Bwrdd Iechyd Cwm Taf Health Board

Annual Report 2010-11 Contents

Message from the Chair and Chief Clinical Services – Service Executive 4 Developments and Improvements 42 About the Health Board 6 Workforce and Organisational The Health Board Development (OD) 47 Committees Job Centre Plus Award Management Arrangements Health & Wellbeing Directors Interests Working in Partnership Governance 10 European Working Time Regulations Workforce Planning Health and Safety Learning and Development Freedom of Information Act 2000 Policy Development and Equal Opportunities Information on Emergency Preparedness Organisational Development (OD) Statement of Internal Control The Future Public Health 19 Our Workforce in Numbers What are our strategic priorities and where do we want Partnership Working 52 to be in 2015? Local Service Boards What are our key achievements this year? Health, Social Care and Wellbeing Partnerships Acute Stroke Services (HSCWB) – Merthyr Tydfi l and Rhondda Cynon Taff Research & Development 30 Children and Young People’s Partnerships – Merthyr Developments Tydfi l and Rhondda Cynon Taff Achievements Community Safety Partnerships – Merthyr Tydfi l and R&D Activity Rhondda Cynon Taff Forward Plan – Aims and Objectives 2011-2012 Welsh Health Specialised Services Patient Care and Safety 34 Committee (WHSSC) 57 Clinical Governance Arrangements Fundamentals of Care Welsh Health Estates 59 Complaints & Compliments 38 Facilities 60 Compliments Looking Forward to 2011-12 63 Performance 41 Financial Performance and Review 64 Waiting Times Targets Cancer Access Targets Accident and Emergency (A&E) Targets Prince Charles Hospital Aberdare Hospital Mountain Ash Hospital

St Tydfi l's Hospital Royal Glamorgan Hospital Dewi Sant Hospital

Ysbyty Cwm Rhondda Ysbyty George Thomas Pontypridd & Cottage Hospital

For further copies of this report, copies of the full audited accounts and any information regarding the Health Board, please contact: Mrs Amanda Powell, Head of Corporate Services Cwm Taf Health Board, Ynysmeurig House, Navigation Park Abercynon, Rhondda Cynon Taff CF45 4SN

A large print version of this report is available on request.

© Cwm Taf Health Board 2011 Mrs Allison Williams, Chief Executive

Dr Christopher Jones, Chairman

Message from the Chair and Chief Executive It gives us both great pleasure to introduce this the second Annual Report for Cwm Taf Health Board. We hope you fi nd this document both interesting and informative.

The Annual Report is an opportunity to highlight levels of immunisation, working with Community our achievements and successes in delivering health Pharmacies to provide access to advice and self- care across Cwm Taf and to demonstrate how we help through to specifi c campaigns such as helping sought to ensure the best use of the resources pregnant mothers to give up smoking. This is a long available to us over the last year. journey to improving the health of people living Firstly, we would like to take this opportunity to in Cwm Taf and one which we are committed to sincerely thank all our staff for their continued hard working really hard, together with our partners in work and dedication to delivering the very best Local Government, other statutory partners and the possible healthcare for our population. From some Voluntary Sector to deliver. of the fantastic feedback we get from local people, Working together, our hospital Consultants, Nurses we know that our staff frequently go the extra mile and General Practitioners have made great progress to support patients and their families during diffi cult in developing services in the community to avoid the times and we are very proud of their efforts to need for unnecessary trips to hospital. From direct- balance the need for quality whilst at the same time access to tests in the community to moving specifi c helping to make the progress necessary to allow us treatments from outpatients to the GP surgery this to achieve our fi nancial and service targets. is all part of a long-term programme of improving This last year has seen many changes and access for our patients in their local community. developments in the way in which we deliver We have been able to secure signifi cant capital services as well as our environments of care. We funds to redevelop services in the Merthyr Tydfi l and have focused efforts on health promotion to assist Cynon Valley areas. This long overdue investment in people in our community to keep well and prevent our hospitals and clinics reconfi rms our commitment ill-health. This has ranged from continued high to provide high quality services as locally as possible.

4 Cwm Taf Health Board Annual Report 2010-11 During 2010/11 on the Prince Charles Hospital It was, therefore, particularly pleasing that staff site we have opened the new Day Surgery Unit, delivering these services received national awards the new Emergency Care Centre and Orthopaedic and further details are available within the report. and Fracture clinics, newly refurbished Wards 7 & Once again the vast majority of patients were 8 and the Macmillan Cancer Care Unit. Other key satisfied with the care provided to them and many developments have seen the building work start on took the opportunity to make complimentary the new Merthyr Tydfil Health Park, and the opening comments and relay messages of thanks to the of the new Treharris GP practice. Work has also staff. However, despite our very best efforts, we progressed well with the new Cynon Valley Hospital know that sadly we don’t always get things right which will open in the next few months. for our patients and one of the key things we Ysbyty Cwm Rhondda opened its doors to patients have done over the last year is review our systems in January 2010 and has now been operational and processes for resolving concerns when they for 18 months. A new MRI Scanner has been are raised with us. I am pleased to say that by operational in the Royal Glamorgan Hospital since the end of 2010/11 we had put in a new set of April 2011 and approximately 18 patients per day arrangements which, we strongly believe will benefit from this service. be well received by our community. Openness Like all other Health Boards in Wales, the financial and transparency is critical to ensure trust and position over the last 12 months has been extremely confidence in local services and this is something challenging and we have been required to deliver that we and our Board is fully committed to significant financial savings to meet our statutory delivering. financial obligations. In developing and delivering We would like to thank all Board Members these programmes, patient care and safety has including our newly appointed Associate Members been paramount and we are pleased that as well and staff side representatives for their hard work, as breaking even we also received an unqualified expertise and commitment to ensuring that we opinion on the annual accounts from our external continue to deliver the best possible health services auditors. for the people of Cwm Taf. In year progress was also made in our performance We would like to specifically take this opportunity against key performance targets included in Welsh to offer our sincere thanks to Mrs M Foster who Government plans such as the Annual Quality retired as Chief Executive following a long and Framework, National Service Frameworks and other distinguished career in healthcare management health care strategies. and also to Dr Chris Turner for all his support as an We are committed to further developing and Independent member of the Board during his term enhancing effective joint working with partner of office with us. organisations through continuing to roll forward Finally, we believe that the Board is better placed “Setting the Direction - Primary and Community to meet the challenges ahead – developing primary Services Strategic Delivery Programme” and and community services, improving standards, embedding our locality arrangements. The strengthening governance, creating financial establishment of a Joint Local Service Board with sustainability and above all improving the health our two Local Authorities has progressed well and and well being of our communities. this is enabling us to develop joined up Health and Social Services Strategies and single plans in services such as Children and Young People. We are determined to ensure that quality, safety and strong governance are at the heart of our organisation. Accordingly, we are working jointly with Healthcare Inspectorate Wales to review our current arrangements and agree how we can further enhance and improve them. We are very proud of the excellent standards of care that we are providing to our local population.

Cwm Taf Health Board Annual Report 2010-11 5 About the Health Board

About the Health Board Our vision is to prevent ill health, protect good health and promote better health by providing services as locally as possible and reducing the need for hospital inpatient care wherever possible.

Local Health Boards are statutory bodies established The Health Board by and accountable to the Welsh Government. Cwm Taf Health Board was established on 1 The organisation is led by a Board of Directors made October 2009 and provides a full range of high up of a Chairman, Vice Chairman, Independent quality hospital and community based services to Members, a number of Executive Directors and the residents of Rhondda Cynon Taf and Merthyr Associate Members. The Chairman, Vice Chairman, Tydfil. Independent Members and Associate Members are appointed for fixed term periods by the Welsh The development of the NHS in Wales is guided by Government and the date of the current term for key strategic documents including “Designed for each is shown below. Executive Directors are full Life”, “Improving Health in Wales” and “Setting time NHS Professionals, are appointed by the Board, the Direction – Primary and Community Services and hold full permanent contracts of employment. Strategic Delivery Programme”. These are reflected Each Independent Member has a specific area of locally in the Annual Quality Framework and Health, responsibility and this is illustrated below also. Social Care and Well Being Strategies, and each have a profound effect on the way in which Health The Board determines policy and sets the strategic Boards develop and provide their clinical services. direction, ensures there is effective internal control and that high standards of governance and behaviour are maintained. It also ensures that the Health Board is responsive to the needs of its communities.

6 Cwm Taf Health Board Annual Report 2010-11 About the Health Board

Chairman Director of Public Health • Dr Christopher Jones (until 31 March 2012) • Mrs Nicola John Vice Chair Director of Workforce & Organisational • Professor Vivienne Harpwood (until 31 March Development 2013) • Mr Ian Stead Independent Members Director of Primary Care, Community & • Councillor Russell Roberts (Local Authority until 7 Mental Health Services May 2012) • Mrs Allison Williams (ended 7 Mar 2011) • Mr John Hill-Tout (Finance until 31 March 2013) Board Secretary / Corporate Director • Dr Chris Turner (University until 31 March 2011) • Mr Stephen Harrhy • Mr Anthony Seculer (Legal until 31 March 2013) Formal business meetings of the Board are normally held monthly and are open to members of the • Mr Geoff Bell (Community until 31 March 2013) public. The Chief Officer and Chair of the newly • Councillor Clive Jones (Community until 31 established Cwm Taf Community Health Council are March 2013) invited to attend. The agendas, supporting papers • Mrs Jennifer Ludlow (Third Sector until 29 and minutes of Board meetings are available for February 2012) public access on the website: http://www.cwmtafhb.wales.nhs.uk • Professor Donna Mead (Community until 31 March 2012) Committees • Mrs Gaynor Jones (Staff Side until 31 March 2013) The Board has five sub Committees, the role and membership of which is as indicated below: Associate Members Integrated Governance Committee – set up • Mr Ellis Williams (Director of Social Services until to scrutinise evidence and information brought 31 May 2012) before it in relation to activities and potential risks • Councillor Gareth Jones (Chair of the Stakeholder which impact on the services provided and provide Reference Group) assurance to the Board that effective governance • Vacancy (Chair of the Healthcare Professionals and scrutiny arrangements are in place across the Forum) Health Board. Chief Executive The Committee is chaired by Dr C D V Jones, • Mrs Margaret Foster (until 4 March 2011) Chair of the Health Board and the members are the Chief Executive, Audit Committee Chair and • Mrs Allison Williams (from March 2011) Lead Director, Quality, Patient Safety & Public Director of Finance & Procurement / Health Committee Chair and Lead Director and the Deputy Chief Executive Corporate Risk Committee Chair and Lead Director. • Mr David Lewis Remuneration Committee – advises the Board on Director of Strategic & Operational salaries and terms of service for Executive Directors Planning and Senior Managers and is made up of the Chair • Mrs Alison Lagier of the Board and all Independent Members. The Chief Executive and Director of Workforce and Executive Nurse Director Organisational Development are in attendance at • Ms Angela Hopkins the meetings. Medical Director Audit Committee – reviews the internal and • Mrs Shona Sullivan (until 30 Sept 2010) external processes, monitors compliance with • Mr Kamal Asaad (from October 2010) legislation, monitors the management of the Health Board’s financial affairs and reviews internal Director of Therapies & Health Sciences control. Mr John Hill-Tout chairs the Committee • Mr Christopher White and Dr Chris Turner, Mr Geoff Bell, Councillor Clive

Cwm Taf Health Board Annual Report 2010-11 7 About the Health Board

Jones and Mrs Gaynor Jones are members. The An Expert Claims Panel has been established Director of Finance and Procurement and the Board to consider individual claims and consider the Secretary/Corporate Director are in attendance at Health Board position in respect of its ability to the meetings. admit liability and settle, or to defend the case. Corporate Risk Committee – provides the Mr A Seculer chairs the Panel and Mrs M S Foster, Board with assurances that the Health Board has Mrs J Ludlow, Mrs S Sullivan, Ms A Hopkins, Mr appropriate arrangements for effective internal S M Harrhy, Mr C White and Mr D H Lewis were control, and for the identification and management members. of risk. Dr C Turner chairs the Committee and Professor D Mead, Mrs J Ludlow, Cllr R Roberts, Management Mr D H Lewis, Mrs S Sullivan, Mrs A Williams, Mr I Arrangements Stead, Mr S M Harrhy, Mrs A Lagier, Mrs M S Foster, The Chief Executive is accountable to the Health Ms A Hopkins, and Mr C White were members. Board for ensuring that its health care services are Quality, Patient Safety & Public Health effective, and that the Health Board’s activities are Committee – provides the Board with assurances managed in an efficient manner. Clinical services are that the Health Board has appropriate arrangements managed through a number of Clinical Divisions, for effective internal review and management of each led by an Executive Director who is supported clinical governance. Professor V Harpwood chairs by a triumvirate team of three people who jointly the Committee and Mrs M S Foster, Mrs A Williams, share responsibility i.e. an Assistant Medical Mr D H Lewis, Professor D Mead, Mr G Bell, Mrs S Director, Divisional Nurse and Divisional General Sullivan, Ms A Hopkins, Mr S Harrhy, Cllr C Jones Manager. Executive Directors, the Board Secretary / and Mrs N John were members. Corporate Director and their staff provide a range of The Health Board also has a Complaints Panel that necessary support functions to assist and facilitate monitors the nature and resolution of complaints the activities of the Clinical Directorates. about services. Mrs J Ludlow chairs the Panel and The Executive Directors, the Board Secretary / Mr A Seculer, Professor D Mead, Mr S M Harrhy, Corporate Director and Assistant Medical Directors Mrs M S Foster, Mrs S Sullivan, Ms A Hopkins and collectively form the Executive Group which advises Mr C White were members. the Board on strategic direction and implements Health Board policy. The Board and each individual Director have confirmed that the conduct of business will be in accordance with the Standing Orders and Standing Financial Instructions, both of which are based on the models for the NHS in Wales. All professionals are also bound by their relevant Codes of Conduct.

8 Cwm Taf Health Board Annual Report 2010-11 About the Health Board

Directors Interests Mrs Jennifer Ludlow • Trustee Voluntary Action Merthyr Tydfil Directors have declared the following interests which may be relevant to the business of the Health • Panel Member Care Council Wales Board: • Jenny Ludlow Consulting Dr Christopher Jones • Member of Alzheimer’s Society (Merthyr Tydfil • Partner at Taff Vale Medical Practice Branch) and Chair (until Jan 2010) • Member of the Bevan Commission from July Professor Donna Mead 2010 • Dean of Faculty of Health Sport and Science, Professor Vivienne Harpwood University of Glamorgan • Professor of Law Cardiff University • Governor Neath Port Talbot Further Education College • Member of the National Information Governance Advisory Board • Director Habren • Involved with the Samaritans Mrs Margaret Foster • Governor – Howells School Llandaff • Non Executive Director Skills for Change Board Councillor Russell Roberts • Husband Consultant Surgeon • Rhondda Cynon Taf County Borough Councillor • Spouse – shareholder in Astra Zenecca • Member of the South Wales Police Authority Mr David Lewis • Member of the Improvement & Development • Member of the Audit Committee, Cardiff Agency Board University • Son employed as a Junior Doctor at Royal • Non Executive Member of Board of University of Glamorgan Hospital Glamorgan from 10 Feb 2011 Mr John Hill-Tout Ms Angela Hopkins • Trustee – Relate Cymru • Royal College of Nursing Accreditation Board Member • Wife Member Cwm Taf Community Health Council Mr Ian Stead Dr Chris Turner • Dolen Cymru / Lesotho – Wales Link Health Committee Member • Director of Registry, Governance and Students Cardiff University Mrs Allison Williams Mr Anthony Seculer • Director Wales Management Council • Secretary / Legal Adviser to South Wales Register of Interest for Welsh Health Specialised Probation Trust Services Committee (WHSSC) is available from the Mr Geoff Bell Committee Secretary in WHSSC at www.whssc. wales.nhs.co.uk • Chair of the Board of Directors / Trustees of Brynawel House Alcohol Rehabilitation Centre • Board Member of Interlink • Member of the Lord Chancellor’s Advisory Committee for Mid Glamorgan (voluntary) Councillor Clive Jones • Elected Councillor Merthyr Tydfil County Borough Council • Merthyr and the Valleys Mind • Cross Road Care Cwm Taf

Cwm Taf Health Board Annual Report 2010-11 9 Governance

Health and Safety These policies are supported by operational procedures, which include: Effective risk and safety management is dependent • Anti-Social Behaviour Referral upon ownership of the management of risks throughout the whole of the organisation. • Fire Policy The development of the Health Board’s risk • First Aid and Provision of First Aid Equipment systems have aimed to simplify processes and • Display Screen Equipment enable managers to assess their risks and generate • COSHH Procedures risk assessments and registers, manage reported incidents and produce statistical reports. These web • Personal Protective Equipment based systems will be backed up by paper based • Local Fire Procedures documentation until they have been rolled out across the Health Board. Operational Health & Safety The review of Risk & Safety Policies has been The Head of Operational Health, Safety & Fire and maintained in accordance with the Risk/Safety Team continue to support managers in addressing Policy Development Plan and included the following health and safety risks and issues. documents: Identicom Lone Worker Alert • Risk Management Strategy System • Risk Management Policy The Health Board is participating in an all-Wales • Workplace Safety and Health Policy alert system for high risk community lone working NHS staff. This system, provided by Reliance Protect, • Risk Assessment Procedure has been purchased via the Welsh Government • Management of Violence and Aggression Policy to address the recommendations made by the • Prevention and Management of Musculo-Skeletal Ministerial Taskforce on Violence and Aggression in Disorders the NHS. • Asbestos Management Plan

10 Cwm Taf Health Board Annual Report 2010-11 Staff Engagement The Health Board’s Committee structures and reporting arrangements have been agreed with staff participation through their representatives and awareness encouraged through the provision of information via team briefings. To further facilitate staff engagement the Health and Safety Website has been developed. This provides a focal point for all health and safety issues ranging from incident reporting and investigation to consultation of documents. The site is continually being updated with new pages being developed.

Monitoring and Audit A series of Responsible Manager Self Assessment Checklists have been developed in order for managers and Integrated Governance Groups to monitor their implementation of policies and procedures. They will be supported by audits undertaken by members of the Corporate Risk & Safety Team.

Enforcement Notices During this period the following enforcement notices were issued by statutory bodies: • Asbestos Management (training, monitoring and procedures) – those due have been signed off by HSE • Wet Work – signed off by HSE • Fire Enforcement Notices The Health Board has worked with the Health & Safety Executive and Fire Service to address the issues identified in the notices. Freedom of Information Act 2000 The Freedom of Information Act 2000 (the Act), creates significant rights of access to official recorded information held by public authorities. Specifically the Act: As required by the Act, the Health Board has in • places a duty on every public authority to adopt place an approved Publication Scheme which is and maintain a Publication Scheme; available from the Health Board’s Internet site. • creates a general right of access to recorded Between April 2010 to April 2011, the Health information held by public authorities; Board processed 245 requests for information. The • places a duty on public authorities to provide a requests came from a variety of sources including reason for refusal where access to information Assembly Members, the media, private companies is refused in reliance on an exemption from and organisations and members of the public. disclosure.

