov.wales/publications?field_policy_areas%5B43%5D=43
Welsh Health Circulars issued by Welsh Government are logged by the Governance Function. EASC has acted upon, and responded to all relevant Welsh Health Circulars (WHC) issued during 2019/20. A list of Welsh Health Circulars issued by Welsh Government during 2019-20 is available at: http://howis.wales.nhs.uk/whcirculars.cfm
7. CHIEF AMBULANCE SERVICES COMMISSIONER’S OVERALL REVIEW OF EFFECTIVENESS
As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the system of internal control is informed by the work of the internal auditors, and the Chief Executives represented on the Joint Committee who have responsibility for the development and maintenance of the internal control framework, and comments made by external auditors in their audit reports.
As Accountable Officer I have overall responsibility for risk management and when required, report to the Cwm Taf Morgannwg University Health Board Audit and Risk Committee/Quality and Safety Committee regarding the effectiveness of risk management within the EASC. My advice to the Joint Committee is informed by reports on internal controls received from all of its Committee and sub-group meetings and the Cwm Taf Morgannwg University Health Board Audit and Risk Committee.
The Joint Committee has considered a range of reports relating to its areas of business during the last year, which have included
EASC Committee Chair’s report Page 53 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework internal and external audit reports and opinion. Each sub-group develops an annual report of its business and the areas that it has covered during the last year and these are reported in public to the EASC. The internal control framework and internal and external related audit support is maturing and will continue to be strengthened going forward. I wish to highlight the following matters that are considered significant and have presented challenges in 2019-2020:
7.1 Emergency Medical Services (EMS) Implementation of the Amber review, commissioned in April 2018 by Welsh Government has been progressed but challenges remain in relation to the: Red response targets patients within the Amber category who were experiencing long waits for ambulance responses handover delays at some emergency departments.
These issues highlighted above all relate to resource availability (ambulances and response vehicles). To address these important issues, the Minister for Health and Social Care has asked me to establish a Ministerial Ambulance Availability Taskforce. The work of the Taskforce is due to report back during 2020-2021 but has been disrupted by the response required to the Covid 19 pandemic. In addition, EASC have supported the initial phases of an independently commissioned Demand and Capacity Review which will ensure that a minimum of 90 whole time equivalent front line staff will be recruited by the Welsh Ambulance Services NHS Trust by 2021. Work is underway with individual health boards to introduce measures which will reduce handover delays and this work is resulting in a reduction in handover hours lost.
7.2 Non-Emergency Patient Transport Service (NEPTS) The work of the NEPTS Delivery Assurance Group is overseeing the transfer of the commissioning arrangements for health boards to EASC:
2019-2020 Hywel Dda University Health Board (UHB) Swansea Bay UHB
2020-2021 Betsi Cadwaladr UHB Powys Teaching Health Board Cwm Taf Morgannwg UHB
EASC Committee Chair’s report Page 54 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework Aneurin Bevan UHB
7.3 Emergency Medical Retrieval and Transfer Service The Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru was established in April 2015. The business case for 24/7 operation was approved by the Committee and is included in the EASC IMTP and commissioning intentions. This will be used to support the implementation of the Major Trauma Centre and network.
8. LOOKING AHEAD
As a result of its work during the year the Cwm Taf Morgannwg University Health Board Audit and Risk Committee/Quality and Safety Committee is satisfied that the EASC has appropriate and robust internal controls in place and that the systems of governance incorporated in the EASC Standing Orders are fully embedded within the Organisation.
Looking forward to 2020-2021 the Cwm Taf Morgannwg University Health Board Audit and Risk Committee and where appropriate it’s Quality and Safety Committee will continue to consider and review the financial, management, governance and quality and risk issues that are an essential component to the success of the EASC.
