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Well-being Statement & Objectives 2017/18

Contents

Introduction ...... 3

Our Well-being Statement ...... 4

How we developed our Well-being Objectives ...... 4

Our Well-being Objectives ...... 6

Allocating resources to support our Well-being Objectives ...... 8

Embedding the principles of the Well-being of Future Generations (Wales) Act 2015 ...... 8

Working with our Public Service Boards ...... 9

Measuring our progress ...... 10

Appendix 1...... 11

Appendix 2...... 13

Appendix 3...... 14

Introduction

The Well-being of Future Generations (Wales) Act 2015 (the Act) is breaking new ground and Wales is the first country to legislate for the well-being of future generations through the establishment of seven national well-being goals and five ways of working:

A prosperous Wales – where everyone has jobs and there is no poverty

A resilient Wales – where we’re prepared for things like floods A healthier Wales – where everyone is healthier and are able to see the doctor when they need to A more equal Wales – where everyone has an equal chance whatever their background

A Wales of cohesive Communities – where Communities can live happily together A globally A Wales of vibrant culture and thriving Welsh language – where we responsible Wales – where we look have lots of opportunities to do after the Environment and think about different things and where lots of other people around the World. people can speak Welsh

Five Ways of Working

Appendix 1 provides a summary of how the national Well-being Goals and Five Ways of Working are defined by Welsh Government as some of the words have a slightly different meaning to that which we might generally use.

Our Well-being Statement

The University Health Board (the UHB) is publishing this Well-being Statement, as required by Section 7 of the Act, to set out its Well-being Objectives for 2017/18 and to describe how these will be linked to our Annual Plan submitted to Welsh Government.

Together, the seven Well-Being Goals for Wales and Five Ways of Working provided by the Act are designed to support and deliver a public service that meets the needs of the present generation, without compromising the ability of future generations to meet their own needs. This is called the Sustainable Development principle. Implementing the Act’s requirements will also support existing statutory commitments, such as the Welsh Language, Equalities and the United Nations Convention on the Rights of the Child.

We welcome our duties under the Act and the opportunities that this presents for public bodies, like the UHB. We are committed to working to make sure that when we make decisions we think about how it will affect people living in Wales both now, and in the future.

How we developed our Well-being Objectives

The UHB established a Task and Finish group drawing membership from across the organisation, and sought input from the office of the Future Generations Commissioner for Wales. Its role has been to steer the implementation of the Act’s requirements and be champions to support embedding this important new legislation. This new way of working is challenging us to review and re-focus our processes for establishing long-term priorities, which will have the greatest impact on meeting the needs of our population. We acknowledge that there is still much to do in order to demonstrate our contribution to all seven national Well-Being Goals, but we are committed to working with our staff, partners, public, stakeholders and the Future Generations Commissioner in order to embed the Act into our everyday working.

Under the Act, each specified organisation has both an individual and a collective duty, via Public Service Boards (PSBs), to set and publish objectives that are designed to maximise its contribution to the Well-being Goals, and to take all reasonable steps to meet these objectives. The UHB’s Public and 4

Patient Engagement Team used an engagement toolkit, which was developed regionally by PSB partners, during the Autumn 2016 Let’s Talk Health and Siarad Iechyd events. These engagement events were designed to generate valuable qualitative information from our population in relation to their current well-being and future well-being priorities. This information fed into the development of the UHB’s Well-being Objectives and the Well-being Assessments of our three partner PSBs. The UHB also used these engagement events as an opportunity to test out the continued relevance of the UHB’s Strategic Objectives as priority areas for 2017/18.

The UHB has agreed that there is strong alignment between our 10 Strategic Objectives and the contribution that as a health organisation we can make to the seven national Well-being Goals and the Five Ways of Working. Meeting the requirements of the Act is not just about setting particular actions or programmes, but embedding core approaches to Sustainable Development in all that we do. This will also support us to meet our duties under the Social Services and Well-being (Wales) Act 2014.