Cwm Taf Health Board Annual Report 2010-11 11 Governance

Information on letter and other reports. In addition, the work of Healthcare Inspectorate Wales (both investigations Emergency Preparedness and reviews) informs the review. I have been advised on the implications of the result of my review of the Compliance with statutory duties effectiveness of the system of internal control by the of the Civil Contingencies Act 2004 Board and the work of the Integrated Governance The Health Board has made significant progress with Committee, Audit Committee, Quality Patient Safety meeting the requirements of the Civil Contingencies & Public Health Committee and the Corporate Risk Act 2004. Over the past year the Health Board has Committee and a plan to address weaknesses and actively participated in a number of multi agency ensure continuous improvement of the system is in exercises to test emergency plans and continues place. to amend and develop these plans as lessons are The scrutiny of these arrangements is in part learned from the exercises. The exercises include informed through the internal mechanisms already rehearsing plans as part of the National Strategy referred to, but also through the independent and of Counter Terrorism as set out in the UKs Contest impartial views and opinions expressed by a range Strategy. of bodies external to the Health Board. These With the continued high risk of an influenza include: pandemic occurring the Health Board has amended • Welsh Government; its plans as / when revised modelling advice has been made available. • Wales Audit Office; • Internal Audit (Price Waterhouse Coopers); Statement of Internal • Healthcare Inspectorate Wales (HIW); Control • Welsh Risk Pool (WRP); 1. Scope of Responsibility • Community Health Councils; The Board is accountable for internal control. As • Health & Safety Executive; Accountable Officer and Chief Executive for this • Post Graduate Medical Education and Training Board, I have the responsibility for maintaining Board (PMETB), Post Graduate and Under a sound system of internal control that supports Graduate Deanery’s, Royal Colleges and other achievement of the organisation’s policies, aims and Academic bodies; objectives, whilst safeguarding the public funds and • Mental Health Act Commissioners this organisation’s assets for which I am personally responsible, in accordance with the responsibilities • Other Accredited Bodies. assigned by the Accounting Officer of NHS Wales. The Board received additional assurance from the Local Health Board and Trust Chief Executives’ detailed scrutiny of its governance arrangements performance in the discharge of these personal undertaken by the Wales Audit Office. responsibilities is assessed by the Head of the 2. The Purpose of the System of Department for Health & Social Services / Chief Internal Control Executive NHS Wales. In addition, the Health Board’s performance across a range of associated areas, The system of internal control is designed to including the management of risk, governance, manage risk to a reasonable level rather than financial and non-financial control, is monitored by to eliminate all risk of failure to achieve policies, the Welsh Government. aims and objectives; it can therefore only provide reasonable and not absolute assurance My review of the effectiveness of the system of of effectiveness. The system of internal control internal control is informed by the work of the is based on an ongoing process designed to Internal Auditors and the Executive officers within identify and prioritise the risks to the achievement the organisation who have responsibility for the of organisational policies, aims and objectives, development and maintenance of the risk assurance to evaluate the likelihood of those risks being and internal control framework, and comments realised and the impact should they be realised, made by the External Auditors in their management and to manage them efficiently, effectively and

12 Cwm Taf Health Board Annual Report 2010-11 Governance

economically. The system of internal control has training, such as the managing safely, specific been in place in the organisation from 1st April training is provided such as the use of medical 2010 ending March 31st 2011 and up to the date devices and safeguarding is provided on an ongoing of approval of the Annual Report and Accounts, and basis. accords with Welsh Government guidance. In addition, the organisation has set in place 3. Capacity to Handle Risk arrangements to share lessons learnt from investigations such as, for example, incidents and The Board has overall responsibility and authority complaints involving junior medical staff so that for the risk management programme through reoccurrences can be prevented. the receipt and evaluation of reports indicating the status and progress of Health Board wide 4. The Risk and Assurance risk management activities. The Integrated Framework Governance, Audit, Quality Patient Safety & The organisation is committed to the principle that Public Health and Corporate Risk Committees, risk must be managed, and as a result will continue comprising a variety of Independent Members and to work to ensure that: Executive Directors, plus representatives from the Community Health Council, oversee the Health • there is compliance with legislative requirements Board’s risk management arrangements, making where non compliance would pose a serious risk; recommendations for change as appropriate. • evidence based guidance and best practice is Operational responsibility in terms of regularly utilised in order to support the highest standard monitoring progress with specific risks is delegated of clinical practice; to the various sub-groups of the Board Sub • all sources and consequences of risk are Committees who then report to the relevant identified and risks are assessed and either Committee as required. These include the Health eliminated or minimised; Board’s Divisional Integrated Governance Groups • information concerning risk is shared with staff and the Workplace Safety and Health Committee, across the Health Board and, where appropriate, which includes membership from Executive partner organisations; Directors and divisional/directorate and locality • damage and injuries are minimised, and people’s representatives, specialist risk personnel and staff health and wellbeing is optimised; safety representatives. • resources diverted away from patient care to The Cwm Taf Health Board’s Risk Management fund risk reduction are minimised; Strategy and Policy, was identified as an essential Policy to help inform the establishment of the new • lessons are learnt from compliments, incidents, organisation which reinforced the principle that complaints, and claims in order to share effective risk management practice is dependent best practice and reduce the likelihood of upon ownership of the management of risks reoccurrence. throughout the whole of the organisation. Staff The purpose of the organisation’s Risk Management are encouraged to take a proactive role in the Strategy and Risk Assurance Framework is to identification and reporting of risks, with an provide a clear pathway for the management emphasis on not apportioning blame, but rather of risk within the organisation. It has provided to promote a learning culture within the Health a clear focus on the major issues to be tackled Board. The Policy clearly defines the respective as well as identifying clear goals and key actions roles and responsibilities of the Health Board, sub to be achieved. It outlines the way in which the Committees, Managers and staff. Risk Management Policy and processes will be Staff awareness of the need to manage risks has embedded within the organisation, taking note of been encouraged through the provision of regular the various requirements of external agencies and and ongoing information via the website and statutory bodies. ongoing training programmes. Case studies and In addition, the Risk Management Strategy and Risk patient stories are presented to the organisation’s Assurance Framework has defined the strategic committees in order that lessons learnt can be direction for risk management, and has provided disseminated and shared. In addition to generic

Cwm Taf Health Board Annual Report 2010-11 13 Governance

the Health Board with a clear path on which to base health and quality improvement overlap into the all future risk management initiatives. overall assurance and governance framework. As the minimisation of risk is the responsibility Over the life of the Risk Management Strategy of staff at all levels within the Health Board its systems will be refined for identifying and management must be mainstreamed into our categorising risks which clearly states under what functions and is not seen as separate to the day circumstances and at what level the organisation to day work of our employees. In order for this would be willing to carry risk. to be achieved every member of staff will need In addition, the Health Board will integrate its the passion, confidence, knowledge and skills to governance arrangements and mainstream NHS minimise the harm to patients and risk of injury or ill Wales sponsored campaigns e.g ‘1000 Lives Plus’, health to staff and visitors. and the Passport Schemes so as to ensure the In addition, patients and the public have an development of effective arrangements which important part to play by proactively participating enhance the quality and safety of patient care. in their care and the organisation will address The organisation uses the Doing Well, Doing this requirement within this and other strategies. Better: Standards for Health Services in Wales as Those that we have contractual relationships with its framework for gaining assurance on its ability are responsible for identifying and managing their to fulfil its aims and objectives for the delivery of own risks, due to the Health Board's contractual safe, high quality health services. This involves self relationship with them. These would include assessment of performance against the standards for example: independent contractors (GPs, across all activities and at all levels throughout the Pharmacists, Dental Practitioners and Optometrists) organisation. Care Homes (with nursing), Voluntary Organisations, As part of this process, the organisation has and those where we have partnership relationships completed the Governance & Accountability for service delivery, e.g. Local Authorities, other assessment module and achieved the following level Health Boards Learning Disability Teams. of performance for 2010/11. (See chart on page 15). The Health Board's clinical governance processes This process has been subject to independent provides assurance to the Board that services internal assurance by Internal Audit and a moderate are safe and meet organisational, external and level of assurance has been assigned in the report. professional standards. In order to achieve that, The organisation has plans in place to achieve the the organisation has developed robust processes improvement actions identified and within clearly in place to identify areas of high risk and address defined timescales proportionate to the risk. concerns, and is committed to supporting the independent contractor services with risk The requirements to use the Standards incorporate management. These include: several elements, requiring an organisational wide response. A programme of work to embed the • embedding the Standards for Health Services Standards was commenced within frontline services in Wales into the everyday working of the so that they are utilised to underpin the delivery of organisation, with appropriate linkages to the 5-Year Service Workforce and Financial Strategic the Annual Quality Framework, Performance Framework plans and contribute to the overall Management Arrangements and SWaFF framework of internal assurance. Programme of the Health Board; Information about the revised Standards was • implementing effective risk management communicated to managers, staff and the public systems, procedures and policies, reducing risk with the intention of using the standards to to the Health Board by protecting its capital, examine the organisation's internal processes and financial resources and reputation; controls in order to identify gaps and issues to • making risk management an integral aspect of be addressed as part of the ongoing continuous the governance agenda within all service and improvement cycle, using the PDSA (Plan, Do, Study, strategic plans; Act) methodology. In addition, the Health Board’s • recognising risk management, clinical Risk Matrix has been utilised in order to provide governance, health and safety, occupational

14 Cwm Taf Health Board Annual Report 2010-11 Governance

Governance and Strongly disagree Disagree Neither agree or Agree Strongly agree Accountability Module disagree We do not yet have We are aware of the We are developing plans We have well developed We can demonstrate a clear, agreed improvements that and processes and can plans and processes sustained good practice understanding of where need to be made and demonstrate progress and can demonstrate and innovation that is we are (or how we are have prioritised them, with some of our key sustainable improvement shared throughout the doing) and what / where but are not yet able to areas for improvement. throughout the organisation/ business, we need to improve. demonstrate meaningful organisation /business. and which others can action. learn from. Setting the direction ✔ Enabling delivery ✔

Delivering results ✔ achieving excellence Overall Maturity 3 Level Scores 1. Identifi ed as something we must address urgently 2. Identifi ed as something we need to do, and plans are being developed for this 3. We are doing this but have identifi ed a number of gaps and need to review existing plans 4. This has been built into our normal practice. We are making progress in this area. 5. We have been doing this for some time, have continually improved and shared learning

the basis for confi rming the risk appetite of the In reviewing the review process Internal Audit organisation. identifi ed a number of key strengths that will Information gained from the self assessment will contribute to the Board’s assurance that the be used in the formation of the risk assurance organisation has met/will meet the requirements of systems and processes to support teams and in the Standards: order to provide the Board with assurance that the • the Initial Board Briefi ng and Core Briefs were organisation has met the requirements placed upon good in content by external standards and requirements. In addition, • Identifying leads for corporate and service issues and actions from the previous standards Reviews have been mapped across to the new standards in order to maintain continuity and delivery of the • the methodology adopted, including the organisation’s plans. development and use of a standardised template, with the ability to use it fl exibly, as appropriate to In addition it has been acknowledged that clearer the area direction and leadership is needed to ensure that the entire organisation is giving appropriate priority • piloting the process with selected areas was seen to the Standards. as a very positive approach In moving the process forward the organisation will • intention to gain feedback prior to roll-out develop its systems for sharing completed reviews A key aspect of the organisation's risk assurance and monitoring improvement. This will entail and management process is the work that has identifying the review cycle for the various standards been undertaken with e.g. staff organisations, the and will need to be developed in conjunction with voluntary sector, independent contractors and other clearer central guidance and information. partner organisations and groups to identify and manage the risks that need to be addressed by the wider health community.

Cwm Taf Health Board Annual Report 2010-11 15 Governance

The Health Board has provided a strong Welsh Health Specialised Services commitment to stakeholder engagement and has Committee adopted a proactive, ‘no surprises’ approach to In accordance with the Welsh Health Specialised continuous engagement. This requires ongoing, Services Committee (Wales) Directions 2009 (2009 open dialogue with partners. With regards to No.35), the LHBs are required to establish a Joint partner agencies, each of the statutory partnerships Committee for the purpose of jointly exercising its (i.e. Health Social Care & Well-Being, Children & Delegated Functions and providing the Relevant Young People’s Partnerships and Community Safety Services from 1 April 2010. Partnerships) has its own process for managed The Welsh Health Specialised Services Committee risk, as managed by its respective partnerships (WHSSC) (Wales) Regulations 2009 (SI 2009 No support team. In relation to the wider public, the 3097) make provision for the constitution of the main forum for discussion are the Health Board's “Joint Committee” including its procedures and four public forum meetings, each of which meets administrative arrangements. on a quarterly basis covering issues from strategic direction to service development, patient safety and The Joint Committee has been established in sustainability. accordance with the Directions and Regulations to enable the seven LHBs in NHS Wales to make 5. Review of Effectiveness collective decisions on the review, planning, As Accountable Officer, I have responsibility for procurement and performance monitoring of reviewing the effectiveness of the system of internal agreed specialised and tertiary services (Relevant control. My review of the effectiveness of the Services) and in accordance with their defined system of internal control is informed by the work Delegated Functions. The Joint Committee therefore of the internal auditors and the executive officers comprises, and is established by, all the LHBs. within the organisation who have responsibility for Integrated Governance Committee the development and maintenance of the internal The role of the Committee is to ensure that it: control framework, and comments made by the external auditors in their management letter and • maintains an oversight of the work of the three other reports. Board Sub Committees ensuring integration of the governance work, addressing issues I have been advised on the implications of the result which fall outside or between the work of the of my review of the effectiveness of the system three committees, ensuring no duplication and of internal control by the Board, the Integrated coordinating issues which need the attention of Governance, Audit Committee, the Corporate Risk all three committees; Committee, Quality, Patient Safety & Public Health Committee and a plan to address weaknesses and • ensures that appropriate mechanisms are in place ensure continuous improvement of the system is in to manage risk issues, identifying and reviewing place. the top 20 risks and ensuring that plans are in place to manage those risks; The Board • oversees the Board's major policy objectives The principal role of the LHB’s Board is to add value such as the SWaFF, identifying issues which need to the organisation through the exercise of strong Board action or involvement, and scrutinising the leadership and control, including: delivery and performance in those areas. • Setting the organisation’s strategic direction Audit Committee • Establishing and upholding the organisation’s The role of the Committee is to review the governance and accountability framework, establishment and maintenance of an effective including its values and standards of behaviour system of internal control and risk management, in • Ensuring delivery of the organisation’s aims particular reviewing the adequacy of: and objectives through effective challenge and • all risk and control related disclosure statements, scrutiny of the Health Board's performance together with any accompanying Head of across all areas of activity. Internal Audit statement, prior to endorsement by the Board;

16 Cwm Taf Health Board Annual Report 2010-11 Governance

• the structures, processes and responsibilities for obligations contained within the Scheme identifying and managing key risks facing the regulations are complied with. This includes organisation; ensuring that deductions from salary, employer’s • the policies for ensuring that there is compliance contributions and payments in to the Scheme are with relevant regulatory, legal and code in accordance with the Scheme rules, and that of conduct requirements as set out in the member Pension Scheme records are accurately Standards for Health Services in Wales, Welsh updated in accordance with the timescales Risk Management Standards and other relevant detailed in the Regulations. guidance; • The organisation has undertaken risk • the operational effectiveness of policies and assessments and Carbon Reduction Delivery procedures; Plans are in place in accordance with emergency preparedness and civil contingency requirements • the policies and procedures for all work as based on UKCIP 2009 weather projections to related to fraud and corruption as set out in ensure that the organisation’s obligation under the Directions and as required by the Welsh the Climate Change Act and the Adaptation Government; Reporting requirements are complied with. • proposed changes to the Standing Orders, Standing Financial Instructions and Financial 6. Significant Internal Control Control Procedures; Problems • circumstances associated with each occasion The Health and Safety Executive issued four where Standing Orders or Standing Financial Improvement Notices during 2010-11. Three were Instructions are waived. concerned with the management of asbestos and one required the development of a Wet Work Risk Corporate Risk Committee Assessment. The role of the Committee is to provide the Good progress has been made in taking forward the Board with assurances that the Health Board has actions needed to lift these notices and the current appropriate arrangements for effective internal position is that the Wet Work Risk Assessment control, identifying compliance with statutory notice and one of the Asbestos Management requirements and for the identification and notices have been lifted and we are on target to management of risk. comply with the remaining notices. Quality, Patient Safety & Public Health In addition, the Fire Authority issued two Committee Enforcement Notices concerning the Centre Core The purpose of the Committee is to provide the and the Ground & First Floor at Prince Charles Board with evidence based and timely advice in Hospital and again good progress has been made in order to assist its discharge, its functions and respect of the work required to achieve compliance. meeting its responsibilities with regard to the It is anticipated that the Enforcement Notice for quality and safety of healthcare in accordance the Centre Core will be lifted at the end of June with its stated objectives and the requirements 2011 when the required works will be assessed and standards determined for the NHS in Wales; as complete. In respect of the Enforcement Notice and ensure delivery of the overall vision statement relating to the Ground and First Floor at Prince of Cwm Taf Health Board, which is to prevent ill Charles Hospital, a Strategic Outline Case has been health, protect good health and promote better prepared and discussed with the Welsh Government health to secure the capital resource necessary to meet the • Control measures are in place to ensure that all requirements of the notice. It is anticipated that this the organisation’s obligations under equality, will be jointly reviewed with the Fire Authority when diversity and human rights legislation are the Strategic Outline Case for the capital works complied with. is submitted to agree an appropriate extension or withdrawal in line with the approved capital work • As an employer with staff entitled to programme and timetable. membership of the NHS Pension Scheme, control measures are in place to ensure all employer

Cwm Taf Health Board Annual Report 2010-11 17 Governance

The reports assessed as providing limited assurance were as follows: • Budgetary control • Payroll • Cash, bank and treasury management • Patient’s property • Acute and Accident and Emergency • Out of Hours • Staff training • Sickness absence Management actions have been agreed for all of the above reports. Responsible Directors will attend the Audit Committee in July 2011 to ensure that the high risk recommendations identified in the individual reports have been actioned. The responsible Directors will submit a report to the July meeting of the Audit Committee for discussion and approval of the agreed actions to increase the level Systems were put in place to monitor of assurance in each of these areas. implementation of the actions needed to comply with the enforcement and improvement notices and The Chair of the Audit Committee will report the the Executive Board has received regular update outcome of these discussions to the Integrated reports to ensure that Directors are taking individual Governance Committee to ensure that the Board is responsibility for the appropriate improvements. aware of the position and to ensure that the actions needed to improve this level of assurance are being During the course of the year a number of internal taken forward in line with the agreed timescales. It audit reviews have been assessed as providing is therefore planned that the issues underpinning limited assurance and as a result of this, the overall the “Limited Assurance” opinion are rectified prior assessment in the Annual Report has been defined to the July Audit Committee which provides the limited assurance. requisite additional assurance for the Board in It is usual practice for the Internal auditors to response to the 2010/11 transition issues. provide “limited” assurance in the annual opinion where they have identified high or critical rated risks during the audit work on business critical systems. The auditors arrived at the assessment as there were a number of high risks identified in the audit Allison Williams, Chief Executive outcomes, a significant number of which referred to June 2011 processes within the Workforce and Organisational Development Unit. There were no critical issues identified in any of the audit reports and some of the reports were assigned a high level of assurance.