Specifically they will: Continue to examine the governance and internal controls of the EASC review the format of the risk register and take into account of the set of context perspectives Oversee the implementation of the Demand and Capacity plan for emergency medical services (EMS) Continue to refine and review the commissioning intentions for EMS, NEPTS and EMRTS Consider the development of commissioning arrangements for a dedicated national transfer and discharge service Deliver the Strategic Commissioning Intentions Support the monthly publication of the Ambulance Quality Indicators Commission EMRTS and WAST to deliver the critical care transfer service Deliver the Ministerial Ambulance Availability Taskforce and its recommendations Deliver alternative pathways in line with the Ministerial request In light of the Covid 19 pandemic, revise the EASC IMTP to reflect the anticipated new normal 9. COVID 19 PANDEMIC
EASC Committee Chair’s report Page 55 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework
At the time of preparing this statement the organisation and the NHS in Wales is facing unprecedented and increasing pressure in planning and providing services to meet the needs of those who are affected by Covid 19. The required response has meant that the EASC team work very differently both internally and with our staff, partners and stakeholders and it has been necessary to revise the way the governance and operational framework is discharged.
At the EASC meeting held on 10 March members agreed that they would: raise issues of service pressure in WAST with the national team at the Welsh Government link Health Board and WAST plans using an agreed mechanism ask the EASC Team to identify the key issues which will have an impact more widely on health boards be mindful of the need to be joined up and ensure collective decision making.
I discussed with the Chair the arrangements to comply with the Standing Orders as committee meetings could not be held in public and the need to ensure that providers were concentrating on providing services during this pandemic period. The EASC Sub Groups were temporarily stepped down during the initial emergency planning phase although all sub groups are now planning or have already reconvened (at the time of writing the report).
This was achieved by taking into account the work done by the NHS Wales Board Secretaries Group, in conjunction with Welsh Government, in developing a number of governance principles that were designed to help focus consideration of governance matters during the COVID-19 crisis. It also took into account Welsh Government’s recently published COVID-19 guidance on ethical values and principles for a healthcare delivery environment.
The EASC team’s response to the COVID-19 pandemic concentrated on the following areas: • Business continuity for the team • Contingency plans for critical functions • Development of a priority work programme • Support for the wider system response to COVID-19 • Postponement and pause of non-critical and priority work programmes • Monitoring impact and risk assessment.
EASC Committee Chair’s report Page 56 of 57 14 July 2020 Emergency Ambulance Services Joint Committee – Governance Framework
10. SIGNIFICANT GOVERNANCE ISSUES
The disclosures given throughout this statement and the recommendations referred to in section 7.1 of this statement should be noted but did not relate to significant governance issues.
11. CONCLUSION
During 2019-2020 no significant internal control or governance issues were identified.
As indicated throughout this statement, the need to plan and respond to the COVID-19 has had a significant impact on the organisation, wider NHS and society as a whole. It has required a dynamic response which has presented a number of opportunities in addition the risks.
The need to respond and recover from the pandemic will be with the organisation and wider society throughout 2020/21 and beyond. I will ensure our Governance Framework considers and responds to this need.
As the Chief Ambulance Services Commissioner, I will ensure that through all reasonable endeavours, robust management and accountability frameworks, significant internal control problems do not occur in the future. However, if such situations do arise, swift and robust action will be taken, to manage the event and to ensure that learning is spread throughout the organisation.
Signed:
Date:18 June 2020
Stephen Harrhy Chief Ambulance Services Commissioner, NHS Wales
EASC Committee Chair’s report Page 57 of 57 14 July 2020 5.3.3 20.113.3 Nodiadau Gwybodaeth Cydbwyllgor Gwasanaethau Iechyd Arbenigol Cymru 8.9.20 a 14.7.20 / Welsh Health Specialised Services Committee Joint Briefings 8.9.20 and 14.7.20 1 20.113.3a WHSCC JC Briefing 8.9.20 v1.0.pdf
WELSH HEALTH SPECIALISED SERVICES COMMITTEE JOINT COMMITTEE MEETING – SEPTEMBER 2020
The Welsh Health Specialised Services Committee held its latest public meeting on 8 September 2020 with a ‘consent agenda’, as described on the WHSSC website. This briefing sets out the key areas of consideration and aims to ensure everyone is kept up to date with what is happening in Welsh Health Specialised Services.
Written questions from members and answers had been published in advance of the meeting and would be embedded within the meeting papers.
The papers for the meeting are available at: http://www.whssc.wales.nhs.uk/2020-21-whssc-joint-committee
Minutes of Previous Meeting The minutes of the meeting of 14 July 2020 were taken as read and approved.