The UHB believes that it will be able to evidence the Five Ways of Working in the following ways:

Our Well-being Objectives are designed to respond to the long-term opportunities and challenges, such as inequalities in health, changes in technological innovation and responding to population demographics. We are involved in a number of different collaborative arrangements and this demonstrates our commitment to partnership working with individuals, communities and organisations. We are committed to the development of integrated services that support people to improve their health and well-being. We have considered how our Well- being Objectives align with and support the emerging Well-being Objectives of our partners. We are committed to fully engage and involve individuals (including children), families, communities and other stakeholders, including our staff, as we d evelop services and respond to challenges. The prevention and early intervention agenda is central to the UHB’s Well-being Objectives and reflects our ambition to become a population health organisation.

Our Well-being Objectives

The Board has agreed there is strong alignment of the Strategic Objectives set out in our Annual Plan submitted to Welsh Government, and their contribution to maximising the delivery of the principles of the Act and the seven national Well-being Goals for Wales. During 2017/18, the UHB has defined its Well- being Objectives as:

 Improve population health through prevention and early intervention;  Support people to live active, happy and healthy lives;  Improve efficiency and quality of services through collaboration with people, communities and partners; and  Ensure a sustainable, skilled and flexible workforce to meet the changing needs of the modern NHS.

The UHB’s Well-being Objectives naturally reflect the contribution that the organisation will make to A Healthier Wales. However, we believe that the actions we take to address our Well-being Objectives will also make a contribution to other national goals which we have illustrated in a table in Appendix 2. The table below demonstrates how the Well-being Objectives will be achieved through the specific action plans for each of our Strategic Objectives and Enabling Plans. Further information on the action which will be taken during 2017/18 to achieve our Well-being Objectives is included in Appendix 3, with the detailed action plans included in our Annual Plan.

The UHB recognises that a stepped approach to implementing the requirements of the Act will be needed and has therefore chosen to focus on a smaller number of Well-being Objectives, which align with the Strategic Objectives and Enabling Plans within our Annual Plan. The more limited, but focused approach will allow the UHB to explore how this new legislation can be implemented in a meaningful way. The UHB acknowledges that greater consideration will be needed in future to ensure our Well-being Objectives take account of, and describe how our contribution can be maximised in relation to all seven of the national Well-being Goals for Wales. Further work will be undertaken during 2017/18 in conjunction with staff, stakeholders and the public. This will also be informed by the on-going development of PSBs’ Well- being Plans and Well-being Objectives. It is essential that there is synergy between our individual contributions as organisations working together to improve well-being for the people of Hywel Dda.

Hywel Dda UHB Well-being Objectives 2017/18 Improve Support people Improve efficiency Ensure a Link to Hywel Dda UHB’s Population to live active, and quality of sustainable, 10 Strategic Objectives & Health through happy and services through skilled and Enabling Plans prevention and healthy lives collaboration with flexible workforce early people, to meet the intervention communities and changing needs of partners the modern NHS   Risk Taking

Behaviours

  Overweight and

Obesity

 Cardiovascular

Disease

 Cancer 

 Diabetes

 Respiratory

  Mental Health and  Wellbeing

  Frailty and

Dementia

 Productivity and

Quality

 Outcomes, Delivery

& Financial Stability

Workforce and  Organisational  Development  Finance

Infrastructure 

investment Research &  

development, and innovation   Digital Health

Enablers Governance,     Communications & Engagement Welsh Language    

Equality &     Diversity Carers    

Allocating resources to support our Well-being Objectives

The Act requires that we publish a statement detailing how as a public body we will ensure that resources are allocated annually to meet our Well-being Objectives. As our Well-being Objectives are aligned to the UHB’s Annual Plan, the resources to enable the actions described in Appendix 3 to be achieved in 2017/18 have been identified through the annual budget setting process. In future years, this will be a fundamental part of our Integrated Medium Term Plan (IMTP) development, which is subject to approval by Welsh Government.

Embedding the principles of the Well-being of Future Generations (Wales) Act 2015

The UHB is committed to using the Act in its decision making to contribute to improving the social, economic, environmental and cultural well-being of Wales.

The UHB is currently revising its Integrated Impact Assessment (the Toolkit) and SBAR (Situation, Background, Assessment, Recommendation) paperwork to ensure that consideration is given to how the Five Ways of Working and seven Well-Being Goals will be demonstrated in any future proposals. The revised templates and the Toolkit will form part of our business planning, governance and reporting processes to ensure that consideration is given to the Act in all decisions made by the Board, Committees, Executive Team or at Directorate/Team level, and how our contribution to the seven national Well- being Goals for Wales can be demonstrated and maximised. This approach will provide a foundation for ensuring that appropriate resources are allocated to services or development plans and will form a key part of the Board Assurance Framework (BAF).