18 Cwm Taf Health Board Annual Report 2010-11 Governance

Public Health Cwm Taf Health Board serves the most deprived population in Wales, and this is seen in our lower life and healthy life expectancy of residents. Together with Blaenau Gwent, Merthyr Tydfil and Rhondda Cynon Taf have the three lowest healthy life (HLE) and life expectancy (LE) estimates in Wales. The greater need for health care is driven by the lower healthy life expectancy.

This year, the Director of Public Health produced • More people in Cwm Taf report having a chronic the first annual report for Cwm Taf, describing the condition than the Wales average, and our health of our population and the challenges we population report the lowest mental health face. status of all Health Boards in Wales. In summary, this report shows that: • Fewer pupils obtain 5 or more GCSEs at grade • Over 40% of residents in Merthyr Tydfil, and over C or above than in less deprived areas of Wales 30% of residents in Rhondda Cynon Taf live in and two and a half times as many working age the most deprived fifth of Wales. people in Merthyr Tydfil are in receipt of out of work benefits compared to more affluent areas • Cancer rates are generally higher in more of Wales. deprived areas, and Cwm Taf has higher death rates from cancer than the average for Wales. What are our strategic • The death rate for circulatory disease in Cwm Taf is falling, as in the rest of Wales, but is priorities and where do consistently higher than average. we want to be in 2015? • Cwm Taf has a higher death rate from respiratory • To increase equality and reduce the inequality disease than the average for Wales. that exists for Cwm Taf residents; in particular by • Within Cwm Taf the death rate due to alcoholic increasing life expectancy and reducing the gap liver disease is increasing. in healthy life expectancy. • For Cwm Taf, the rate of conceptions in young • The number of people smoking, particularly in women aged 15-17 is higher than the average Merthyr Tydfil where the rates are the highest for Wales. in Wales, will compare favourably to the Wales

Cwm Taf Health Board Annual Report 2010-11 19 Public Health

average and be on target to achieve 16% by • Uptake rates for breast and cervical screening will 2020. be 80%, particularly in Merthyr Tydfi l where the • Levels of overweight and obesity are no longer uptake rates are lower than the Wales average. the highest in Wales. • The number of drug and alcohol related referrals • Participation rates in physical activity for both will compare favourably to the rest of Wales. adults and children will continue to increase, • That fewer people in Cwm Taf will suffer with measurable progress made towards the preventable harm from accidents and injury achievement of multi-agency actions identifi ed particularly falls in older people. within local plans. • To promote the positive links between health and • Teenage pregnancy rates fall consistently, work, and reduce economic inactivity where poor particularly for Merthyr Tydfi l which has the health is a barrier. highest rate in Wales. • Together with partners we will deliver plans to What are our key improve mental wellbeing; the mental health achievements this year? component summary score for residents in Cwm Taf will improve to be at least as good as the rest Making Every Contact Count: of Wales. getting prevention into all • Vaccination and immunisation for childhood pathways immunisations, and seasonal fl u will achieve the Cwm Taf Health Board employs approximately Welsh Government’s targets. 9000 people. Health workers will be in contact with many thousands of local people every day. We can make every contact count by increasing the skills

Key Messages Health is poorer in Cwm Taf than any other Health Board in Wales. People living in Cwm Taf don’t live as long as those in the rest of Wales. Many factors which infl uence our health are outside the remit of health services.

20 Cwm Taf Health Board Annual Report 2010-11 and knowledge of every health worker on how • Cwm Taf Health Board met the Annual Operating they provide support for healthy living. Training Framework target of increasing referrals by 30% on such techniques as Brief Intervention, can help to Stop Smoking Wales. them identify people who are ready to change their • The community pharmacy Stop Smoking service lifestyles and help them to get started. We have is now available from 29 local pharmacies and trained staff in Stroke services, Maternity services, approximately 500 people have accessed the Surgical and Ophthalmology services – in all these service in the past year. areas, stopping smoking in particular can reduce • Maternity units have introduced a direct referral patient’s risks signifi cantly and enabling people to pathway to Stop Smoking Wales allowing better do this may be the most useful intervention a health access to smoking cessation support for women worker could do. and their partners who want to quit smoking. Smoking • Stop Smoking Wales have trained 134 health Smoking is the largest single cause of avoidable and community care professionals in Brief ill health and early death in Wales and a leading Intervention in Smoking Cessation. This course is cause of health inequalities. Research shows that accredited by Royal College of Nursing (RCN) and smokers are more likely to heart, lung and infectious Agored Cymru. complications, have impaired wound healing, and • A direct referral pathway for patients awaiting have a longer hospital stay. Sickness absence from elective surgery has been established. work is a third higher for smokers compared to non- smokers. This year:

Healthy Life Expectancy and Life Expectancy by Local Authority in Wales

85 Key: Life Expectancy Healthy Life Expectancy 80

75

70

65

60

55

50 Powys Cardiff Conwy Torfaen Newport Swansea Bridgend Anglesey Flintshire Gwynedd Wrexham Caerphilly Ceredigion Denbighshire Merthyr Tydfi l Tydfi Merthyr Pembrokeshire Blaenau Gwent Monmouthshire Carmarthenshire Neath Port Talbot Neath Port Vale of Glamorgan Vale Rhondda Cynon Taff Rhondda Cynon

Cwm Taf Health Board Annual Report 2010-11 21 Public Health

Vascular Risk Reduction – scan, and how many are started on aspirin within preventing the risk of heart hours, and how many are mobilised quickly. disease and stroke The next steps are to consolidate the effort to Heart disease. This is a success story! Premature prevent heart disease and stroke. A huge amount deaths (under the age of 75) are falling year on of investment already goes into identifying year, in men and women, although still above the people who are at risk, especially through the average for Wales and there is still inequity related work that our GP practices are doing as part to deprivation. A large contribution to this is the of the Quality and Outcomes Framework, such reduction in smoking, as well as improved health as managing hypertension and high lipids. We care. Local health services have helped by improving have started work towards making this more prevention (such as increased aspirin prescribing and systematic and developing ways to implement the management of high blood pressure), diagnosis and recommendations of the Vascular Risk Reduction treatment. Review (Halcox Report). The lifestyle risk factors, such as smoking, physical inactivity and obesity, are Stroke. Services for people who have had a stroke being addressed at a population level and also for have improved signifi cantly over the last year, due to high risk individuals. Services such as the National co-ordinated efforts by everyone involved in stroke Exercise Referral Scheme, and Stop Smoking Wales, prevention, treatment and care. We know that have good evidence of cost effectiveness and outcomes are improved after stroke if people get are being protected against the current fi nancial fast assessment and treatment. In both hospitals, climate. audits over the last year have shown marked improvements in most areas set out in the Welsh Government Intelligent Targets: how quickly people are assessed by a specialist, including getting a CT

22 Cwm Taf Health Board Annual Report 2010-11 Five Ways to Wellbeing Connect ... Be Active ... Take Notice ... Keep Learning ... Give ...

Mental and Emotional Health Sexual Health Source: New Economics Foundation In Rhondda Cynon Taff, the Teenage Pregnancy and • Improving mental health (especially early in life) Sexual Health Strategy was launched in June 2010. will reduce inequalities, improve physical health, A Sexual Health Advisory Board (SHAB) was formed reduce health-risk behaviour and increase life to oversee the implementation of the strategy. expectancy (one study found by 7.5 years), Merthyr Tydfi l continued to deliver on the 2008 – economic productivity, social functioning and 2011 strategy. quality of life. A Quality Approach to Sex and Relationships • Mental illness is consistently associated with Education (SRE) toolkit was developed in deprivation, low income, unemployment, poor partnership with Newport, Cardiff, Blaenau Gwent education, poorer physical health and increased and Monmouthshire and has been disseminated to health-risk behaviour. In Cwm Taf, 13% of schools. people report that they are currently being A basic Sexual Health Training course has been treated for a mental illness, compared with 10% developed and delivered to nearly 80 staff Wales average (Welsh Health Survey, 2008-9) working with young people providing them with Service development support: the knowledge and confi dence to talk to young people about sexual health issues, and to sign-post • Primary Care pilot of low level psychological them, when necessary, to sexual health or other intervention, such as guided self management appropriate services in their area. The course also and telephone follow ups, based on Conditions enabled participants to deliver the Condom Card Management Program. The full proposal is being Scheme either as condom issuers or condom card developed for further roll out to other practices.

Cwm Taf Health Board Annual Report 2010-11 23 Public Health

programmes throughout Cwm Taf with a total of 102 families registering with the programme. Obesity Mapping In December 2010 a report was submitted to the Welsh Government outlining how Cwm Taf Health Board is addressing the issue of obesity in children and adults against four tiers of intervention. The report was compiled following a mapping process that was co-ordinated by Cwm Taf Local Public Health Team for Level 1, and the Department of Dietetics, Cwm Taf Health Board for Levels 2 – 4. The mapping process highlighted gaps in service provision which lead to the development of key recommendations. An obesity steering group has been established to ensure the recommendations from the report are acted upon. Current work streams as a result of the recommendations from the report include: development of community weight management programmes, increase of resources to promote the issuers. Thirty-five new condom card issuers were breastfeeding environment, level 4 referral pathway trained in Merthyr Tydfil. for obesity as part of the exercise referrals schemes In Rhondda Cynon Taf and Merthyr Tydfil there and obesity in women of child bearing age. were 692 NEW Condom Card registrations between Lunchtime Supervisors’ training materials: April 2010 and March 2011. Over 34,300 condoms A resource to support schools were issued helping reduce the risk of sexually Sixty primary schools from across Rhondda Cynon transmitted infections and unplanned pregnancy. Taff have attended workshops to introduce the There are now 40 Community Pharmacy Emergency ‘Lunchtime Supervisors’ training materials – a Hormonal Contraception (EHC) services throughout resource to support schools’. As part of the local Merthyr Tydfil and Rhondda Cynon Taff. This means implementation of Appetite for Life the resource that access to the EHC (more commonly known as ‘the morning after pill), is more readily available for those young people between the ages of 14 and 25 who are worried about contraception failure or have practiced unsafe sex. The Sexual Health Outreach nurse programme has been expanded, and covers Merthyr Tydfil, Cynon Valley and Rhondda Fach. It is intended to continue to roll out the programme to Rhondda Fawr and Taff areas.

Food and Fitness MEND is a Welsh Government funded ten-week multi-component healthy lifestyle programme encompassing education on healthy eating, fun games to stimulate an active interest in physical activity and behaviour modification techniques to boost-self confidence. It is aimed at overweight/ obese children 7-13 years of age and their families. MEND has now successfully completed 10

24 Cwm Taf Health Board Annual Report 2010-11 Public Health

was designed to support the delivery of in-house awarded the National Quality Award for Healthy training for Lunchtime Supervisors. Developed by Schools (NQA). The school is only one of six schools the Healthy Schools team, the resource recognises in Wales to achieve NQA status. that if a school is to successfully implement a whole school approach to food and fitness it is essential Infection Protection that as part of this, Lunchtime Supervisors are Childhood immunisations empowered and supported to recognise the value • The uptake of childhood immunisations in Cwm of their role in school. Taf is good and is improving towards the target Initial feedback from schools has been extremely of 95% for selected childhood immunisations. positive. Comments from teachers that attended • Uptake of first dose of Human Papilloma Virus workshops include, “A very informative course (HPV) vaccine in girls in the 2010-11 School Year which will make a positive impact on our school.” 8 was above the Wales average: and “Thank you for a great afternoon which has Merthyr Tydfil 89.6% given me a chance to reflect on current practice and Rhondda Cynon Taf 89.3% lots of ways to develop and provide training”. Wales 83.4%. Primary Schools across Merthyr Tydfil and Bridgend will also benefit from the resource as following their attendance at workshops; the School Catering Services from both areas have begun rolling out the training to their Primary Schools.

Welsh Network of Healthy Schools Scheme Brecon Road Infants School is the first school in Merthyr Tydfil to achieve a prestigious award for health. The school was inspected by the Welsh Government for two days and as a result was

Cwm Taf Health Board Annual Report 2010-11 25 Public Health

To accompany the poster and leafl et campaigns, two websites were launched: www.alcoholisnoexcuse.co.uk and www.explainalcohol.co.uk

Cardiff Blues and Wales International Rugby player Martyn Williams supporting the domestic abuse campaign.

Pay Slip Flu Jab Reminder Message Seasonal Flu A bi-lingual Flu Jab reminder message was included 2,200 Flu Jab reminder stickers were distributed on payslips for all staff employed within Public to elderly residents across Cwm Taf via Meals on Health Wales, along with 3,100 Merthyr Tydfi l Local Wheels packaging in partnership with Merthyr Authority staff. The message encouraged staff to Tydfi l County Borough Council and Rhondda Cynon consider the Flu Jab for themselves but to also pass Taf County Borough Council, thus ensuring this the message to friends, relatives and neighbours. important reminder message reached the most The same message was also included in the Cwm vulnerable and housebound residents across the Taf Core Brief for staff as well as the front page locality. of the Cwm Taf, Merthyr Tydfi l County Borough A Seasonal Flu Vaccination Awareness Pack was Council and Rhondda Cynon Taf County Borough designed and developed for Cwm Taf Community Council websites. Pharmacists. During prescription checks Pharmacists offered further information to patients about the immunisation and referred patients to their GP for a Flu Jab where appropriate.

Keep Well this Winter Young people engaged with the Duke of Edinburgh Award Scheme in Merthyr Tydfi l prepared, packed and delivered 300 Keep Well this Winter Information bags during November 2010. The bags contained information to help support housebound elderly residents to keep warm, safe and well during the cold winter months. Health information was supported by further information from local partners e.g., Care & Repair, Merthyr Tydfi l Fire and Rescue Service, Merthyr Tydfi l County Borough Council and Age Cymru. Bags also included a fl eece blanket and a pair of bed socks for every recipient,

26 Cwm Taf Health Board Annual Report 2010-11 Public Health

funded by Cwm Taf Public Health Team to further experience leads to us focussing on the quality of Anna Rhyder- enhance the health through warmth theme. care, treating patients with compassion, dignity and Richardson respect and providing the best treatment available. launching the Substance Misuse parental role Throughout 2010/2011, the Health Board has modelling Alcohol is No Excuse’ and ‘Explain Alcohol’ provided a range of opportunities to engage its campaign. The Public Health Team as part of the local citizens and below is summary of just a few of those Community Safety Partnership recently played initiatives: a large part in developing two social marketing • Regular meetings held of the Public Fora, i.e. campaigns to raise awareness of the issues around Rhondda Valleys, Cynon Valley, Merthyr Tydfi l domestic abuse (‘Alcohol is No Excuse’) and parental and Taff Ely Fora, have provided opportunities role modelling of alcohol use (‘Explain Alcohol’). for participants to comment on Mental Health The launch of the domestic abuse campaign Services; Individual Health Records; Primary Care coincided with the start of the Six Nations Rugby Services; the Health Board’s 5 Year Plan and the internationals, and the parental role modelling development of the Health Park at Merthyr Tydfi l campaign with the Easter holidays. • Establishment of a Stakeholder Reference Both campaigns were well received by professionals Group (SRG), with representatives from local and the general public, so much so that other Local authorities, voluntary sector, community groups, Authorities in Wales have taken the resources and patients and carers. Providing advice to the amended them for use in their own areas. Health Board, its role is to build upon existing To accompany the poster and leafl et campaigns, successful engagement mechanisms; ensure that two websites were launched citizens are at the heart of issues relating to local www.alcoholisnoexcuse.co.uk and health services; infl uence the planning, design www.explainalcohol.co.uk and delivery of local health services and refl ect localism and local issues Public and Patient Involvement • Numerous consultation events with local groups and Patient Experience and communities on the developments of the The Health Board is committed to involving Health Social Care and Well Being Strategies and its patients and the public in the redesign and Children and Young People’s Plans 2011-2014 development of local health services. In addition, • Service users and carers are represented on the it recognises that understanding the patient organisation’s planning groups for mental health,

Cwm Taf Health Board Annual Report 2010-11 27 Public Health

chronic conditions, diabetes, substance misuse • The Reader Group which consists of patients, and learning disabilities relatives/carers review all patient information • Patient Participation Groups are in place in a documentation processed across the Health number of GP practices Board to ensure patients have access to good relevant information which is user friendly, Patient Experience explicit and meaningful. • Introducing the ‘Have Your Say’ scheme to seek • The Health Board now has a robust process for patients’ experience/views in relation to their the recruitment, management and support of journey through the hospital care process. The volunteers across the organisation through the information received is fed back to the relevant Patient Experience Department with reference Senior Nurse/Ward Manager for the area with to the Volunteers Policy. There are currently an action plan and outcomes required. This eight volunteer projects ongoing with a total of information is also fed back into Directorate/ 50 volunteers being recruited across the Health Divisional Integrated Governance meetings. Board. Volunteering projects will enhance patient • The Patient Experience Forum, which consists care, support carers and staff and aid in the of existing and past patients, meets monthly development of services on a Health Board wide with the opportunity of sharing their opinions basis. on a variety of issues/projects enabling them to • The Patient Support Service attend each infl uence services for patients and improving the Directorate Governance meeting to enable patient experience.

Acute Stroke Services Acute stroke care at both the Royal Glamorgan Patients who suffer a Transcient Ischaemic Attack and Prince Charles Hospitals has greatly improved (TIA or ‘mini stroke’) are now referred to a TIA clinic following the development of specialist stroke the next working day for assessment of their risk of teams who are working to evidence based targets stroke, and for appropriate treatment. The evidence for the fi rst 7 days of stroke care. The outcomes shows that timely management of TIA patients can for someone who has suffered a stroke are much reduce the incidence of stroke in those at higher improved if the stroke is treated as a medical risk, and prevention is surely better than cure! emergency and if certain interventions are Cwm Taf’s in-house Stroke Services Training undertaken within given timescales. Programme reached the fi nal three in the Since April 2010, compliance against the Acute “Achieving Excellence in Learning, Teaching & Stroke Intelligent Targets has improved as follows: Development” category of the 2010 Advancing Healthcare Awards for Allied Health Both hospitals now offer thrombolysis, a ‘clot Professionals and Healthcare Scientists. busting’ treatment, for eligible stroke patients which The Programme is offered to all can signifi cantly improve the patient’s chances of existing and new staff involved in recovery and independence following an ischaemic the care of stroke patients, and stroke. The service is currently available during ensures they are competent in Monday to Friday daytime and plans are underway stroke care skills. to offer the service out of hours during 2011/12.

28 Cwm Taf Health Board Annual Report 2010-11 Public Health

feedback whilst ensuring we improve learning from informal complaints; • The Patient Experience Department will shortly be involved with corporate induction in conjunction with our Patient Experience Forum members. These training sessions will be based around issues raised via the Patient Support Service including a patient’s experience/story of their care and treatment received. These sessions will raise awareness around the importance of treating service users with dignity and respect. • A Citizen Engagement/Patient Experience Steering (CE/PE) Group has recently been established to ensure a more co-ordinated approach to how we engage, involve our service users and improve the patients experience. Membership of the group consists of Divisional/ Directorate appointed CE/PE Champions.