Action log & matters arising Members noted there were no outstanding actions or matters arising.
Chair’s Report The Chair’s Report referred members to a Chair’s Action taken on 14 July 2020 to approve temporary amendments to the WHSSC Standing Orders, which was ratified.
The Chair reported that, as planned, this would be her last meeting and that the Minister had appointed her replacement, the details of which would be announced shortly.
Managing Director’s Report The Managing Director’s report, including updates on a new commissioning assurance framework and Radio-frequency Ablation for Barrett’s Oesophagus, was taken as read.
TAVI Management of Severe Aortic Stenosis during the COVID-19 Pandemic
WHSSC Joint Committee Briefing Page 1 of 3 Meeting held 8 September 2020 Version:1.0
Members received a paper outlining the current situation and the impact of the COVID-19 pandemic on the management of severe aortic stenosis and the evidence to support the short term commissioning arrangements for TAVI for the intermediate patient group during the pandemic, together with proposed funding arrangements.
Members (1) supported the recommendation that WHSSC formally changes the commissioning policy to include intermediate risk patients but allows decision making on individual cases to be taken by clinical discretion through the MDT process, and (2) approved the WHSSC position regarding funding in that payments under the block contract and pass through arrangements for TAVI devices will be limited up to 2019-20 outturn levels.
Options Appraisal for a Permanent Perinatal Mental Health In Patient Mother and Baby Unit (MBU) in Wales Members received a paper that informed them of the options appraisal exercise and scoring of the short listed options for a permanent perinatal mental health in patient MBU in Wales.
It was reported that a letter from the Board of Community Health Councils in Wales had been received that was supportive of the options appraisal process but noted that more further formal public engagement was expected on the options once a preferred option was identified.
Members (1) noted that both options meet the WHSSC service specification, (2) supported the recommendation from the non-financial options that Neath Port Talbot Hospital is the preferred location of a permanent mother and baby unit, and (3) noted that the final preferred option will be subject to the usual business case process to access Welsh Government capital.
Major Trauma Network Readiness Assurance Update Members received a paper that provided final assurance that the South Wales Trauma Network is ready to go live on 14th September 2020.
Members received final assurance and noted that following a robust assessment process by the Trauma Network Team and as recommended by the Trauma Network Implementation Board all component parts of the Trauma Network are ready and the Network can proceed to launch on 14th September 2020.
Welsh Renal Clinical Network 2019-20 Annual Report The Welsh Renal Clinical Network 2019-20 Annual Report was taken as read.
Financial Performance Report – Month 4 2020-21
WHSSC Joint Committee Briefing Page 2 of 3 Meeting held 8 September 2020 Version:1.0
A paper that set out the financial position for WHSSC for month 4 of 2020-21, including a forecast under spend of £6m at year end, was taken as read. The under spend related mainly to months 1-4 underspend on the pass through elements of Welsh provider SLA’s, COVID-19 block arrangements with NHSE for Q1 and Q2 below the plan baseline and Q1 2020-21 development slippage.
The Director of Finance reported that, while the full month 5 report was not yet available, the position had continued to improve.
Other reports Members also took as read the update reports from the following joint Sub-committees and Advisory Groups: All Wales Individual Patient Funding Request Panel; Integrated Governance Committee; Management Group; Quality & Patient Safety Committee; and Welsh Renal Clinical Network Board.
WHSSC Joint Committee Briefing Page 3 of 3 Meeting held 8 September 2020 Version:1.0
1 20.113.3b WHSCC JC Briefing 14.7.20 v1.0.pdf
WELSH HEALTH SPECIALISED SERVICES COMMITTEE JOINT COMMITTEE MEETING – JULY 2020
The Welsh Health Specialised Services Committee held its latest public meeting on 14 July 2020 with a ‘consent agenda’, as described on the WHSSC website. This briefing sets out the key areas of consideration and aims to ensure everyone is kept up to date with what is happening in Welsh Health Specialised Services.
Written questions from members and answers had been published in advance of the meeting and would be embedded within the meeting papers.
The papers for the meeting are available at: http://www.whssc.wales.nhs.uk/2020-21-whssc-joint-committee
Minutes of Previous Meeting The minutes of the meeting of 12 May 2020 were taken as read and approved.