The Task and Finish group will also develop a plan for communication and engagement both with our public and with our workforce. Internal communication and engagement will be fundamental to ensuring that awareness is raised about the requirements of the Act, how the UHB is working to implement this, and how at an individual, team or directorate level the workforce can demonstrate its commitment to the Act. This will be central to our work of embedding the Act within the organisation.

To date, we have focused on our public engagement activities as part of the development of each of the PSB’s Well-being Assessments. We recognise that we need to learn from our early public engagement work to ensure that in future we are involving people who represent the rich diversity of cultures, communities and service users of the Hywel Dda area. 8

We will continue to work collaboratively with our PSB partners in order to make the best use of our resources and implement a consistent approach to public engagement, which extends beyond the boundaries of individual organisations. In particular, we will be seeking to ensure dialogue and involvement of specific communities or patient groups who have diverse needs, and those who are considered to have protected characteristics.

Working with our Public Service Boards

As a member of Carmarthenshire, Ceredigion and Pembrokeshire PSBs, the UHB has been working as part of both local and regional groups to support the development of the PSB Well-being Assessments. The UHB is a member of three PSBs within each of our local authority areas: Carmarthenshire, Ceredigion and Pembrokeshire.

Over the past 12-months the UHB has:

 Participated in a regional Well-being data group – reviewing existing data sources to feed into knowledge about the current state of well-being. The Local Public Health Team has played a central role in this work.

 Participated in a regional Well-being engagement group – the group designed a regional Well-being Survey and a toolkit which provided a framework for undertaking public engagement activities.

 Implemented the regional engagement toolkit - this was utilised by the UHB’s Public and Patient Engagement Team to shape the delivery of the Autumn 2016 Let’s Talk Health and Siarad Iechyd events. These events generated valuable qualitative information about the views of our population in relation to their current well-being and future well-being priorities. We also used these events to test out the continued relevance of the UHB’s Strategic Objectives.

 Participation in local PSB’s editorial groups – the UHB has been represented and has contributed to the development and structure of the Well-being Assessments each PSB is required to publish.

Work is now commencing on the development of PSB’s Well-being Plans and Well-being Objectives, which will set out how organisations, including the UHB, will work collaboratively with our partners to improve well-being in our communities. This is a new way of working and the Board acknowledges that there will need to be synergy between Well-being Plans of each organisation,

and the actions that we identify to take forward needs to focus on how the expertise of the UHB can contribute to the wider Well-being Goals.

Measuring our progress

The National Well-being Indicators will help us to measure whether our collective efforts are having an impact on outcomes for the Welsh population. In addition, we will also measure progress towards delivering our Well-being Objectives through the established organisational governance processes (our Business Planning and Performance Assurance Committee).

The table below demonstrates the link between our Well-being Objectives and the National Indicators for Wales and establishes a line of sight between our local organisation actions and the contribution this will make towards national outcomes for the Welsh population.

Well-being Objective Contribution to National Indicators

Improve population health through prevention 1, 2, 3, 4, 5, 6, 24 and early intervention

Support people to live active, happy and 1, 2, 3, 5, 6, 24, 29, 30, healthy lives 35, 38

Improve efficiency and quality of services 23, 24, 26, 27 through collaboration with people, communities and partners

Ensure a sustainable, skilled and flexible 16, 28 workforce to meet the changing needs of the modern NHS

We will publish an annual report in 2018, as required by Section 13 (Part 2) of the Act to demonstrate how during 2017/18 we made progress in meeting the Well-being Objectives we have set.

Appendix 1

The table below provides the official definition used by Welsh Government to describe the seven national Well-being Goals.

Wales’ National Well- being Goals Official Definition used by Welsh Government

An innovative, productive and low carbon society which recognises the limits of the global environment and therefore uses resources efficiently and proportionately (including acting on climate change), and which develops a skilled and well-educated population in an

economy which generates wealth and provides employment opportunities, allowing people to take advantage of the wealth generated through securing decent work. A nation which maintains and enhances a biodiverse natural environment with healthy functioning ecosystems that support social, economic and ecological resilience and the capacity to adapt to change (for example climate change).