Acute Stroke target: April 2010 March 2011

Bundle 1 – fi rst 3 hours Rapid assessment 9% compliant 100% compliant Specialist diagnosis

Bundle 2 – fi rst 24 hours CT scan Admitted to acute stroke unit 15% compliant 74% compliant Swallow screen undertaken Nutritional screen undertaken Aspirin prescribed if appropriate

Bundle 3 – fi rst 3 days Physiological monitoring Manual handling assessment 35% compliant 87% compliant Patient mobilised Physiotherapy assessment Specialist medical review

Bundle 4 – fi rst 7 days OT assessment Full impairment assessment Multi-disciplinary team goals set 0% compliant 90% compliant Expected Date of Discharge discussed with patient Patient information given

Janet Ivey and Tanya Edmonds at the Awards ceremony.

Cwm Taf Health Board Annual Report 2010-11 29 Research & Development Research and Development activities for 2010-2011, highlighting developments, achievements and key aims and objectives for 2011-2012.

Developments The Health Board’s R&D Office has been an active participant in discussions at a national level National R&D Structure associated with the establishment of the NISCHR AHSC and the PCU. The structure of R&D management and funding across Wales has changed considerably during Following the harmonisation and centralisation 2010-2011, with the establishment of the: of the research governance process for Primary and Secondary care research across Cwm Taf • National Institute for Social Care and Health Health Board in recent times, further changes Research (NISCHR, formerly WORD) are planned nationally, with the implementation • NISCHR Academic Health Science Collaboration of the Permissions Coordinating Process, due to (AHSC) commence July 2011. The Health Board’s R&D • NISCHR Permissions Co-ordinating Unit (PCU). Office is in preparation for this significant change. Achievements

Funding Following the submission of a Needs Based Assessment document issued by NISCHR and the consolidation of Primary Care Research Governance processes being transferred to the management of the existing secondary care R&D Office, the ring fenced funding provision for R&D support from NISCHR increased from £98K to £260K, with additional and recurring transitional funding of £75K, taking the total funding allocation for the Health Board to £335K for 2010-2011. This increase in funding has been used to fund research and development support staff to include a

30 Cwm Taf Health Board Annual Report 2010-11 R&D Activity Cwm Taf Health Board has a very pro-active R&D department, which reports through the Executive Medical Director. The R&D activity for Cwm Taf continues to flourish with 83 projects being reviewed and processed between April 2010 and March 2011. Areas of research include Diabetes, Mental Health, Nursing, Pathology, Management and Cancer, some examples of these are provided in the table below:

Activity Area Project Title Principal Investigator Diabetes Prevalence of diabetes in a rehabilitation setting (Dewi Sant Hospital) Dr Philip Evans ARTEMIS – Avastin Randomised Trial with neo-adjuvant chemotherapy for patients Cancer Dr Jacinta Abraham with early breast cancer Cardiology Identification of Donor Hearts Using Biochemical Probes Dr Robert Bonser Central Adjudication of Modified Rankin Scale Disability Assessments in Acute Stroke Dr Richard Dewar Stroke Trials Pharmacy What influences the prescribing of antibiotics in lower respiratory tract infection? Mr Mark Allman Analytical evaluation of the effect of thrombocytosis on serum electrolytes Pathology Dr Keith Myers concentration Anaesthetics SPOT(Light): Sepsis Pathophysiological & Organisational Timing Dr Tamas Szakmany Psycho-education with problem solving (PEPS) therapy for adults with personality Mental Health Dr Juan Delport disorder: A community based randomised controlled trial Trans-cerebral exchange of free radicals during surgical ischaemia – reperfusion; General Surgery Mr Mike Lewis focus on blood-brain barrier integrity and neuro-cognitive function

Clinical Trials Pharmacist (1.0wte) and a supporting of research findings, translating research into Pharmacy Technician (0.5wte). Investment in this improvements in clinical practice and patient care. area was undertaken to support dispensing and The funding has also been used to provide financial trials management support for Cancer (in close support for a research project (Midwifery) that collaboration with the Wales Cancer Trials Network) required support costs. and Commercial trials to provide the opportunity The R&D Office supported and facilitated bids for and increase Cwm Taf’s patient recruitment into funding Clinical Research Time (AHSC Fellowship such trials. award) and for increasing R&D support staff in The additional funding will also be used to fund the Pharmacy, Pathology and Radiology, through an required staffing structure for the R&D Office, to AHSC funded and managed competitive process. develop and improve the R&D support for research The Health Board was awarded an AHSC Research active professionals in both Primary and Secondary Fellowship, following a successful bid submitted Care across the Health Board. The new staffing by Dr Tamas Szakmany (Consultant Anaesthetist) structure will enable the capture of data and to the value of £143,526. The funding will monitoring of all the Health Board’s research activity support a 3 year research study investigating and facilitate the showcasing and distribution

Cwm Taf Health Board Annual Report 2010-11 31 Research & Development

developing a scoring system to identify which medical referrals would be suitable for ambulatory care management. This scoring system was found to be a useful tool and is currently being studied on a wider scale for further verification and validation. The first prize for poster presentation was awarded to Ms Helen Welch, ESP Physiotherapist for her review of outcomes of treatment pathways according to sub-classification of lower back pain. Ms Welch found that the sub classification criteria used allowed the correct pathway choice for patients’ conditions. Mr Peter Mekhail, a Surgical SpR was awarded second prize for his poster, which looked at the time period taken between referral and the start of treatment in patients with oesophageal cancer, to identify the main source of delay and to assess The pathophysiological response and genetic its clinical significance on long term survival. The susceptibility to sepsis in intensive care patients. study suggested that improvements in planning, streamlining referral pathways and optimized In addition, there was also a successful bid for resource allocation would result in a reduction £60,308 to appoint a Clinical Research Scientist in delays in the management of patients with in Laboratory Medicine, for a 3 year fixed term oesophageal cancer. contract submitted by Dr John Geen (Consultant Clinical Biochemist). Mr Avanish Saklani, Surgical SpR won third poster prize for his work on assessing the efficacy of basic R&D Conference rapid recovery programme on median ward stay The Health Board's R&D Annual Conference, held in after laparoscopic or open colorectal resection. September 2010 at Royal Glamorgan Hospital, was It was demonstrated that laparoscopic resection chaired by Professor Tim Maughan (Chair of NISCHR and increased education of patients and staff with CRC). This gave the Health Board's research active regard to early mobilisation, feeding and discharge professionals the opportunity to showcase some is the key to early discharge post surgery, which is of of the excellent work being undertaken across the financial benefit to the Health Board. organisation, where Speech and Language Therapy Membership and Collaboration and Physiotherapy took the honours for an oral presentation. The study, carried out by Dr Kathryn The Associate Medical Director for R&D (Dr John Head, Clinical Speech and Language Therapist for Geen) and R&D Manager (Miss Susan Kedward) Stroke, is the first in the UK to establish a reliable continue to be active members of the Wales R&D and valid dysphagia screening tool for use with Directors group and The Forum of NHS Wales acute stroke patients. for R&D Management in Health and Social Care (FORWARD), respectively. Membership of these Second prize was awarded to Mr David Bosanquet, groups ensures the continued representation of the Surgical SpR for his presentation on Extra- Health Board on all R&D issues and allows an input anatomical Bypass Grafts in patients undergoing into the strategic development of R&D at regional femoro-femoral or axillo-femoral bypass surgery. and national levels. Contrary to previous publications, the study demonstrated that long term primary patency in The Health Board, through the AMD for R&D, those patients that survive axillo-femoral procedures has representation on the recently formed AHSC are better than those undergoing femoro-femoral implementation Group and a further group is procedures. being set up to establish the formation of a South East Wales Academic Health Science Centre with Dr Lesley Ala, Consultant Physician won third oral neighbouring Health Boards’ and Cardiff University presentation prize for his pilot “AMB Score” study,

32 Cwm Taf Health Board Annual Report 2010-11 Research & Development

/ Medical School. The aim of the Academic Health • Review and update the Health Board R&D Science Centre is to change how health related strategy in line with NISCHR, AHSC, BRU education and research is managed and undertaken strategies for R&D across Wales. and help secure additional research funding. • Provide research governance training sessions The Health Board has been named as a collaborator for staff, ensuring that this training becomes in a successful bid submitted to NISCHR, for the an explicit component of the Health Board's establishment of a NISCHR Biomedical Research induction programme for new staff. Centre (BRC) for Neuropsychiatric, Genetics and • To develop educational and research partnerships Genomics in Cardiff. to facilitate a greater degree of collaboration with NHS organisational neighbours, Higher Forward Plan – Aims and Educational Institutions and Industry, in line with Objectives 2011-2012 the national strategy of the AHSC. This will help secure further funding in the future and raise • To develop a Research Governance Plan, detailing the profile of the Health Board as an important the existing R&D systems and processes in place. research resource. The establishment of this plan will provide the R&D Office with the opportunity to review the • To continue to develop the relationship with current systems and processes which will ensure: social care practitioners and offer support and advice to research active professionals across the –– ongoing compliance with the Research Health Board. Governance Framework for Health and Social Care 2009 and other legislation. • To maximise all R&D funding opportunities notably the submission of strong and attractive –– Undertake a review against Standard 21 of bids to the AHSC call for Clinical Research the Standards for Health Services to evaluate Time and support staff, which will enable the current activity and identify any necessary organisation to continually develop the R&D improvements. infrastructure and increase capacity for research. –– a streamlined, consistent and co-ordinated • To establish a small grants scheme to pump approach for research governance, in line with prime research projects and support own account the new NISCHR PCU process. research during 2011-2012. • The establishment of a Communications • To develop and implement systems that capture Project, which will evaluate the R&D Office R&D activity and facilitate the closing of the R&D communication activities. The following project loop. This will ensure that R&D findings provide products will be delivered: the evidence base for establishing best practice –– A stakeholder and engagement plan – the required when changing patient care and plan will identify target groups, internal management. and external stakeholders, mechanisms for • The Executive Medical Director and AMD for communication, key messages i.e. the role of R&D have a planned timetable throughout 2011, the R&D Office etc. to attend Directorate and Senior management –– R&D Intranet page – will be a mechanism meetings across Cwm Taf, to outline the recent for facilitating R&D communications such as changes and developments in R&D at both guidance on the research governance process, Health Board and National level. Attendance at document templates, training, funding the meetings will also seek to increase the profile opportunities, publications, events and of the R&D office and outline what support is newsletters. available for all research active professionals, • The Research and Development Conference both experienced and novice, wishing to for 2011, the date for this event has been set undertake research within the Health Board. for 19th October at Prince Charles Hospital. Professor Sir Mansel Aylward has agreed to act as the scientific chair for the day.

Cwm Taf Health Board Annual Report 2010-11 33 Patient Care and Safety The Patient Care and Safety Unit, led by the Executive Medical, Nursing and Therapies and Health Science Directors, continues to ensure that commitment to the safety of patients and the quality of care provided to them remains the primary focus of the organisation’s business.

Clinical Governance This last year witnessed a transition in the governance arrangements in providing public Arrangements assurance on the quality of health services, as a set Each meeting of the Board and the Quality Patient of revised national Standards for Health Services Safety and Public Health Committee opens with were published, with a new approach to ensure that a patient story to highlight the experiences of these Standards are used to measure the quality and patients, both where there have been positive safety of services at ward/service area level. Under encounters, as well as where the standards the previous arrangements, the organisation developed organisation aspires to achieve have not been met, its Annual Healthcare Standard Improvement plan, where there is more to do to improve. which was completed by the end of March 2011. The new approach under the reviewed Standards, is Ensuring good governance remains core to the supported by the development of specific localised quality improvement agenda. The Health Board service improvement plans replicated across all has participated in a range of nationally driven departments and services. The responsibility for programmes and during this last year, has focused both monitoring the Improvement Plan, and on extending its range of such programmes in ensuring that appropriate arrangements are mental health, surgical and medical services, planned for the new Standards for Health Services, infection prevention and control, and skin integrity is delegated to the Quality, Patient Safety and through pressure ulcer prevention. Public Health Committee. The Health Board has The Clinical Divisions have fully established reported on progress in implementation to Welsh Integrated Governance Groups, through which Government on a quarterly basis. governance priorities are monitored and progressed, The Health Board has initiated a number of service and these also look to identify issues that have improvements in response to what members of staff wider organisational relevance in the drive for and the public have told us about the quality and continuous improvement in quality and safety of safety of the services provided. Some examples of hospital, community and primary care services. these are:

34 Cwm Taf Health Board Annual Report 2010-11 • Reduction in health associated infections. checks of staff performance, developments have Building on previous significant reductions in also included the re-introduction of a system to infection rates, a 20% reduction in Clostridium better capture patient's views and suggestions difficile infections was achieved, reflecting for improvements. considerable effort by staff from across the • Leadership Walkrounds. As part of the 1000 Lives Health Board. Plus programme, Board Members have continued • The GP Out of Hours Service undertook a review to undertake ‘Walkrounds’ to clinical areas across based on a report published in England, which the organisation on a weekly basis. The emphasis recommended specific standards and systems is focused on patient safety, with the visiting for monitoring quality and safety. As well as team basing their questions and observations developing and implementing rigorous audit on themes such as infection prevention and

Cwm Taf Health Board Annual Report 2010-11 35 Patient Care and Safety

Ms Angela Hopkins, Executive Nurse Director

36 Cwm Taf Health Board Annual Report 2010-11 Patient Care and Safety

control, staffing issues, and incident reporting. Standard 10 - Oral health & hygiene They provide the opportunity to highlight The Health Board has developed a Mouth Care any concerns and identify necessary actions, Assessment Tool and Care Plan. This tool has been emphasising learning and development. highlighted at the Chief Nursing Officers showcase During this next year, the new Standards for conference 2010 as an example of best practice. Health Services will drive the quality and safety • 85% patients had mouth care assessment on improvement agenda through their application at admission (2009 results 43%) local service level. A stronger focus will emerge with an emphasis on demonstrating that wherever • 93% patients had mouth care plan of care any areas for improvement are identified, that this Standard 12 – Preventing pressure ulcers will be a catalyst for making tangible progress to The successful implementation of the SKIN bundles enhance the safety and quality of our services. has produced excellent results: This will be further strengthened by a renewed commitment and a more integrated approach • 98% patients had risk assessment on admission to make certain that when things do go wrong, • 98% patients had a care plan learning lessons, and making positive changes • 98% compliance to use of recognised risk becomes the primary objective for all staff. assessment tool Fundamentals of Care • 98% patients evidence of on going assessment Focussed work for 2011 relates to toilet needs, The Fundamentals of Care (FOC) audit tool is a communication and information and sleep, rest and mechanism for evaluating and monitoring the activity. Improvement work will continue to focus quality and standard of patient care across Wales. on all 12 standards of Fundamentals of Care; the An annual audit ensures that all care delivery ultimate aim is to be 1st in all 12 Fundamentals of is systematically monitored against standards. Care standards. The FOC Audit asks questions of staff, checks documentation and asks for feedback from patients / carers regarding the quality of the care they have received. Below are the average Health Board's FOC audit scores for each standard during 2009 & 2010.

Standard 2009 2010 Communication & Information 89% 92% Respect & Relationships 89% 87% Ensuring Safety 88% 91% Promoting Independence 91% 91% Sleep, Rest & Activity 83% 83% Comfort & Alleviating Pain 89% 90% Personal Hygiene 84% 84% Eating & Drinking 87% 89% Oral Health & Hygiene 84% 86% Toilet Needs 92% 92% Pressure Area Care 88% 88%

The Health Board has made significant progress within each standard and measures favourably with other NHS organisations and is leading on Standards 10 – oral health & hygiene and Standard 12 Preventing pressure ulcers.

Cwm Taf Health Board Annual Report 2010-11 37 Complaints & Compliments Cwm Taf Health Board is committed to providing a complaints process which is accessible and transparent to patients and users of our service.

The Health Board views all types of feedback from received a detailed formal response within 20 users as an opportunity to reflect, learn and where working days. The investigation of these complaints appropriate, make positive changes to services. highlighted a number of instances where there was When dealing with complaints about the services need for a change to practice or service provision, it provides, the Health Board aims to achieve the and a small sample of the actions implemented over Principles for Remedy as published by the Public the past year are set out below. Services Ombudsman for Wales in March 2008, • The Pathology Directorate will reintroduce namely: barcode tables and scanners for patient • Getting it right specimens to ensure that transcription errors do not occur. • Being customer focused • Additional staff training in relation to the • Being open and accountable protection of confidential information has been • Acting fairly and proportionately arranged. • Putting things right • The Senior Nurse will undertake 'spot checks' of • Seeking continuous improvement the Acute Medical Unit to ensure that carers and relatives are being kept informed of the patient's During the year 403 formal complaints were condition and audits will be carried out to ensure received, which was a decrease on the previous year that the discussion is noted within the patient when 482 formal complaints were received. records. Complaints are reviewed by the Health Board’s • The GP Out of Hours Service is planning to Complaints Panel in addition to regular reports launch an educational forum for participating being provided to the Quality, Patient Safety and doctors and this will provide additional Public Health Committee and the Corporate Risk opportunities for revision in the management of Committee. acute illness. Anonymised case studies will form Of the 403 complaints received, 86% were the basis of these educational events. acknowledged within two working days and 31%

38 Cwm Taf Health Board Annual Report 2010-11 • The Health Board has now fully implemented the from the Health Board. A further 15 requests were All Wales Fluid Monitoring Chart and nursing made to the Public Services Ombudsman Wales staff have received training on the completion of for review, resulting in 6 cases being accepted for these charts. further investigation. • A patient advice leaflet for wound care following Caesarean Section will now be produced. Compliments Whilst most complainants were satisfied with For the same period a total of 1,762 compliments the outcome of investigations, 9% of cases were were received, with 53 formal letters expressing escalated to external organisations for review. gratitude and appreciation for treatment being sent During the year the Independent Review Secretariat directly to the Chief Executive Officer. Additionally, received 18 requests for review from complainants a further 1,709 expressions of gratitude were who were unhappy with the responses received reported by wards and departments. This does not

Cwm Taf Health Board Annual Report 2010-11 39 Complaints & Compliments

A total of 1,762 compliments were received, with 53 formal letters expressing gratitude and appreciation for treatment being sent directly to the Chief Executive Offi ce

take into account the many cards and gifts that The Health Board has embraced this new approach. were also received but not formally reported. Staff teams – the Concerns Team, Patient Safety Team and the Patient Experience Team are already Putting Things Right – The NHS working closely together under the leadership of (Concerns, Complaints and Redress the Director of Nursing to ensure that the best Arrangements) (Wales) Regulation service is delivered. Training programmes based on 2011 the new guidance, are in progress to equip staff In April 2011, the Welsh Government regulation across all areas of the Health Board to manage came into place for dealing with complaints, claims concerns in the best way. Most importantly, our and incidents – collectively known as Concerns. emphasis is on learning from concerns, in order that “Putting Things Right” introduces a better way of we are continually improving patient safety, and the dealing with things that go wrong, which is based quality and standard of the care we provide – we on a more integrated and supportive process for look forward to being able to share these widely in people to raise their concerns, and more openness the coming year. and involvement with them, resulting in better outcomes. It should: • Be easier for people to access; • Deliver a fair outcome for people; • Recognise people's individual needs; • Enable fairness in the way people and staff are treated; • Make the best use of time and resources; • Show that lessons have been learnt.