Action log & matters arising Members noted there were no outstanding actions or matters arising.
Managing Director’s Report The Managing Director’s report, including updates on the mother and baby unit, IVF, the Swansea mobile PET scanner, the PET international webinar and NCCU expenditure on mental health services for the COVID- 19 period, was taken as read.
Paediatric Ketogenic Diet A paper that set out the current concerns and risks associated with the implementation of the Integrated Commissioning Plan scheme for the Paediatric Ketogenic Diet service at CVUHB, as a result of a funding shortfall on one of the key posts for the service, was taken as read and the funding of the dietitian element to allow the service to be developed in NHS Wales was approved.
WHSSC Joint Committee Briefing Page 1 of 3 Meeting held 14 July 2020 Version:1.0
All Wales Traumatic Stress Quality Improvement Initiative A paper setting out the commissioning arrangements for the All Wales Traumatic Stress Quality Improvement Initiative and informing members of the confirmation of funding from Welsh Government for the Initiative was taken as noted.
Integrated Commissioning Planning The Director of Planning presented an overview of the suite of papers describing the WHSS Team approach to the Integrated Commissioning Plan for specialised services during the COVID-19 pandemic, acknowledging that priorities needed to be aligned between specialised and other services and that there was a need to remain flexible.
The content of the suite of papers was noted, particularly (1) the approach to new investment agreed for 2020-21 by Management Group and (2) the work underway regarding new interventions which may offer alternative treatment options for patients which reduce the risks of COVID-19 harm. Support was confirmed for (1) the revised process for the development of the WHSSC 2021-24 Integrated Commissioning Plan and (2) the revised process for the prioritisation of new interventions during the COVID-19 pandemic.
Risk assessment during the COVID-19 pandemic A paper outlining the risk management approach being taken by the WHSS Team during the COVID-19 pandemic was taken as read and supported.
In particular, members noted (1) that the CRAF continues to be monitored, (2) that risk assurance was being undertaken on individual services, and (3) the additional strategic risks detailed in the paper and their link to the risk appetite statement.
Independent Hospitals Commissioning The Director of Finance presented an overview of the paper that provided an update on the commissioning of independent hospitals in Wales for the initial three month period to 6 July 2020, funded by Welsh Government, and the extension period to 6 September 2020, funded by health boards. Six hospitals had been commissioned from the outset but the arrangement had only been extended with four of the hospitals. It would be for local health boards to contract direct with the independent hospitals beyond 6 September committing their own funding but the WHSS Team would be available to assist in the process. NHSE was extending similar English contracts for two months but for reduced capacity.
The content of the paper was noted.
WHSSC Joint Committee Briefing Page 2 of 3 Meeting held 14 July 2020 Version:1.0
Trauma Network “Go Live” Update A paper that provided an update on the progress made to determine readiness of the South Wales Trauma Network and to recommend a ’go live’ date of Monday 14 September 2020 was noted. Members received assurance that the Trauma Network is ready to go live and approved the proposed ‘go live’ date.
WHSSC Protocol for Dealing with Concerns A revised version of the Protocol (previously approved in 2016) was presented that reflected changes to the structure of the WHSS Team, including addition of the Quality Assurance team, and improved clarity around the process for concerns regarding the function of the WHSS Team. The revised version of the Protocol was approved.
WHSSC Sub-Committee 2019-20 Annual Reports A suite of papers setting out the WHSSC Sub-committee 2019-20 Annual Reports was taken as read. It was noted that the WCRN Annual Report would follow.
WHSSC Annual Self-Assessment Exercise 2019-20 A paper that provided members with information and assurance relating to the WHSSC Annual Self-assessment Exercise for 2019-20, for the Joint Committee and its Sub-committees and Groups, was taken as read. The actions arising from the exercise, recorded in section 3.7 of the paper, were noted.
Financial Performance Report – Month 2 2020/21 A paper that set out the financial position for WHSSC for month 2 of 2020-21, including a forecast under spend of £2m at year end, was taken as read. The Director of Finance reported that, while the full month 3 report was not yet available, finance teams had been made aware that the month 3 forecast under spend at year end had increased to around £6m.