A society in which people’s physical and mental well- being is maximised and in which choices and behaviours that benefit future health are understood. A society that enables people to fulfil their potential no matter what their background or circumstances (including their socio economic background and circumstances). A nation which, when doing anything to improve the economic, social, environmental and cultural well-being of Wales, takes account of whether doing such a thing makes a positive contribution to global well-being.

A society that promotes and protects culture, heritage and the Welsh language, and which encourages people to participate in the arts, and sports and recreation.

Attrative, viable, safe and well-connected communities.

There are five (5) things that public bodies need to think about to show that they have applied the sustainable development principle. These are set out in the table below.

Five Ways of Working

Looking at the long term so that we do not compromise the ability of future generations to meet their own needs.

Understanding the root causes of the issues to prevent them happening in the first place.

Working with others in a collaborative way to find shared sustainable solutions.

Involvement of a people in decisions that affect them, and ensuring that those people reflect the diversity of our area.

Taking an integrated approach so that we consider how our well-being objectives may impact upon each of the

well-being goals, and on the objectives of other public bodies.

Appendix 2

The table below describes how the UHB’s Well-being Objectives link to the seven Well-being Goals of the Act.

Hywel Dda University Health Board’s Well-being Objectives Improve Support Improve Ensure a population people to efficiency and sustainable, Wales’ Well- health live quality of skilled and being Goals through active, services flexible prevention happy through workforce to and early and collaboration meet the intervention healthy with people, changing lives communities needs of the and partners modern NHS

   



   



   

Appendix 3

Well-being Objective 1: Improve population health through prevention and early intervention

Why we have chosen this objective:

The UHB has articulated its ambition to become a population health organisation and to encourage and support people to make healthier choices for themselves, their children, their families and their communities. There is compelling evidence that a child’s experiences in the early years (0-4), has a major impact on their heath and life chances, as both children and adults, but we also need to continue to tackle some of the major public health challenges.

Overweight and obesity remains a major public health challenge in Hywel Dda for both children and adults. Being overweight or obese can cause many psychological and physical problems including, increased risk of Type 2 Diabetes, cardiovascular disease, certain types of cancer, bone and joint conditions and physiological issues such as low self esteem.

The health impact of associate with the misuse of alcohol is considerable; more people die from alcohol related causes than from breast cancer, cervical cancer and MRSA infection combined. Fetal alcohol syndrome is also a risk to the babies. Misuse of drugs, both legal and illegal, and other mind-altering substances such as solvents, can damage health in a variety of ways. These include fatal overdoses, addiction, mental health problems, and infections caused by injecting.

Whilst overall smoking prevalence continues to decline, this remains a priority area given the impact of smoking on long term health. In addition, preventative screening and health check programmes are central to improving individual health and well-being outcomes to address heart disease, stroke, cancers, diabetes and respiratory illness.

Proposed Actions during 2017/18:

 Continue to implement the All Wales Obesity Pathway to ensure a holistic approach to tackling overweight and obesity.  To increase service capacity to support smoking cessation through expansion of the Hospital Smoking Cessation Service and ensuring wide ranging uptake and full implementation of Community Pharmacy Level 3 Smoking Cessation Services.  Continue to provide support for the further roll out of the Alcohol Liaison Service.  Implementation of the Living Well, Living Longer health check programme.  Development of telemedicine links for key tumour pathways e.g. Oncology Dermatology.

Examples of how we will measure success:

 Our target for smoking cessation is to reduce prevalence to 16% by 2020 (from 18% now).  Reduce the number of people who drink above the daily recommended guidelines by 1% by 2020, and by 2% the number of people who binge drink on a weekly basis.  Reduce drug related deaths by 5% by 2020.  Reduce childhood obesity by 1.0% and adult obesity by 0.5% by 2010.  Increase the number of patients aged >50 who have had their blood pressure measured towards a target of 92%.  Increase the update of bowel screening by 5% by 2020.