40 Cwm Taf Health Board Annual Report 2010-11 Complaints & Compliments

Performance During 2010-11, the Health Board remained committed to improving services to patients and achieving the key targets set by the Welsh Government.

Waiting Times Targets • 99% of patients referred as non urgent cases were treated within 31 days – the target was The waiting times targets are set out to improve the 98%. length of times that patients wait for appointments, • 90% of patients referred as urgent cases were diagnostic tests and treatments. treated within 62 days – the target was 95%. The patient journey through the health care system The Health Board continued to focus on the delivery is commonly known as the patient pathway. of cancer services in a number of areas to ensure Within the patient pathway there will be one or all residents had access to the same high level more referral to treatment (RTT) periods each of of cancer care irrespective of which hospital and which will have a target attached. service they accessed. The large numbers of patients treated during This ensured cancer services were delivered in line 2010/11 enabled the Health Board to maintain with the NHS Wales National Cancer Standards. the waiting times targets required by the Welsh Government. Accident and Emergency The targets were to ensure that 95% of patients (A&E) Targets were treated within 26 weeks and that no patients waited longer than 36 weeks overall. The Health Board's performance against the Welsh Government A&E target of patients to be seen Both of these targets were met and maintained and treated, admitted or discharged from A&E throughout 2010/11. departments within 4 hours, was 89% against a The target was achieved by the service responding 95% target. to challenging changes in patient pathway re- This was a difficult year across Wales with design, the treatment of long waiting patients and numbers of A&E attendances up in all areas and balancing referral demand and clinical capacity in a corresponding pressure on A&E departments, both sustainable way. in treating patients with minor injuries, and also treating and admitting patients to hospital beds. Cancer Access Targets The All Wales average A&E performance against this The Health Board performance against the Welsh target was 86% compared to 89% achieved within Government cancer waiting times targets showed the Health Board. that:

Cwm Taf Health Board Annual Report 2010-11 41 Clinical Services – Service Developments and Improvements

New Supported Recovery Unit The new unit will include a multi-disciplinary team With the aid of Capital funding, the Mental comprising of medical, nursing, therapy, psychology, Health Directorate is developing a new 15 pharmacy and administrative staff and will allow the bedded fast track rehabilitation unit at Ysbyty repatriation of patients placed with the independent George Thomas in Treorchy. This development will sector providers both within Rhondda Cynon Taff create an environment suitable to mental health and Merthyr Tydfil as well as those placed out of county. The new Supported rehabilitation which is in a quiet and peaceful Recovery Unit at area but also within walking distance of the town Ty Llidiard Ysbyty George centre and public transport networks and includes Thomas showing provision of all single rooms, most with full en-suite The new £15m purpose built mental health unit the patio and the for young people at the Princess of Wales Hospital, lounge area. facilities.

42 Cwm Taf Health Board Annual Report 2010-11 Ty Llidiard Mental Health Unit, Princess of Wales Hospital, Bridgend

Bridgend is now open and providing specialised care ‘Fun with Food’ Group and support in a safe modern environment. The ‘Fun with Food’ group is an evidence based Ty Llidiard is the new home of 19 young men therapy for children with sensory food aversion and women aged 12 – 18 years suffering from and children who are reintroducing oral feeding a variety of mental health problems. Although following the use of long term alternative feeding the construction project has been managed by methods. The group is run in children’s centres in Abertawe Bro Morgannwg Health Board, the unit the Royal Glamorgan Hospital and the Kenshole itself is run by Cwm Taf Health Board for patients Children’s Unit in Aberdare Hospital weekly for six from across South Wales. weeks. The groups are evaluated through clear outcome measure ratings, and through a parent Colorectal Cancer Patient satisfaction questionnaire. Children have been Information DVD found to explore food with more confidence, which Professor Haray’s vision of producing an interactive in most cases leads to reduced aversion. Parental informative tool for patients with bowel cancer satisfaction is positive with comments such as “my resulted in the creation of a DVD to support patients. The DVD has been in use since March 2009 and was awarded 1st prize in the category ‘Continuity of Care’ at the Patient Experience Network (PEN) Awards in January 2011.

Cwm Taf Health Board Annual Report 2010-11 43 Clinical Services – Service Developments and Improvements

son has tried foods he wouldn’t normally eat” and the majority of parents agreed that they feel more confident helping their child.

ELKLAN Training The Health Board has provided a programme of ELKLAN training to schools across Rhondda Cynon Taff and Merthyr Tydfil to facilitate greater school involvement in improving and enhancing communication for children with speech, language and communication difficulties. ELklan is a UK recognised training package to empower teachers and teaching assistants to manage communication difficulties in schools, special schools and special units. Training takes place intensively over two or three days, or weekly over 8 or 10 weeks and leads to an accredited qualification. Once trained, the school staff can independently manage many communication difficulties in children, and enhance communication skills for all the children in their care. In Cwm Taf training has been provided to one special school, and a group of mainstream establishments, and is planned for all special schools and special educational units from Autumn.

Speech & Language Therapy The Speech & Language Therapy Department now covers hearing impaired units in Rhondda and Taff Ely as well as the Cynon Valley and Merthyr Tydfil areas which facilitates an equitable service across the Health Board.

Swallow Laryngectomy Club The Swallow Laryngectomy Club allows patients who have undergone laryngectomy surgery (and their partners, spouses, carers, friends, family) to meet socially and discuss pertinent issues. It also allows them to meet with those who have undergone similar experiences, share experiences promoting survivorship following a cancer diagnosis. We train these patients to become “expert patients” and meet with those considering laryngectomy surgery. MALDI Analyzer The Pathology directorate is an area that is heavily dependent on technology and recently the microbiology department has taken delivery of a new MALDI analyzer for identifying bacteria. This state of the art system uses mass spectrometry

44 Cwm Taf Health Board Annual Report 2010-11 Clinical Services – Service Developments and Improvements

to produce a “fingerprint” of the bacteria and in Chronic Conditions Management much the same way as human fingerprints are The Health Board has continued to develop a specific to an individual, bacteria are identified. This scheme to maintain patients with chronic disease new technology analyzer is the first in Wales and in their home and prevent avoidable admissions. indicates that the Directorate is forward thinking Consultants and specialist nurses have commenced and determined to provide a quick and quality a programme of work to provide general practice service for the Cwm Taf public. with more expertise to manage patients in their homes or in the community. To this end clinics Primary Care have been established with consultants and Developments specialist nurses working alongside GPs and practice nurses. A small number of these clinics The Health Board is committed to driving forward have been introduced for patients with diabetes, new ways of working, with a key priority for the chronic respiratory disease and chronic pain with a Primary Care Team being the delivery of primary programme to extend these further during 2011-12. and community services that are reliable, accessible, enabling, and supportive, in order to prevent ill Optometry health, protect good health and promote better The Health Board has worked with community health. optometrists to provide alternative pathways to During 2010/11 there were thirty one different the Hospital Eye Service. This year has seen the types of enhanced services offered by general development of a Referral Refinement Scheme for practice, with the most significant advancements patients with raised intraoccular pressures. This evident in minor surgery, INR (Warfarin) monitoring, has resulted in over 350 patients not having to be diabetes management, drugs and alcohol misuse, referred for a hospital appointment in the first 6 and the management of care home residents. A months of this scheme being available. service provided by advanced nurse practitioners has identified patients with conditions which if untreated would have resulted in a hospital admission. The development of a GP with Special Interest in ENT (the first in Wales) has resulted in a significant redirection of referrals (70 per month) and a service that was originally designed as an ear wax removal service has grown to provide a primary care solution to a number of impaired hearing conditions. Over 75% of practices in Cwm Taf now offer at least Level 3 INR monitoring service (bleed, monitor and dose patients) which is reducing the pressure on the hospital based service. The Health Board became the first in Wales to offer a laboratory based test for the exclusion of heart failure for GPs and has also established a cardiology advice service for GPs. The development of an outpatient follow up local enhanced service (LES) has also resulted in a reduction in the number of patients waiting for appointments in secondary care. Only 10% of the patients reviewed by their GPs required a follow up appointment in hospital.

Cwm Taf Health Board Annual Report 2010-11 45 Dental Services issues identified during the Practice Development Through the work of the Health Board’s Oral Visits (PDV) and wherever possible the team will Health Group more stringent referral criteria have promote the use of improvement grants to fund been developed to reduce the number of patients minor to moderate improvements, e.g. extensions, referred to secondary care for dental extractions. enhancements to security. In addition, a closer working relationship has been Localities developed with the Community Dental Service which has resulted in more than 80 children being The development of localities is in keeping with treated outside of the hospital service. the vision set out in “Setting the Direction”, the Primary & Community Services Strategic Delivery Primary Care Estates Programme. During 2010/11 four localities were The Primary Care Team has always been committed established (Merthyr Tydfil, Rhondda, Cynon and to driving the Health Board’s Primary Care Estates Taff Ely) and the community hospitals and district Strategy forward. GP premises are inspected and nursing services were incorporated into the locality structure together with the local general practices. Each locality is led by a Clinical Director, three of whom are GPs, supported by a manager and nurse. Locality working is the way forward for the Health Board and therapies services, health visiting, school nursing and a range of other community based services will be incorporated during 2011/12. The formation of the Primary Care and Localities Division has contributed significantly to a much closer working relationship between primary and secondary care. This has resulted in the development of appropriate referral criteria and a steady transfer of services from secondary to primary care. Further developments are: • The establishment of a Sister leading the HSG service • Three more reporting radiographers successfully completing their training in A&E reporting and establishing the service at Royal Glamorgan Hospital and making our team more robust at Prince Charles Hospital.

46 Cwm Taf Health Board Annual Report 2010-11 Workforce and Organisational Development (OD) The Health Board places strong emphasis on having a diverse workforce and strongly promotes the importance of equality & diversity in its employment practices/policies.

Workforce & Organisational Development is Job Centre Plus Award focusing its efforts on delivering an excellent customer service, consistency in approach and value The Health Board was delighted to win the Large added services. Change continues to be high on the Employer Recruitment Partnership Award and to Health Board’s agenda in order to modernise both be runner-up in the Diversity in Action category. services and its workforce to ensure that the delivery Both awards were presented by Job Centre Plus in of care is second to none. With greater emphasis recognition of the work with the local community being placed on developing services and care in to assist long term unemployed people back into community settings. work with assisted training and work experience programmes. As part of our centralisation a Human Resources Operations helpdesk has been introduced for staff and managers to ensure that they can access advice Health & Wellbeing and support during office hours. This has proven to At one time or another many staff will experience be a great success. a few of life’s ups and downs. These can be health Specialist leads have been identified from within and work-related, but we can also experience many Workforce & OD, to offer a rich skills mix to the other challenges ranging from financial concerns, Health Board on areas such as European Working relationship difficulties and caring responsibilities Time Directive issues, sickness absence management which can affect our health and well-being and and employee relations. ultimately our ability to work. In order to support staff during these times the Health Board has The Health Board’s Resolve mediation service is introduced a new service called 'Worksure'. This going from strength to strength with many success service was introduced in October 2010. stories and is still instrumental in reducing the numbers of formal disciplinary and grievance cases. 'Worksure' is a new Health & Wellbeing Service which offers all staff advice, guidance and support when unable to work or when staff feel they are ‘at risk’ of becoming unable to work, due to health

Cwm Taf Health Board Annual Report 2010-11 47 Workforce and Organisational Development (OD)

or personal issues. Worksure complements existing to look forward three to five years to develop a support systems, policies and procedures and forms detailed plan; this data is also used for all Wales part of the Health Board’s commitment to adopting education commissioning plans. a holistic approach to work and life, and maximising the contribution that every employee can make. Learning and Worksure is committed to working in partnership Development with staff side representatives. There are early signs that it is improving both attendance and morale and The development of skills for staff is vital. We have we will be developing the service further next year. established a structured approach to planning learning and development and to encourage the Occupational Health Services are also vital in our creation of new roles to better deliver healthcare. overall well being plans. We are developing this We are also encouraging staff development reviews service and working to improve access to services by using ‘KSF Lite’, an easier way to carry out such as physiotherapy and also to systematically risk structured reviews so that we can ensure proper assess the workplace to avoid unnecessary harm staff training and development on and off the job. and illness at work. We have also been working to achieve the Gold Policy Development and Corporate Health Standard, a measure of our health and wellbeing support for staff. Work has included Equal Opportunities developing physical activities such as cycling and Much work was carried out to ensure that the walking groups as well as smoking cessation help, new Health Board’s policies were up to date better nutrition and health events to raise staff and reflected best practice. Many policies were awareness. amended and approved in partnership with staff representatives. Working in Partnership Equality of opportunity and compliance with The Health Board continues to see the importance legislation is also crucial and a number of policies of engaging its staff side partners in the work that were developed and approved and staff awareness it undertakes. There is a staff side representative raised to ensure compliance. on the Executive Board, all major committees and working groups and an Independent Board Organisational member. We understand that an excellent working relationship with our staff side representatives is key Development (OD) to engaging with our staff. OD is about helping the organisation to be able to achieve change effectively and achieve its strategic European Working Time objectives. A number of projects and change Regulations plans were supported and the recently formed Turnaround Team is being actively supported to The Health Board has made significant progress in drive rapid change in major areas of service delivery. relation to EWTD compliance for medical staff. The Health Board recognises that EWTD compliance The Future is not just about medical staff and has set up a The work of the Workforce and OD unit will steering group (with specialist leads) with emphasis continue to be focused on driving forward the now being placed on looking at clinical areas change agenda for the Health Board. A new more which historically have not been compliant as a strategic approach to workforce planning will be result of poor rota management, existing on-call introduced, sickness absence management will arrangements, and other issues. remain a high priority as will staff and clinical Workforce Planning engagement to take forward the service plans of the Health Board. It is vital that we develop a staffing plan which will reflect our future organisation and service delivery models. We work closely with clinical colleagues

48 Cwm Taf Health Board Annual Report 2010-11 Workforce and Organisational Development (OD)

Staff of the Health Board receiving Employer Recruitment Partnership Award from Job Centre Plus

Worksure Team

Cwm Taf Health Board Annual Report 2010-11 49 Workforce and Organisational Development (OD)

Our Workforce in Numbers Over the year the numbers of staff employed fell by 39, with 760 whole time equivalent starters and 799 whole time equivalent leavers. The actual numbers employed at the end of the year is detailed below.

Cwm Taf LHB Staff in post by Staff Group – March 2011, WTE Mar 2011 Cwm Taf Hosted Org WTE Headcount WTE Headcount WTE Headcount Add Prof Scientifi c and Technic 236.18 273 236.18 273 – – Additional Clinical Services 1277.77 1513 1275.77 1511 2 2 Administrative and Clerical 1382.47 1600 1332.75 1548 49.72 52 Allied Health Professionals 371.38 412 371.38 412 – – Estates and Ancillary 816.84 1111 790.58 1084 26.26 27 Healthcare Scientists 144.17 161 144.17 161 – – Medical and Dental 612.16 654 611.16 653 1 1 Nursing and Midwifery Registered 2366.29 2644 2366.29 2644 – – Students 17.8 18 17.8 18 – – Total 7225.06 8386 7146.08 8304 78.98 82

The chart below also shows the breakdown of staff by type.

Cwm Taf LHB Starters & Leavers Analysis by FTE Apr 2010 - Mar 2011 30 Apr 31 May 30 Jun 31 Jul 31 Aug 30 Sep 31 Oct 30 Nov 31 Dec 31 Jan 28 Feb 31 Mar Total 2010 2010 2010 2010 2010 2010 2010 2010 2010 2011 2011 2011 Starters 97.55 39.50 48.27 85.75 168.71 121.06 39.98 20.47 15.52 30.45 42.45 50.62 760.33 Leavers 61.32 49.53 41.24 53.36 200.31 68.38 45.56 36.95 38.23 51.19 64.97 87.56 798.60 Turnover 0.83% 0.67% 0.56% 0.72% 2.73% 0.92% 0.62% 0.50% 0.52% 0.70% 0.89% 1.20% 10.86% Average 0.91%

50 Cwm Taf Health Board Annual Report 2010-11 Workforce and Organisational Development (OD)

Absence levels started the year in April at a level of 5.10%, peaking during the winter period with the infl uenza outbreak at 6.7%. Sickness absence has now fallen to 4.91% in March which is below the Health Board target of 5.21% and shows the beginnings of a downward trend following the implementation of Worksure.

7.0

6.5 Cwm Taf Actual

6.0 Sickness % 5.5 Cwm Taf Target

5.0

4.5

Apr 2010 May 2010 Jun 2010 Jul 2010 Aug 2010 Sep 2010 Oct 2010 Nov 2010 Dec 2010 Jan 2011 Feb 2011 Mar 2011

Cwm Taf Health Board Annual Report 2010-11 51 Partnership Working The Health Board has developed a strong foundation of partnership working with Local Authorities, Voluntary Sector Organisations, Staff, Independent Practitioners, and other key partners which underpin excellent working relationships in the delivery of health and social care services to the people of Merthyr Tydfil and Rhondda Cynon Taff.

The Health Board is a statutory partner in a number The vision for the Rhondda Cynon Taf Community of key strategic partnerships across Merthyr Tydfil Strategy 2010-20 “Live. Grow. Aspire. Achieve.” and Rhondda Cynon Taff. These include: is to create a County Borough of Opportunity, • Local Service Boards focusing on the core improvement themes of: • Health, Social Care and Well-being Partnerships • Safer Communities • Children and Young Peoples Partnerships • Healthier Adults and Communities • Community Safety Partnerships • Children and Young People The statutory requirements remain separately with • Economic Regeneration and Transport each of the two Local Authorities and the Health • Environment and Housing Board’s commitment to the partnerships is assured. The Merthyr Tydfil Plan “Its Looking Good: Merthyr Tydfil 2020 Turning Aspirations into Reality” is Local Service Boards focusing on four main themes: The Health Board is a full partner in both the RCT • A Prosperous, Cultural and Diverse Merthyr Tydfil and Merthyr Tydfil Local Service Boards and also the • A Healthy, Safe and Fair Society joint LSB which has been formed to tackle common issues across both areas. • A Sustainable Living Environment In 2010/11, both Local Service Boards were required • Learning For Life. to produce new Community Strategies. The The Health Board was involved in the development Community Strategy is the overarching strategy of the two Community Strategies and is committed for each Local Authority area, setting the overall to playing its part in their delivery across Cwm Taf. strategic direction and priorities which should then be reflected within all the other statutory and non statutory plans for each County Borough.