Other reports Members also took as read the update reports from the following joint Sub-committees and Advisory Groups: All Wales Individual Patient Funding Request Panel; Integrated Governance Committee; Management Group; Quality & Patient Safety Committee; and Welsh Renal Clinical Network Board.
WHSSC Joint Committee Briefing Page 3 of 3 Meeting held 14 July 2020 Version:1.0
5.3.4 20.113.4 Adroddiad Sicrwydd Pwyllgor Partneriaeth Cydwasanaethau / Shared Services Partnership Committee Assurance Report 23.7.20 1 20.113.4 SSPC Assurance Report 23 July 2020.doc
ASSURANCE REPORT
NHS WALES SHARED SERVICES PARTNERSHIP COMMITTEE
Reporting Committee Shared Service Partnership Committee Chaired by Mrs Margaret Foster, Chair Lead Executive Mr Neil Frow, Managing Director, NWSSP Author and contact details. Peter Stephenson, Head of Finance and Business Development Date of meeting 23 July 2020 Summary of key matters including achievements and progress considered by the Committee and any related decisions made.
The full agenda and accompanying reports can be accessed on our website.
1. Managing Director’s Update The Managing Director updated the Committee on:
COVID-19 – Since the start of the COVID-19 crisis, NWSSP have been able to deliver over 200m items of PPE to front line staff in NHS Wales and in Social Care. Staff across NWSSP have worked extremely hard to keep sufficient stocks of PPE available to meet demand and this is continuing as we move towards a potential 2nd wave of COVID 19 combined with the usual winter pressures. In anticipation of this, over 600m additional items of PPE are currently on order and, when delivered, will put us in a very strong position to be able to continue to meet demand going forward.
SSPC members and other key stakeholder groups are shortly to be surveyed on their views of NWSSP’s performance across all services during the crisis so that lessons can be learnt so we can understand what can be improved upon in future.
IP5 - The establishment of specialist laboratories in IP5 continues and NWSSP have been working with Public Health Wales, Welsh Government and the Department of Health & Social Care to support the construction of the laboratories on the 1st floor. The principles behind these developments have been agreed by the IP5 Project Board. Leases and memoranda for the occupation are currently being drawn up and implemented to govern the arrangements that cover the occupation of the building for this purpose. Audit & Assurance - All 2019/20 annual opinions have been issued and presented to Audit Committees. Revised plans for 2020/21 have been agreed by Audit Committees and work is underway at all health bodies. Plans are likely to change again depending on the continued impact of COVID-19 and Audit & Assurance will continue to be flexible and work with health bodies to agree any 1 further changes that will need to be made. Employment Services – the recent announcement of the retirement of the Director of Employment Services, Paul Thomas, with effect from 31 October, has provided the opportunity to strategically realign the Employment Services portfolio formally under the direction and leadership of our Workforce Director Gareth Hardacre. 2. Items for Approval Quarter 2 Plans – Alison Ramsey introduced the paper on the Q2 Plans. The key messages in our submission were:
We have not stood down any of our core services during the period and performance levels have been maintained. We have adapted quickly to the needs of the NHS in Wales; solution focussed and dynamic in our response. We continue to forecast a breakeven outturn for 2020/21; this includes a significant increase in the level of income and expenditure in 2020/21 compared with our IMTP. We have adopted a number of new ways of working. The most significant of which in terms of scale, risk and cost has been providing PPE supplies to the wider healthcare areas: social care, funeral directors and the four family practitioner areas. We revised our Scheme of Delegation to facilitate rapid decision making and maintain sound governance, particularly to secure supplies of priority stocks including oxygen, PPE, ventilators and beds. We moved the majority of our workforce to a home working model within a few weeks, and our ICT infrastructure has proved to be resilient. This was facilitated through the provision of additional capital provided by Welsh Government. We have brought forward a number of planned initiatives that were included in our IMTP: roll-out of Office 365, adoption of agile working and a review of our contact centres. We have extended the consultation process and postponed the TUPE process for the Laundry service programme until April 2021 to avoid disruption to planning for winter pressures and a potential second peak of COVID-19. We paused the Medical Examiner service programme, but this has resumed from 1 July.