Well-being Objective 2: Support people to live active, happy and healthy lives

Why we have chosen this objective:

Living healthy and independent lives allows us to fulfil our potential, meet our educational aspirations and play a full part in the economy and society of Wales.

Actions that support people from birth through to old age will maximise health and well-being throughout life. This Well-being objective has strong alignment to Objective 1 as many of the underpinning actions in relation to prevention and early intervention will impact on an individual’s ability to live an active, happy and healthy life.

Proposed Actions during 2017/18:

 Introduce a Diabetes self management programme for patients deemed suitable.  Development of telehealth solutions to deliver care closer to home.  Pilot telephone helpline service for patients with prostrate disease (to support faster access to treatment for “watch and wait” patients with developing symptoms).  Establish a cancer ‘Survivorship’ Task and Finish Group to scope gaps and priorities for development.  To further develop the Local Primary Mental Health Support Service, incorporating the development of primary care memory services.  To commission a range of residential and supporting living schemes for both Mental Health and Learning Disability services jointly with our local authority partners.  Frailty Specialty Nurses in place working alongside primary care pharmacists to support proactive care in community and residential/nursing home settings.

How we will measure success:

 Reduce the number of amputations for people with diabetes by 50%.  All people with Type 1 and Type 2 diabetes are offered a self management programme.  Every person with Chronic Obstructive Pulmonary Disease attends a self 16

management programme.  19% reduction in the UHB’s suicide rate per 100,000 population.  Increase the number of health professionals taking up training and education in dementia.

Well-being Objective 3: Improve efficiency and quality of services through collaboration with people, communities and partners

Why we have chosen this objective:

Given the economic austerity there is a continued drive to ensure that money is well spent in the most effective way and in a prudent approach. Work on community resilience and strong links with the third sector are an important mechanism to progress community involvement and co-production.

There is also enormous potential to build the level of communication that takes place between the patients and the healthcare system through digital means, providing patients with more rapid access to services and aiding efficiency within the organisation.

Proposed Actions during 2017/18:

 Develop a Clinical Services Strategy to ensure that services are sustainable and capable of delivering to agreed standards.  Strengthening primary care, community and other out of hospital services.  Further development of regional collaborative arrangements to deliver services, such as the Mid Wales Health Care Collaborative, A Regional Collaboration for Health (ARCH) and the West Wales Care Partnership.  Embedding innovation and research in local service delivery through our involvement in the ARCH and the Mid Wales Health Care Collaborative.  Development of the Cylch Caron project in Tregaron to bring together primary and community health services, social care and housing services in a very rural part of Ceredigion.  Explore technologies to accelerate citizen engagement in their health and wellbeing, and bring care closer to home.  Delivery of an active offer concept so that members of the public don’t need to ask for services in Welsh, but that they are automatically offered.

How we will measure success:

 Use digitally-enabled services routinely to monitor long term health conditions and daily tasks to support independent living.  Establishment of pooled budget arrangements for commissioning of Care

Homes.  All papers presented to Board to include equality impact assessment.  Evidence of increased engagement with protected groups.

Well-being Objective 4: Ensure a sustainable, skilled and flexible workforce to meet the changing needs of the modern NHS

Why we have chosen this objective:

Supporting people to stay in stable jobs and sustain long-term employment reduces the chances of unemployment and poverty. Recruitment has been a priority across all clinical groups and we need to work collaboratively to secure innovative solutions to our workforce challenges.

Proposed Actions during 2017/18:

 Working with local schools to increase awareness of the opportunities available to them across the NHS.  Development of a “Grow your Own” project which enables Support Workers to enter nurse degree or other professional registration programmes.  Development of integrated roles working across Local Authority and NHS boundaries through ARCH (A Regional Collaboration for Health) and our work with the West Wales Care Partnership.  Development of joint workforce models across Mid Wales for Unscheduled Care as part of our work with the Mid Wales Healthcare Collaborative.  Development of links through ARCH to ensure our workforce is provided with educational opportunities to increase their skills.  Establish twenty (20) apprenticeships in a range of areas including informatics, business administration and estates.

How we will measure success:

 Reductions in variable pay costs for agency and locum staff.  Increase in staff retention.  Develop a Carers Policy in order to support the workforce with their caring responsibilities.