52 Cwm Taf Health Board Annual Report 2010-11 Health, Social Care and • Improving services and joint working Wellbeing Partnerships We will continue to work across the two Boroughs where appropriate on a range of health and social (HSCWB) – Merthyr Tydfil care initiatives in order to improve outcomes for our and Rhondda Cynon Taff residents, share best practice and make the best use of resources. The Health Board is a lead partner in the Health, Social Care and Wellbeing Partnerships in both HSCWB Engagement Events Merthyr Tydfil and Rhondda Cynon Taff. Key A variety of events were held during the year to achievements during 20010/11 include: consult with members of the public and staff about Development of HSCWB Strategies the development of the new Strategies, to raise 2011‑14 awareness of healthy lifestyles, share information and signpost people to services. These included: New three year Strategies have been produced for both Merthyr Tydfil and Rhondda Cynon • Events for staff in Prince Charles Hospital and Taff. Although there are two separate Strategies Royal Glamorgan Hospital reflecting the local needs of each area, we used • A range of services were showcased at a 50+ common needs assessment, strategy development 'Life is What you Make It' event in Llantrisant and consultation processes. The new HSCWB Leisure Centre, attended by nearly 1000 people Strategies have three priority Themes: • The Health Board was a finalist in the NHS Wales • Promoting healthy lifestyles and preventing ill Awards for 2010 for their public engagement health work at the Wellbeing Zone at the annual • Promoting independence and protecting the Big Bite event in RCT. The Wellbeing Zone vulnerable was recognised as an innovative approach to improving health and wellbeing. In 2010 we used

Cwm Taf Health Board Annual Report 2010-11 53 Partnership Working

the event to launch the national Change4Life Board is supporting the development and roll out campaign. The campaign aims to help families of similar groups across RCT and Merthyr Tydfil. and children to eat well and get active. Children and Young Working with Communities People’s Partnerships Many of our communities in Cwm Taf suffer from high levels of deprivation and lifestyles which – Merthyr Tydfil and do not support good health. The Health Board Rhondda Cynon Taff recognises the importance of working with local groups to develop vibrant, sustainable and healthy The Health Board has continued its commitments communities. Examples in 2010/11 include: to supporting our statutory partnership planning agenda with significant ongoing contributions to • Ongoing development of the Community the Children and Young People’s Partnerships in Mental Health project - working in collaboration Merthyr Tydfil and Rhondda Cynon Taff. The last with Communities 1st Partnerships in RCT, the year has seen development in the following areas: Health Board is a partner in a successful £46,000 Outcomes Fund bid to develop four peer support Development of the Children and groups in Maerdy, Glyncoch, Tonyrefail and Young People’s Plans 2011-14 Darran Las. The Health Board has taken the lead in developing • Community weight management project – and inputting into key areas of the new local following the example of the Maerdy “Fat Club” Children and Young People’s Plans 2011‑14. We which won first prize in the Health Challenge have had specific involvement in the Health Priorities RCT Crystal Trophy Award for 2010, the Health and Core Aim groups that link strongly to the health and well being of our communities, ensuring that

54 Cwm Taf Health Board Annual Report 2010-11 Partnership Working

been directly involved in joint commissioning groups and in the development of and implementation of the draft action plan. The Health Board is now well placed to further implement the programme and awaits final guidance on the future direction of the programme. This will link directly with the development of our locality arrangements and our out of hospital care priorities.

Reduction of Suicide and Self Harm in Young People The Health Board has played an active role in the work to reduce suicide and self harm in young people with strong representation on the overarching multi-agency, multi-disciplinary strategy group and the various related task and finish groups. Progress to date includes finalisation and sign-off of the overarching strategy and development of the supporting action plan. A local training strategy has also been produced in order to develop and co-ordinate levels of awareness raising, training and the development and implementation of a protocol and supporting information pack for immediate response in the event of a suspected suicide locally (currently in draft form awaiting evaluation of implementation). Community Safety these incorporate the principles of the new Child Partnerships – Merthyr Poverty and the emerging Families First guidance. Tydfil and Rhondda Some of the key themes that have emerged within the new plans are: Cynon Taff • Positive early years and good heath The Health Board is committed to playing a key role in taking forward the statutory community • Emotional and Mental Health and Well Being safety agenda in Merthyr Tydfil and Rhondda Cynon • Sexual Health and Well Being Taff, with significant ongoing contributions to the • Healthy Lifestyles, Physical Health and Well Being respective Community Safety Partnership Delivery • Children and young people with complex health Plans. Key partnership achievements in 2010/2011 needs and/or disabilities include: • Safeguarding, Freedom from abuse and exploitation

Families First The Health Board has played an active role in the various Consortia and Partnership meetings that have been developed as a result of Rhondda Cynon Taff and Merthyr Tydfil forming part of a Southern consortia with Blaenau Gwent, tasked with implementing and developing the emerging Families First Pioneer Programme. Key staff have

Cwm Taf Health Board Annual Report 2010-11 55 Partnership Working

choices and responsibilities of the characters and were invited to draw some connections between the fictional scenarios and their own lives. The over- arching aim of the session was to engage the group in discussion and debate about the use and misuse of alcohol – inviting them to consider the impact that alcohol use might have on self and on others both in the short and long term.

Peer Mentoring Scheme In RCT and Merthyr Tydfil, a Peer Mentoring Scheme (PMS) was introduced to provide additional wrap around support for adult substance misuse service users to help them move on at the end of treatment. The aim of the scheme is to: • Assist those with on-going substance misuse problems achieve some degree of economic independence with the assistance of Peer Mentors; recruited and selected from a background of drug and alcohol problems. • Focus on individuals furthest from the Community Pharmacy Needle employment and education market and to use Exchange Service Peer Mentors to provide specific, post treatment To enhance the community pharmacy needle directed support. exchange service, a training programme was • Focus on a care pathway back into training, devised and delivered to pharmacists and pharmacy education and/or employment. The PMS is also staff. Its aim was to improve the skills and resources designed to help individuals avoid relapsing into of participating pharmacies by: problematic behaviour. • Sourcing and providing harm reduction literature and resources; • Emphasising the importance of harm reduction as key part of the service they deliver; • Providing information on local substance misuse services to enable staff to signpost clients to specialist and other support services.

Antisocial Behaviour Merthyr Tydfil was chosen as a pilot site for the Baroness Newlove Programme and was asked to select an antisocial behaviour problem within specific neighbourhoods. Underage drinking and the resulting antisocial behaviour was highlighted as a priority issue and the following preventative education initiative was developed and delivered to groups of young people: Geese theatre productions delivered interactive sessions to young people focusing specifically on the connection between alcohol misuse and offending / anti-social behaviour. Throughout the sessions, the young people were asked to consider the behaviour,

56 Cwm Taf Health Board Annual Report 2010-11 Partnership Working

Welsh Health Specialised Services Committee (WHSSC) Our strategic aim is to ensure that there is equitable access to safe, effective and sustainable specialist services for the people of Wales, as close to patients’ homes as possible, within available resources

In 2010 the seven Local Health Boards in Wales The Joint Committee established the Welsh Health Specialised Services The Joint Committee is established as a Statutory Committee (WHSSC) to ensure that the population Sub Committee of each of the Local Health of Wales has fair and equitable access to the full Boards in Wales. It is led by an Independent Chair, range of specialised services. appointed by the Minister for Health and Social This followed a consultation on specialised Services, and membership is made up of three services for Wales in 2009, which recommended Independent Members, one of whom is the Vice improvements on how the NHS plans and secures Chair, the Chief Executives of the Local Health specialised services. In establishing WHSSC to work Boards, Associate Members and a number of on their behalf, the seven Local Health Boards Officers. (LHBs) recognised that the most efficient and Whilst the Joint Committee acts on behalf of effective way of planning these services was to the seven LHBs in undertaking its functions, the work together to reduce duplication and ensure responsibility of individual LHBs for their residents consistency. remains and they are therefore accountable to The Joint Committee is a new arrangement and, citizens and other stakeholders for the provision of for the first time, brings Local Health Boards in specialised and tertiary services. Cwm Taf Health Wales together to plan specialised services for the Board as host LHB, employs the staff supporting the population of Wales. This is a fundamental change Joint Committee and the Financial Statements of in the way these services are planned and has WHSSC have been incorporated into their Financial required the creation of new systems and processes Accounts. to reflect these new arrangements. These have included completely new corporate and financial What We Do reporting arrangements. The Welsh Health Specialised Services Committee (WHSSC) plans, secures and monitors the quality of a range of Specialised Services.

Cwm Taf Health Board Annual Report 2010-11 57 Welsh Health Specialised Services Committee (WHSSC)

clinical quality through a rolling programme of service review. • Ensure a formal process of public and patient involvement underpins our work. The first year of operation has been challenging, but satisfying. The focus for the year has been on setting the foundations to ensure that specialised services are aligned better with, and more transparent to, the wider NHS in Wales.

Key achievements in 2010/11 A separate Annual Report for the Welsh Health Specialised Services Committee (WHSSC) has been developed and this is available from the website www.whssc.wales.nhs.uk During 2010/11 notable achievements included : • Establishment of the Joint Committee and appointment of Independent Members;

Specialised services tend to be expensive because • Agreement of a robust Governance and of the nature of the treatments involved, so are a Accountability Framework; complex and costly element of services provided by • Agreement of an Annual Plan for Specialised the NHS. Particular aspects of specialised services, Services for 2010/11; such as the relatively small number of specialised • Development of Transcatheter Aortic Valve hospitals and the unpredictable nature of activity, Implantation (TAVI) services at both UHW, Cardiff require specific arrangements to make optimal and Morriston Cardiac Centre, Swansea; use of scarce resources and mitigate risk through a process of collaboration. It is also important that • Development of a bariatric surgery service at the we develop services experienced in treating patients Welsh Institute of Metabolic and Obesity Surgery, with the rarest conditions, as it is only through Swansea; ensuring this critical mass of patients (the smallest • A new transplant unit opening at University number that is considered safe and cost effective to Hospital of Wales, Cardiff, enabling the number treat by any individual or centre) that such services of transplants to increase from 90 to 140 per can be delivered. annum; Its role is to: • A Self Care Dialysis Unit at Morriston Hospital, • Assess needs and identify appropriate Swansea has promoted independence for a interventions. growing number of patients as well as increasing the number of patients on Home Haemodialysis; • Plan, procure and performance monitor Specialised Services. • Additional investment in Cystic Fibrosis Services; • Develop, negotiate, agree, maintain and monitor • Establishment of the Neonatal Network and contracts with providers of Specialised Services. Transport Service, which has resulted in a reduction of the number of babies needing • Undertake reviews of Specialised Services and neonatal care in England; manage the introduction of drugs and new technologies. • Successful implementation of a second cycle of IVF for all eligible couples; • Manage the pooled budget for planning and securing Specialised Services and put financial • Transfer of PET scan services for the population risk sharing arrangements in place. of South, West and Mid Wales from the Cheltenham Imaging Centre to PETIC, UHW site, • Establish clear processes for the designation of Cardiff. specialised service providers and ensure ongoing

58 Cwm Taf Health Board Annual Report 2010-11 Welsh Health Specialised Services Committee (WHSSC)

Welsh Health Estates Welsh Health Estates is an all-Wales NHS organisation committed to promoting and facilitating the delivery of high standards in patient care in Wales.

At the core of Welsh Health Estates’ work is the • Our specialist decontamination engineers tested belief that the health estate plays a crucial role in and validated 98 sterilizers and 96 washer patient care and the patient experience. Welsh disinfectors and also completed 18 steam quality Health Estates’ stated mission therefore is ‘to tests. champion modern and sustainable healthcare • Pre-clinical validation of 23 specialist mechanical environments’. and electrical engineering systems serving critical To achieve this, the varied nature of the built areas were undertaken by our performance environment requires that we employ a mix of standards engineers. highly skilled professional and technical staff who • Space for Health, the new on-line NHS provide advice to the Welsh Government on policy information service for healthcare premises as well as support to Health Boards and NHS Trusts professionals, was successfully launched. with the delivery of their strategic and operational Welsh Health Estates became part of the new NHS plans. Staff receiving Wales Shared Services Partnership on 1st April 2011, Achievements during 2010/2011 include: Client of the Year operating under the name of NHS Wales Shared Award at the • Winning both the Constructing Excellence Wales Services Partnership – Facilities Services. It continues Excellence in Wales Client of the Year and Construction Excellence to be hosted by the Health Board. Ceremony UK Client of the Year for the work in support of the national Designed for Life: Building for Wales construction framework. • Property management support was provided in relation to the acquisition of 15 properties for approximately £7m. Work was also undertaken in relation to 49 disposals, 24 of which were completed in year with sale receipts totalling £7.1m. • Lease management services on 40 separate cases delivering £1.00m savings for NHS Wales. • Professional estates support in respect of primary care centres procured through 3rd Party Developments including 6 new schemes being completed with a capital value of approximately £30m and funding bids for 4 proposed schemes being approved with a capital value of £16m.

Cwm Taf Health Board Annual Report 2010-11 59 Facilities The Health Board has a significant Major Capital Programme with a range of schemes at various stages of development.

Capital Projects Prince Charles Hospital Macmillan Cancer Prince Charles Hospital Ward Unit Refurbishment Programme Following the exceptional response, several years This £56m scheme to refurbish 12 wards at Prince ago, to the fund raising campaign, the planning Charles Hospital commenced in August 2008 and finally turned to reality. The construction works for comprises of 6 phases, the last of which is due this state of the art Chemotherapy Day Case Unit to complete in January 2013. The second pair of were completed in April 2010 and the Unit received wards, 7 & 8, was completed and occupied in its first patients in June 2010. The Unit enables October 2010. The much enhanced facilities have patients to receive their treatment close to home in been welcomed by both staff and patients as a a purpose built unit, which is designed to provide a significantly improved environment of care. comfortable and relaxing environment. Prince Charles Hospital Emergency Care Centre The construction works for the first phase of this £22m project was completed in February 2011, and the A&E department and the Fracture and Orthopaedic clinics moved into the new build accommodation in March 2011. The overall scheme is due for completion in May 2012 when the full Emergency Care Centre will provide an integrated unscheduled care service bringing together the services from Accident and Emergency, the Medical Assessment Unit and GP Out of Hours service. The fracture and orthopaedic clinic services will also be co-located in this purpose designed accommodation. In addition, as part of the scheme the Hospital’s main entrance including outpatients reception / waiting area is being refurbished.

60 Cwm Taf Health Board Annual Report 2010-11 Prince Charles Hospital Day Surgery Unit The new Day Surgery Unit at Prince Charles Hospital is located on the first floor above the Emergency Care Centre and opened in July 2011. The new Unit has modern facilities including a large waiting area for adults, a paediatric waiting room, 2 theatres, a dedicated first stage recovery for 3 trolleys and a ward area for 9 trolleys. Merthyr Tydfil Health Park The Full Business Case for this landmark scheme was developed across 2010/11 and received formal Ministerial approval in March 2011. The Health Board received early funding to accelerate the enabling and early works and a formal 'Topping Out' ceremony was undertaken by the then Minister for Health & Social Services, Edwina Hart, at the end of March 2011. As it stands the scheme will be completed in late 2012 at a cost of £33.42m. Aberdare Primary Care Centre Emergency Care Unit, Prince A developer was formally appointed to this scheme Cynon Valley Hospital Charles Hospital Construction of this £70m project commenced in in December 2010, and is currently in negotiation November 2008. with Rhondda Cynon Taff CBC regarding site purchase. The new facility will replace the existing The 128-bedded hospital will replace outdated Aberdare Health Centre and a local GP surgery, facilities in Mountain Ash and Aberdare and will providing accommodation for two GP practices, provide state-of-the-art healthcare facilities to meet Community Dental, sexual health, podiatry, the needs of the Cynon Valley residents. audiology, dietetics and mental health. The new facility will have single sex en-suite rooms Hirwaun Medical Centre and four bed single sex bays, which will improve The Health Board has received funding approval privacy and the dignity of patients and also reduce from the Welsh Government for a new medical the risk of infection spreading. centre in Hirwaun which will replace the existing Renal Dialysis Unit Health Centre, and provide new facilities for the GP In partnership with the Cardiff and Vale UHB, the practice, podiatry and community nursing. Work is Health Board is progressing a Business Case for expected to commence on site shortly. a new renal dialysis unit on the Prince Charles Hospital site. In April 2011 the scheme achieved Clinical engineering planning permission and the Business Case has been The Clinical Engineering Department has achieved submitted to the Welsh Government. Construction accreditation with the Institute of Physics and works are anticipated to commence in 2012. Engineering in Medicine for training clinical Treharris Practice technologists; the only centre within Wales to achieve this. This eagerly awaited local development was completed at the end of March and formally The innovative approach towards the provision of opened on 19 April 2011. This creatively designed in sourcing maintenance contracts has permitted and spacious new facility replaces the old Treharris private contract cancellations, substantial cost Health Centre, providing accommodation for the GP avoidance and more importantly improved Practice, Cardiff & Vale Community Dental, Podiatry, governance arrangements. This has also impacted CMHT clinics, sexual health, midwives & young upon the capital replacement programme peoples clinics. and provided substantial cost savings on new anaesthetic machines and patient monitoring systems.

Cwm Taf Health Board Annual Report 2010-11 61 Facilities

Improvement in medical device management the Credits for Cleaning software in accordance strategies, policy and partnership working has with the Welsh Government directive. demonstrated considerable benefits and has The Housekeeping Department is leading the way received positive recognition from healthcare in Wales to adopt and deliver the BICs Cleaning standards. Operative Proficiency Certificate to create a team of The medical equipment libraries provide 24/7 highly skilled, specialist and valued staff to support availability for medical equipment and the the patient care environment. infrastructure continues to grow ensuring a The Catering Department has worked flexibly to rationalised approach for replacement equipment in accommodate the principles outlined in “Free the future. to Lead, Free to Care” and Fundamentals of Governance arrangements are assured through a set Care initiatives which allows for greater nurse of clear KPI’s reporting through a scorecard system. involvement in the meal time improving nutritional Local arrangements are now in place to implement care for our patients. The department has also the national ‘Modernising Scientific Careers’ supported the Dietetic Department with the programme which will allow greater flexibility in introduction of the innovative reformed pureed the future for partnership working and further meals across the Health Board. innovative approaches for patient care. Developments within portering are underway and an enhanced role is being created to improve value Hotel Services for money in this area, but more importantly to The Hotel Services Department continues to strive to better serve our patients in a number of key areas deliver high quality patient centric services which are which include security and car parking management not only demand responsive but also provide value along with the traditional hospital porter tasks. for money. Reducing our Carbon Footprint Over the past year there have been many key achievements, most notably; the full utilisation of The Health Board continues to make excellent progress in reducing the annual consumption in its utilities and therefore its carbon footprint. Gas and water consumptions have both been reduced by 5% on the previous year whilst electricity has reduced by 15%. These reductions are attributed to improved house keeping measures by all staff within the organisation together with the commissioning of the Combined Heat and Power Unit in the Royal Glamorgan Hospital which provides both electricity and heat to the site. We are keen to build on the successes of the last year and to further improve services where possible maintaining performance against the challenging financial targets.