Q2 continues to be a challenge as we aim to evaluate the new ways of working we have adopted quickly, re-focus on our planned service improvements for 2020-21, enable our staff to take a well-earned break, whilst planning with our customers for a potential second peak to COVID-19. We are well placed to meet the challenge but we are seeking confirmation on a number of revenue and capital funding streams to help us achieve our aims for the year ahead.
The Committee APPROVED the Q2 Plan for submission. The Committee separately NOTED two papers on the Planning and Recovery Group, and its successor, the Adapt and Future Change Group, which were provided in support of this item.
2 All-Wales Laundry Programme Business Case – the agenda item was introduced by the Capita consultant who has been engaged on the Programme. She reminded Committee members of the progress achieved thus far and outlined the specific elements of the Business Case. There was a detailed discussion on the report and she outlined the detailed information that was required by Welsh Government to satisfy their initial feedback on the initial OBC. She also highlighted the further information that would be required as part of the next stage. The Committee APPROVED the Business Case for submission to Welsh Government.
Temporary Medicines Unit – An update was provided on progress with the Unit which is governed by a Project and Service Management Board. The build of the facility is well advanced within IP5 with completion expected at the end of July. Validation work is being programmed for August with the aim of declaring the unit functionally ready to use from September onwards, if the COVID situation should require. A Technical Agreement has been drawn up, in consultation with the Chief Pharmacist Group and other key stakeholders, covering the respective responsibilities of the TMU Service and the Health Boards in the supply of medicines. In summary: The TMU is a Technical & Professional Service; All Clinical responsibilities and decisions lie with the Health Boards; and The TMU will only make and supply the products which the Health Boards request. The Chief Pharmacist Group have now endorsed the agreement, and the Committee were therefore content to APPROVE the Technical Agreement.
Single Lead Employer ‐ The Committee received an update on progress with the project and also a request to approve a set of revised operating and management governance framework documents required to support the expansion of the current SLE Model from 30 July 2020. The Committee APPROVED the documents and also noted that if there were any further minor changes or amendments required, they were happy to delegate these to the Project Board. Any significant changes would however need to be brought back to the SSPC in September 2020
Amendments to Standing Orders - The Committee:
NOTED the extension of the increased financial limits for COVID-19 expenditure to 30 September 2020 which was approved by the June Velindre Trust Board; and
ENDORSED the amendments directed by Welsh Government relating to the temporary disapplication of tenure of office of the Chair prior to formal approval by the Velindre University NHS Trust Board.
Service Level Agreements 2020/21 The Committee APPROVED the core Service Level Agreements for 2020/21
3 noting that there were no significant amendments from the prior year. 4. Items for Noting Medical Examiner Update – the impact of COVID 19 meant that the implementation timeframe had to be suspended in March, with Medical Examiner Service capacity at that point diverted to support Health Boards manage the impact of the disease on the death certification process.
Finance & Workforce Report - NWSSP had achieved a small surplus of £11k for the 2019/20 financial year. The accounts have now been formally audited by Audit Wales and the position confirmed. This has been separately reported to the NWSSP Audit Committee. The current forecast position for 2020/21 remains break even on the assumption that we are fully funded by Welsh Government for COVID related expenditure. The forecast outturn for the risk pool is consistent with that set out in the IMTP which will the risk sharing agreement to be invoked. Staff sickness is currently at very low levels, which may at least in part be due to a large number of staff being able to work from home.
Corporate Risk Register – The Register now contains the COVID-related risks that were previously reported separately. There are three red risks on the register relating to: the replacement of the NHAIS system which has had some technical difficulties but is still on-track to go live in October; the need to replace the Ophthalmic Payments system by September 2020 where work is on-going to develop an in-house system but contingency arrangements are in place to cover any delays; we have yet to receive confirmation of COVID funding from Welsh Government 6. Items for Information The following papers were provided for information: Finance Monitoring Reports (April, May, June 2020); and Audit Committee Highlight Report (June 2020). 7. Any Other Business There were no further items discussed. Matters requiring Board/Committee level consideration and/or approval
The Board is asked to NOTE the work of the SSPC and ensure where appropriate that Officers support the related work streams.
Matters referred to other Committees N/A Date of next meeting 17 September 2020
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