62 Cwm Taf Health Board Annual Report 2010-11 Facilities

Looking Forward to 2011-12 As Chair and Chief Executive of Cwm Taf Health Board we firmly believe that bringing together the strengths of all our staff working together across our hospitals and the community will help us to shape our services in such a way that we best meet the needs of our population today and into the future.

One of the keys to this is the need to improve organisational development will ensure all staff performance, quality and financial stability by are fully engaged and have the skills needed to reducing harm, waste and variation. We recognise achieve results and deliver high quality safe services. also the need to work in an integrated way with key To complement this programme of change and partners to ensure the right care is delivered by the development we will also need to continue to right people at the right time and in the right place. improve our operational performance across the Opportunities available to us through key strategic board. We have taken a bold step in commencing policy documents such as “Setting the Direction - a Turnaround Programme, the aim of which is to Primary and Community Services Strategic Delivery ensure that we balance quality and the use of our Programme” will help us to drive service change resources in a challenging financial climate. This will and put in place new systems of care that deliver result in us doing different things in the future. more services out of hospital and in the community. Change is always difficult but is necessary if we are Our hospitals will always play a very important part to fulfil our statutory obligations to our patients, in the healthcare of our local population but we our staff, our partners and the Welsh Government. must ensure they are used appropriately. We remain wholly committed to delivering the Over the next 12 months we will be working with best possible healthcare and are confident that by our staff and the community to undertake a service- working together we will continue on our journey by-service review of pathways and care settings to improve the health of our population. so that we can meet the challenges of changing demand, quality improvements and deliver safe, effective and affordable services. Preventing ill health protecting good health and promoting better health will require transitional and transformational change and effective

Cwm Taf Health Board Annual Report 2010-11 63 Financial Performance and Review

I am delighted to provide this introduction to these Financial Statements. The last Financial year provided signifi cant challenges across the Public Sector and Cwm Taf was no exception. We started the year with a £46m challenge but with a combination of £28m local savings plus £18m support from the Welsh Government were able to present a small surplus within the Accounts. This was a remarkable achievement and is a testament to the hard work of managers and staff throughout the organisation. I would like to pay particular credit to our Staff Side colleagues who committed themselves fully to supporting the Financial Savings Programme. In addition we achieved our Capital Resource Limit target and also our payment requirement, paying 97.4% of our bills within 30 days. We needed to produce the Accounts to an even tighter timescale this year than in previous years. The successful outcome of the Audit process represents a signifi cant achievement and my thanks are due to my staff, to colleagues in WHSSC, our hosted body, and also to our Auditors in Wales Audit Offi ce and Price Waterhouse Cooper. The pressure on our Finances has continued into 2011/12. The organisation will need to refresh its energies into achieving our Statutory targets but I have every confi dence that the recently introduced Turnaround Programme will make a signifi cant contribution to us achieving these targets. In addition, the Finance team has totally revamped the way we produce reports for our managers. I am sure I will be reporting another successful year in the next Annual Report.

David Lewis Director of Finance & Procurement/Deputy Chief Executive

I confi rm that as far as I am aware, there is no relevant audit information of which the NHS body’s auditors are unaware. I have taken all the steps that I ought to have taken as a director in order to make myself aware of any relevant audit information and to establish that the NHS body’s auditors are aware of that information.

Allison Williams Chief Executive

64 Cwm Taf Health Board Annual Report 2010-11 Foreword These accounts have been prepared by the Local Health Board under schedule 9 section 178 Para 3(1) of the National Health Service (Wales) Act 2006 (c.42) in the form in which the Welsh Ministers have, with the approval of the Treasury, directed. Statutory background The Local Health Board was established on 1 October 2009 following the merger of Cwm Taf NHS Trust, Rhondda Cynon Taf Local Health Board and Merthyr Tydfi l Local Health Board. The Welsh Health Specialised Services Committee (WHSSC) was established on 1 April 2010, responsible for the joint planning of specialised and tertiary services on behalf of Local Health Boards in Wales. The Committee is hosted by Cwm Taf Local Health Board. Performance Management and Financial Results Local Health Boards in Wales must comply fully with the Treasury's Financial Reporting Manual to the extent that it is applicable to them. As a result the Primary Statement of in-year income and expenditure is the Statement of Comprehensive Net Expenditure, which shows the net operating cost incurred by the LHB which is funded by the Assembly. This funding is allocated on receipt directly to the General Fund in the Statement of Financial Position. The statutory duty for Local Health Boards is enacted in the National Health Service (Wales) Act 2006. Net Operating Costs incurred by Local Health Boards should not exceed their allocated Resource Limit. The primary performance measure for Local Health Boards is the Achievement of Operational Financial Balance. This note compares net operating costs expended against Resource Limits allocated by the Assembly and measures whether operational fi nancial balance has been achieved in year. These accounts are a consolidation of the Health Board and WHSSC activities, with the balances relating to Cwm Taf Health Board only separately disclosed where appropriate. The prior period comparators have been restated to incorporate the balances of Health Commission Wales (predecessor of WHSSC) in line with merger accounting principles.

David Lewis Allison Williams Director of Finance & Procurement / Deputy Chief Chief Executive Executive, Cwm Taf Local Health Board Cwm Taf Local Health Board June 2011 June 2011

Cwm Taf Health Board Annual Report 2010-11 65 Analysis of Income and Expenditure of Cwm Taf Health Board activities The main source of funding came from the Welsh Assembly Government totalling £547.331 million. Additional income of £84.280 million was also received which is detailed below Income £000 % Local Health Boards 37,367 44.34 WHSSC 7,493 8.89 NHS & Primary Care Trusts 2,534 3.01 Local Authorities 5,340 6.34 Injury Costs Recovery (ICR) Scheme 2,109 2.50 Education, Training & Research 10,150 12.04 Welsh Assembly Government 1,967 2.33 Local Health Boards WHSSC Trusts NHS & Primary Care Authorities Local Injury Costs Recovery (ICR) Scheme & Research Training Education, Assembly Government Welsh income Dental Fee Other income

Dental Fee income 2,917 3.46 – – – – – – – – – Other income 14,403 17.09 Total 84,280 100

0 20 40 60 80 100 Analysis of Operating Expenditure

Expenditure on Primary Healthcare Services 0 20 40 60 80 100 £000 % General Medical Services 43,881 31.91 Pharmaceutical Services 16,979 12.35 General Dental Services 15,226 11.08

0 20 Medical Services General 40Pharmaceutical Services Dental Services General Ophthalmic Services General 60 expenditure Other Primary Health Care 80 drugs and appliances Prescibed 100 General Ophthalmic Services 3,328 2.42 0 20 40 60 80 100 Other Primary Health Care expenditure 3,266 2.38 Prescibed drugs and appliances 54,797 39.86 Total 137,477 100

0 20 40 60 80 100

0 20 40 60 80 100 Expenditure on Hospital and Community Health Services - Non-Staff

£000 % 0 20 40 60 80 100 Supplies and services 39,284 43.41 0 20 40 60 80 100 0 20 40 60 80 100 Establishment 5,761 6.37 Premises 11,968 13.23 Depreciation 15,994 17.67

Fixed asset impairments and reversals 11,451 12.65 0 20 40 60 80 100 0 20 40 60 80 100 Audit fees 506 0.56 Supplies and services Establishment Premises Depreciation Fixed asset impairments and reversals Audit fees debts special payments and irrecoverable Losses, expenses Other operating 0 20 40 60 80 100 Losses, special payments and irrecoverable debts 2,821 3.12 Other operating expenses 2,707 2.99 Total 90,492 100

0 20 40 60 80 100 0 20 40 60 80 100

0 20 40 60 80 100 66 Cwm Taf Health Board Annual Report 2010-11 0 20 40 60 80 100

0 20 40 60 80 100

0 20 40 60 80 100 0 20 40 60 80 100

0 20 40 60 80 100

Operating Expenses

The operating expenses of the LHB were £635.121 million £000 %

0 Primary Healthcare Services 20 from Healthcare other providers 40 60 Hospital and Community Health Services 80 100 Primary Healthcare Services 137,477 21.65 Healthcare from other providers 127,547 20.08 Hospital and Community Health Services 370,097 58.27 0 20 40 60 80 100 Total 635,121 100

0 20 40 60 80 100

0 20 40 60 80 100

Expenditure on Healthcare from other providers 0 20 40 60 80 100

£000 % Welsh LHBs 26,430 20.72 0 20 40 60 80 100 Welsh NHS Trusts 7,405 5.81 WHSSC 52,145 40.88 Voluntary organisations 1,789 1.40 0 20 40 60 80 100 0 20 40 60 80 100 NHS Funded Nursing Care 2,639 2.07 0 20 40 60 80 100 Continuing Care 32,631 25.59 LHBs Welsh Trusts NHS Welsh WHSSC organisations Voluntary Care NHS Funded Nursing Continuing Care BSC/BSP Other BSC/BSP 1,228 0.96 Other 3,280 2.57

Total 127,547 100 0 20 40 60 80 100

0 20 40 60 80 100

Expenditure on Hospital and 0 20 40 60 80 100 Community Health Services - Staff Costs 0 20 40 60 80 100

£000 % Board Members & Senior Managers 11,343 4.06 0 20 40 60 80 100 Medical 57,761 20.66 Dental Staff 1,632 0.58 Nursing, Midwifery & Health Visiting 120,536 43.10 Professional, Scientifi c & Technical 40,339 14.43

Admin & Clerical 26,583 9.51 0 20 40 60 80 100

Ancillary and Support Staff 17,079 6.11 & Senior Managers Members Board Medical Dental Staff Visiting Midwifery & Health Nursing, Technical c & Scientifi Professional, Admin & Clerical Ancillary and Support Staff Estates (inc maintenance) Other Estates (inc maintenance) 4,140 1.48 Other 192 0.07 Total 279,605 100

0 20 40 60 80 100

Cwm Taf Health Board Annual Report 2010-11 67 Statement of Comprehensive Net Expenditure for the year ended 31 March 2011 2010-11 2009-10 Restated Cwm Taf Cwm Taf HB activities Total HB activities Total £'000 £'000 £'000 £'000 Expenditure on Primary Healthcare Services 137,477 137,477 135,701 135,701 Expenditure on healthcare from other providers 127,547 660,476 75,209 677,101 Expenditure on Hospital and Community Health Services 370,097 372,491 383,490 386,013 635,121 1,170,444 594,400 1,198,815 Less: Miscellaneous Income 84,280 619,603 81,395 74,260 LHB net operating costs before interest and other gains and losses 550,841 550,841 513,005 1,124,555 Investment Income 0 0 52 52 Other (Gains) / Losses (7) (7) 38 38 Finance costs 199 199 5,319 5,319 Net operating costs for the fi nancial year 551,033 551,033 518,310 1,129,860

Achievement of Operational Financial Balance The LHBs performance for the year ended 31 March 2011 is as follows: 2010-11 £000 Net operating costs for the fi nancial year 551,033 Less Non-discretionary expenditure 3,580 Less Revenue consequences of Bringing PFI schemes onto SoFP 153 Net operating costs less non-discretionary expenditure and revenue consequences of PFI 547,300 Revenue Resource Limit 547,331 Under spend against Revenue Resource Limit 31

It should be noted that there were changes in funding fl ows between 2009-10 and 2010-11. In 2010-11 WHSSC received their funding from Local Health Boards and this is recorded as Miscellaneous Income. In 2009 -10 funding for specialised services was provided direct from the National Assembly and this is reported in the Statement of Changes in Tax Payers Equity as National Assembly Funding Other Comprehensive Net Expenditure 2009-10 2010-11 restated £'000 £'000 Net gain on revaluation of property, plant and equipment 0 6,584 Net gain on revaluation of intangibles 0 0 Net gain on revaluation of available for sale fi nancial assets 0 0 Receipt of donated or government granted assets 332 1,201 Gain on other reserves 0 (5) Impairment and reversals 0 0 Transfers from donated and government grant reserves (775) (213) Transfers from other bodies within the Resource Accounting Boundary 0 468 Other comprehensive net expenditure for the year (443) 8,035

Net operating costs for the fi nancial year (551,033) (1,129,860)

Total comprehensive net expenditure for the year (551,476) (1,121,825)

68 Cwm Taf Health Board Annual Report 2010-11 Statement of Financial Position as at 31 March 2011 31 March 2011 31 March 2010 Restated Cwm Taf Cwm Taf HB activities Total HB activities Total £'000 £'000 £'000 £'000 Non-current assets Property, plant and equipment 359,285 359,285 318,479 318,479 Intangible assets 0 0 0 0 Trade and other receivables 8,910 8,910 1,433 1,433 Other fi nancial assets 0 0 0 0 Other assets 0 0 0 0 Total non-current assets 368,195 368,195 319,912 319,912 Current assets Inventories 3,632 3,632 3,226 3,226 Trade and other receivables 34,032 37,263 41,085 43,373 Other fi nancial assets 0 0 0 0 Other current assets 0 0 0 0 Cash and cash equivalents 840 2,545 1,492 1,505 38,504 43,440 45,803 48,104 Non-current assets classifi ed as "Held for Sale" 0 0 1,500 1,500 Total current assets 38,504 43,440 47,303 49,604 Total assets 406,699 411,635 367,215 369,516 Current liabilities Trade and other payables 54,318 71,096 52,781 66,759 Other fi nancial liabilities 0 0 0 0 Provisions 22,569 22,569 28,334 28,499 Other liabilities 0 0 0 0 Total current liabilities 76,887 93,665 81,115 95,258 Net current liabilities (38,383) (50,225) (33,812) (45,654) Non-current liabilities Trade and other payables 2,707 2,707 2,841 2,841 Other fi nancial liabilities 0 0 0 0 Provisions 17,163 17,163 8,610 8,610 Other liabilities 0 0 0 0 Total non-current liabilities 19,870 19,870 11,451 11,451 Total assets employed 309,942 298,100 274,649 262,807 Financed by: Taxpayers' equity General Fund 290,712 278,870 254,911 243,069 Revaluation reserve 15,804 15,804 15,869 15,869 Donated asset reserve 3,256 3,256 3,684 3,684 Government grant reserve 170 170 185 185 Total taxpayers' equity 309,942 298,100 274,649 262,807

Cwm Taf Health Board Annual Report 2010-11 69 Statement of Cash fl ows for year ended 31 March 2011

2010-11 2009-2010 Restated Cwm Taf Cwm Taf HB activities Total HB activities Total £'000 £'000 £'000 £'000 Cash Flows from operating activities Net operating cost before interest (550,841) (550,841) (513,005) (1,124,555) Movements in Working Capital (3,506) (1,649) (6,310) (11,096) Other cash fl ow adjustments 40,135 39,970 60,357 60,990 Provisions utilised (9,751) (9,751) (7,721) (7,721) Interest paid (108) (108) (4,213) (4,213) Net cash outfl ow from operating activities (524,071) (522,379) (470,892) (1,086,595) Cash Flows from investing activities Purchase of property, plant and equipment (65,703) (65,703) (59,749) (59,749) Proceeds from disposal of property, plant and equipment 1,630 1,630 145 145 Purchase of intangible assets 0 0 0 0 Proceeds from disposal of intangible assets 0 0 0 0 Payment for other fi nancial assets 0 0 0 0 Proceeds from disposal of other fi nancial assets 0 0 0 0 Payment for other assets 0 0 0 0 Proceeds from disposal of other assets 0 0 0 0 Interest received 0 0 56 56 Rental Income 0 0 0 0 Net cash outfl ow from investing activities (64,073) (64,073) (59,548) (59,548) Net cash outfl ow before fi nancing (588,144) (586,452) (530,440) (1,146,143)

Cash fl ows from fi nancing activities Welsh Assembly Government funding (including capital) 586,769 586,769 515,888 1,131,202 Capital receipts surrendered 0 0 0 0 Capital grants received 971 971 522 522 Capital element of payments in respect of fi nance leases and on-SoFP (248) (248) (358) (358) Cash transferred (to)/ from other NHS bodies 0 0 0 0 Net fi nancing 587,492 587,492 516,052 1,131,366 Net increase/(decrease) in cash and cash equivalents (652) 1,040 (14,388) (14,777) Cash and cash equivalents (and bank overdrafts) at 1 April 2010 1,492 1,505 15,880 16,282 Cash and cash equivalents (and bank overdrafts) at 31 March 2011 840 2,545 1,492 1,505

70 Cwm Taf Health Board Annual Report 2010-11 Salaries of Senior Managers

31 March 2011 31 March 2010 Benefi ts in Benefi ts in Other kind Other kind Salary Remuneration (Rounded to Salary Remuneration (Rounded to (bands of (bands of the nearest (bands of (bands of the nearest £5,000) £5,000) £00) £5,000) £5,000) £00) £000 £000 £00 £000 £000 £00 Cwm Taf Local Health Board Executive Directors Mrs M Foster Chief Executive of Cwm Taf NHS Trust to 30th September 2009; Chief Executive of Cwm Taf LHB from 1st October 2009 to 4th March 2011 160-165 0 5 170-175 0 5 Mrs A Williams Director of Primary, Community and Mental Health Services of Cwm Taf LHB from 1st October 2009 to 6th March 2011; Chief Executive of Cwm Taf LHB from 7th March 2011 115-120 0 1 65-70 0 1 Mr D H Lewis Director of Finance & Information of Cwm Taf NHS Trust to 30th September 2009; Deputy Chief Executive/Director of Finance & Procurement of Cwm Taf LHB from 1st October 2009 125-130 0 0 120-125 0 0 Mrs. S C Sullivan Medical Director of Cwm Taf NHS Trust to 30th September 2009; Medical Director of Cwm Taf LHB from 1st October 2009 to 30th September 2010 90-95 0 0 175-180 0 2 Mr K Asaad Medical Director of Cwm Taf LHB from 1st September 2010 95-100 0 3 0 0 0 Ms A M Hopkins Nurse Director of Cwm Taf NHS Trust from 1st September 2009; Nurse Director of Cwm Taf LHB from 1st October 2009 110-115 0 2 65-70 0 0 Mrs A Lagier Joint Chief Executive of RCTtLHB & MTLHB to 30th September 2009; Director of Workforce Planning & Organisational Development of Cwm Taf LHB until 30th November 2009; Director of Strategic & Operational Planning of Cwm Taf LHB from 1st December 2009 110-115 0 6 110-115 0 5 Mr I Stead Director of Workforce Planning and Operational Development of Cwm Taf LHB from 1st December 2009 110-115 0 8 35-40 0 1 Mr C White Director of Therapies and Health Science of Cwm Taf LHB from 1st March 2010 95-100 0 9 5-10 0 0 Mrs N John Joint Director of Public Health of RCTtLHB & MTLHB to 30th September 2009; Director of Public Health for Cwm Taf LHB from 1st Feb 2010( Note 1) 0 0 0 0 0 0 Mr P Hollard Deputy Chief Executive & Director of Strategy of Cwm Taf NHS Trust until 30th September 2009; Director of Strategic & Operational Planning of Cwm Taf LHB from 1st October 2009 to 30th November 2009 0 0 0 75-80 0 0

Independent Members Dr CDV Jones Chairman of RCT tLHB to 30th September 2009; Chairman of Cwm Taf LHB from 1st October 2009 85-90 0 2 55-60 0 9 Prof V Harpwood Vice Chair of Cwm Taf LHB from 1st October 2009 40-45 0 1 25-30 0 0

Cwm Taf Health Board Annual Report 2010-11 71 Salaries of Senior Managers – continued

31 March 2011 31 March 2010 Benefi ts in Benefi ts in Other kind Other kind Salary Remuneration (Rounded to Salary Remuneration (Rounded to (bands of (bands of the nearest (bands of (bands of the nearest £5,000) £5,000) £00) £5,000) £5,000) £00) £000 £000 £00 £000 £000 £00 Cllr R Roberts Chairman of Cwm Taf NHS Trust to 30th September 2009; Independent Member of Cwm Taf LHB from 1st October 2009 10-15 0 0 25-30 0 0 Dr. C B Turner Non-Executive Director of Cwm Taf NHS Trust to 30th September 2009; Independent Member of Cwm Taf LHB from 1st October 2009 10-15 0 0 10-15 0 0 Mr J Hill-Tout Non-Executive Director of Cwm Taf NHS Trust to 30th September 2009; Independent Member of Cwm Taf LHB from 1st October 2009 10-15 0 0 10-15 0 1 Mr A Seculer Independent Member of Cwm Taf LHB from 1st October 2009 10-15 0 5 5-10 0 0 Mr G Bell Non Executive Director of RCTtLHB to 30th September 2009; Independent Member of Cwm Taf LHB from 1st October 2009 10-15 0 0 10-15 0 0 Cllr Clive Jones Acting Chairman of MTLHB to 30th September 2009; Independent Member of Cwm Taf LHB from 1st October 2009 10-15 0 0 15-20 0 0 Mrs J Ludlow Non-Executive Director of MTLHB to 30th September 2009; Independent Member of Cwm Taf LHB from 1st October 2009 10-15 0 3 10-15 0 1 Prof D Mead Independent Member of Cwm Taf LHB from 12th January 2010; 10-15 0 0 0-5 0 0

Executive Directors to 30th September 2009 Cwm Taf NHS Trust Mrs R J Walker Nurse Director until 31st August 2009 0 0 0 35-40 0 5 Mrs A Phillimore Director of Human Resources until 31st July 2009 0 0 0 30-35 0 1 Mr S T James Acting Director of Human Resources from 1st July 2009 0 0 0 20-25 0 0

RCTtLHB Mr Mark Thomas Joint Director of Finance 0 0 0 35-40 0 0 Dr Anne Evans Medical Director 0 0 0 45-50 0 0 Mrs Lynda Williams Nurse Director 0 0 0 25-30 0 0 Miss Samia Saeed Head of Health Strategy 0 0 0 30-35 0 0 Mr Stephen Davies Head of Primary Care 0 0 0 30-35 0 0

72 Cwm Taf Health Board Annual Report 2010-11 Salaries of Senior Managers – continued

31 March 2011 31 March 2010 Benefi ts in Benefi ts in Other kind Other kind Salary Remuneration (Rounded to Salary Remuneration (Rounded to (bands of (bands of the nearest (bands of (bands of the nearest £5,000) £5,000) £00) £5,000) £5,000) £00) £000 £000 £00 £000 £000 £00

MTLHB Maria Thomas Director of Nursing and Clinical Lead until 30th June 2009(Note 2) 0 0 0 15-20 60-65 0 Dr Nigel Waskett Joint Medical Director 0 0 0 25-30 0 0 Julie Keegan Joint Associate Director of Planning 0 0 0 30-35 0 0 Pamela Wenger Joint Associate Director of Corporate Services 0 0 0 25-30 0 0

Non Executive Directors/Independent Members to 30th September 2009 Cwm Taf NHS Trust Mrs M Williams Non-Executive Director 0 0 0 0-5 0 0 Professor J Wademan Non-Executive Director 0 0 0 0-5 0 0 Dr V Winckler Non-Executive Director 0 0 0 0-5 0 0 Mr Martyn Waygood Non-Executive Director 0 0 0 0-5 0 0

RCTtLHB Dr Hasmukh V Shah GP Member 0 0 0 0-5 0 0 Dr Wesley P Saunders GP Member 0 0 0 0-5 0 0 Dr Kurt I Burkhardt GP Member 0 0 0 0-5 0 0 Mr Selwyn Jones Optometrist Member 0 0 0 0-5 0 0 Mr Alan Crabbe Pharmacy Member 0 0 0 0-5 0 0 Mrs Sylvia Jones Carer Member 0 0 0 0-5 0 0 Mrs Katrina Clarke Dental Member 0 0 0 0-5 0 0 Mrs Jacqueline Murphy Community Lay Member 0 0 0 0-5 0 0 Mrs Antonia Forte Voluntary Sector Member (note 3) 0 0 0 0 0 0 Ms Lynette Ward Therapy Member 0 0 0 0 0 0 Mrs Joanne Smith Nurse Member 0 0 0 0 0 0 Cllr Annette Davies Local Authority Member 0 0 0 0 0 0

Cwm Taf Health Board Annual Report 2010-11 73 Salaries of Senior Managers – continued

31 March 2011 31 March 2010 Benefi ts in Benefi ts in Other kind Other kind Salary Remuneration (Rounded to Salary Remuneration (Rounded to (bands of (bands of the nearest (bands of (bands of the nearest £5,000) £5,000) £00) £5,000) £5,000) £00) £000 £000 £00 £000 £000 £00 Mr Wynne Vaughan Local Authority Member 0 0 0 0 0 0 Mr Tony Young Local Authority Member 0 0 0 0 0 0 Cllr Michael Forey Local Authority Member 0 0 0 0 0 0

MTLHB Ray Thomas, Local Authority Member 0 0 0 0-5 0 0 Roy Bailey, Community Representative 0 0 0 0-5 0 0 Dr Kevin Thomas, GP Representative 0 0 0 0-5 0 0 Shiraz Megji, Optometry Representative 0 0 0 0-5 0 0 Mark Griffi ths, Pharmacy Representative 0 0 0 0-5 0 0 Huw Jones, Dental Representative 0 0 0 0-5 0 0 Jeffery Edwards, Voluntary Representative 0 0 0 0-5 0 0 Gill Bowtell, Therapy Representative 0 0 0 0 0 0 Simon Morgan, Associate Member, Trade Union 0 0 0 0 0 0 Dr David Cassidy, Associate Member 0 0 0 0 0 0 Ms Rachel Marsh, Associate Member 0 0 0 0 0 0 Laura Guard, Associate Member 0 0 0 0 0 0 Cllr Gareth Jones, Local Authority Member 0 0 0 0 0 0 Cllr Derek Games, Local Authority Member 0 0 0 0 0 0 Cllr Brian Mansbridge, Local Authority Member 0 0 0 0 0 0 Mr Giovanni Isingrini, Local Authority Offi cer 0 0 0 0 0 0

Benefi ts in kind relates to mileage allowances received in excess of the Inland Revenue tax free rate (fi gures given in hundreds). Notes 1. Mrs Nicola John is employed by Public Health Wales. She did not receive any remuneration directly from Rhondda Cynon Taff LHB or Cwm Taf LHB 2. Mrs. Maria Thomas took part in the VER scheme and retired on 30th June 2009. The amount under "other" salary costs represents the amount she was entitled to under the terms of the scheme. 3. Mrs Antonia Forte does not receive honorarium payments. Payments of £2,699 were made to her employers in respect of time spent on Rhondda Cynon Taff LHB duties to 30th September 2009.

74 Cwm Taf Health Board Annual Report 2010-11 Pension Entitlements of Senior Managers

Lump sum Total at age 60 Real accrued related to Real increase pension at accrued Cash Cash Real Employer’s increase in in pension age 60 at pension at Equivalent Equivalent increase contrib- pension at lump sum 31 March 31 March Transfer Transfer in Cash ution to age 60 at aged 60 2011 2011 Value at Value at Equivalent stake- (bands of (bands of (bands of (bands of 31 March 31 March Transfer holder £2,500) £2,500) £5,000) £5,000) 2011 2010 Value pension £000 £000 £000 £000 £000 £000 £000 £00 Cwm Taf Local Health Board Executive Directors Mrs M Foster Chief Executive to 4th March 2011(Note 1) 0-2.5 2.5-5 75-80 235-240 n/a 1,857 n/a 0 Mrs A Williams Director of Primary, Community and Mental Health Services to 6th March 2011 Chief Executive from 7th March 2011 0-2.5 2.5-5 25-30 85-90 413 445 (32) 0 Mr D H Lewis Deputy Chief Executive/Director of Finance & Procurement 0-2.5 2.5-5 50-55 155-160 1,143 1,155 (34) 0 Mrs. S C Sullivan Medical Director to 30th September 2010 (Note 2) 5-7.5 15-17.5 80-85 240-245 n/a 1,655 n/a 0 Kamal Asaad Medical Director from 1st September 2010 2.5-5 7.5-10 40-45 125-130 910 840 31 Ms A M Hopkins Nurse Director 2.5-5 7.5-10 30-35 95-100 637 603 11 0 Mrs A Lagier Director of Strategic & Operational Planning 0-2.5 2.5-5 35-40 110-115 479 531 (48) 0 Mr I Stead Director of Workforce Planning and Operational Development (Note 3) n/a n/a n/a n/a n/a n/a n/a 0 Mr C White Director of Therapies and Health Science 7.5-10 25-27.5 30-35 90-95 480 374 66 0 Mrs N John Director of Public Health (Note 4) 5-7.5 15-17.5 40-45 125-130 840 760 40 0

Notes: 1. Mrs M Foster retired on 4th March 2011 and therefore no longer has a CETV. 2. Mrs S Sullivan retired on 30th September 2010 and therefore no longer has a CETV. 3. Mr I Stead is in receipt of his NHS Pension. He became eligible to join the 2008 Pension Scheme during 2010-11 whilst in employment with Cwm Taf LHB. Figures for additional benefi ts under the 2008 scheme are not currently available from the NHS Pensions Agency. 4. Mrs N John receives no remuneration directly from Cwm Taf LHB. Pension contributions are paid by Public Health Wales.

The NHS Pension scheme which is open to all NHS employees requires all members to contribute on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings, with the employers contributing 14%. Pensionable pay is determined by the number of years pensionable service and is related to the level of earnings/fi nal salary at the time of retirement. Pension contributions of Executive Directors are entirely consistent with the standard NHS Pension Scheme. Pension benefi ts are calculated on the same basis for all members.

As Independent members do not receive pensionable remuneration, there will be no entries in respect of pensions for Independent members.

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefi ts accrued by a member at a particular point in time. The benefi ts valued are the member's accrued benefi ts and any contingent spouse's pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefi ts in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefi ts accrued in their former scheme. The pension fi gures shown relate to the benefi ts that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV fi gures and the other pension details include the value of any pension benefi ts in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefi t accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real Increase in CETV This refl ects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to infl ation, contributions paid by the employee (including the value of any benefi ts transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. In the budget of 22nd July 2010 the Chancellor announced that the uprating (annual increase) of public sector pensions would change from the Retail Price Index (RPI) to the Consumer Prices Index (CPI). As a result the Government Actuaries Department undertook a review of all transfer factors. The new CETV factors have been used to calculate the CETV for 2011. As these are lower than the factors used in 2010 the CETV for some Executive Directors have fallen.

Cwm Taf Health Board Annual Report 2010-11 75 Reporting of other compensation schemes for all staff – exit packages

NHS Body Cwm Taf LHB Number of departures included in (b) and (c) where special payments Exit package cost band Total number of exit have been made (special (including any special Number of compulsory Number of other packages by cost band payment element payment element) redundancies (b) departures agreed (c) (total cost) (totalled)) <£20,001 0 4 4 (£52,909.80) 4 (£52,909.80) £20,001 - £40,000 0 4 4 (£112,917.88) 4 (£112,917.88) £40,001 - £100,000 0 7 7 (£381,193.95) 7 (£381,193.95) £100,001 - £150,000 0 0 – – £150,001 - £200,000 0 0 – – Total number of exit packages by type (total cost) 15 15 (£547,021.63) 15 (£547,021.63) Total number of special Total number (and cost) of exit payments (and total cost of packages special payment element) 15 (£547,021.63) 15 (£547,021.63)

Public Sector Payment Policy – Measure of Compliance

Prompt payment code – measure of compliance The Assembly requires that Health Boards pay all their trade creditors in accordance with the CBI prompt payment code and Government Accounting rules. The Assembly has set as part of the Health Board fi nancial targets a requirement to pay 95% of the number of non-NHS creditors within 30 days of delivery.

2010-11 2009-10 Number £000 Number £000 NHS Total bills paid 3,308 16,452 4,141 47,916 Total bills paid within target 3,264 16,162 4,041 47,394 Percentage of bills paid within target 98.7% 98.2% 97.6% 98.9% Non-NHS Total bills paid 103,495 169,465 107,628 126,447 Total bills paid within target 100,762 166,835 103,586 123,371 Percentage of bills paid within target 97.4% 98.4% 96.2% 97.6% Total Total bills paid 106,803 185,917 111,769 174,363 Total bills paid within target 104,026 182,997 107,627 170,765 Percentage of bills paid within target 97.4% 98.4% 96.3% 97.9%

76 Cwm Taf Health Board Annual Report 2010-11 Related Party Transactions During the year none of the Board members or members of the key management staff or parties related to them has undertaken any material transactions with the Local Health Board. The Assembly Government is regarded as a related party. During the year Cwm Taf Local Health Board has had a signifi cant number of material transactions with the Assembly and with other entities for which the Assembly Government is regarded as the parent body namely,

2010-11 31 March 2011 Payments to Receipts from Amounts owed Amounts due related party related party to related party from related party £000 £000 £000 £000 Welsh Assembly Government 9 603,390 199 642 WHSSC (see below) 52,145 7,647 79 559 NHS Trusts Public Health Wales 149 2,055 56 77 Velindre 7,451 830 429 152 Welsh Ambulance Services 1,491 70 10 5 Local Health Boards ABMU 10,150 8,775 595 549 Aneurin Bevan 1,431 22,781 67 1,078

Betsi Cadwaladwr 255 238 9 19 Cardiff & Vale 20,622 10,262 1,034 2,309 Hywel Dda 548 568 92 48 Powys 1,326 1,388 38 94 Total 95,577 658,004 2,608 5,532

In addition, the Local Health Board has had a number of material transactions with other Government Departments and other central and local Government bodies. Most of these transactions have been with:

Rhondda Cynon Taf County Borough Council 5,729 4,187 2,452 1,018 Merthyr Tydfi l County Borough Council 1,216 1,384 385 493

The LHB has also received revenue payments from Cwm Taf NHS Charitable Funds totalling £0.419m (£0.355m in 2009-10) the Trustees for which are also members of the Board. A number of the LHB's Board members have interests in related parties as follows:

Name Details Interests Dr Chris D V Jones Chairman Partner at Taff Vale Medical Practice Professor Vivienne Harpwood Vice Chair Professor of Law, Cardiff University (to December 2010) Mr David Lewis Director of Finance and Procurement Non executive member of the Board, University of Glamorgan Cllr Russell Roberts Independent Member Leader of Rhondda Cynon Taf County Borough Council Cllr Clive Jones Independent Member Councillor of Merthyr Tydfi l County Borough Council Dr. Chris Turner Independent Member Director of Registry, Governance and Students, Cardiff University Professor Donna Mead Independent Member Dean of Faculty of Health Sport and Science, University of Glamorgan

Cwm Taf Health Board Annual Report 2010-11 77 Related Party Transactions (continued) WHSSC is a statutory sub-committee of each of the 7 Local Health Boards in Wales. Therefore, any related transactions would form part of each LHB's statutory fi nancial statements. Whilst WHSSC has an executive team these are not executive directors and they are employed by Cwm Taf LHB as the host organisation. During 2010/2011, the WHSSC Joint Committee adopted a risk sharing approach which is applied to all fi nancial transactions. In accordance with the Joint Committee's Standing Orders, the Joint Committee must agree the total budget to plan and secure the relevant services delegated to it. The Joint Committee must also agree the appropriate contribution of funding required from each LHB. Each LHB will be required to make available to the Joint Committee the level of funds outlined in the annual plan. The income received from each LHB during 2010/2011 as per note 4 is as follows

Income allocation £000's Cardiff and Vale 101,858 Abertawe Bro Morgannwg 109,156 Cwm Taf 52,144 Aneurin Bevan 103,275 Hywel Dda 70,548 Powys 26,669 Betsi Cadwalladr 131,295 Total 594,945

The main contractual agreements WHSSC has with providers of tertiary and specialist services are as follows

£000's Cardiff and Vale LHB 161,278 Aneurin Bevan LHB 2,961 Betsi Cadwalladr LHB 31,173 Abertawe Bro Morgannwg LHB 100,777 Cwm Taf LHB 7,210 Hywel Dda LHB 380 Velindre NHS Trust 29,600 Welsh Ambulance Services NHS Trust 113,936 Total Welsh Organisations 447,315

There are other ad hoc arrangements for individual patients and treatments which are not reported here. Accounting Policies The Welsh Assembly Government provides guidance on the Accounting polices to be used to prepare the LHB Accounts.

Work in relation to the Code of Audit Practice £’000 Accounts and Governance 341 Use of Resources 214 Further assistance services – Total auditors remuneration (including WHSSC) 555

VSM Uplift During 2010-11 pay awards for very senior managers complied with National Assembly for Wales guidance.

78 Cwm Taf Health Board Annual Report 2010-11 Report of the Auditor General for Wales to the National Assembly for Wales on the Summary Financial Statements I have examined the summary fi nancial statements contained in the Annual Report of Cwm Taf Local Health Board’s statutory fi nancial statements set out on pages 65 to 78.

Respective responsibilities of the Accounting Offi cer and auditor The Accounting Offi cer is responsible for preparing the Annual Report. My responsibility is to report my opinion on the consistency of the summary fi nancial statements with the statutory fi nancial statements and the remuneration report. I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or material inconsistencies with the summary fi nancial statements.

Basis of opinion I conducted my work in accordance with Bulletin 2008/3 ‘The auditor’s statement on the summary fi nancial statements’ issued by the Auditing Practices Board for use in the United Kingdom.

Opinion In my opinion the summary fi nancial statements are consistent with the statutory fi nancial statements and the remuneration report of Cwm Taf Local Health Board for the year ended 31 March 2011 on which I have issued an unqualifi ed opinion. I have not considered the effects of any events between the dates on which I signed my report on the full fi nancial statements, 14 June 2011 and the date of this statement.

Huw Vaughan Thomas Wales Audit Offi ce Auditor General for Wales 24 Cathedral Road 23 September 2011 Cardiff

Cwm Taf Health Board Annual Report 2010-11 79 Cwm Taf Health Board, Ynysmeurig House, Navigation Park, Abercynon, Rhondda Cyon Taff CF45 4SN. Bwrdd Iechyd Cwm Taf, Tyˆ Ynysmeurig, Navigation Park, Abercynon, Rhondda Cynon Taf CF45 4SN. Tel/Ffon: 01443 744800 www.cwmtafhb.wales.nhs.uk