Main Report Health Board Meeting
1st November 2012
AGENDA ITEM: I (VI) Subject Key Issues – Chairman’s Report & Activities Prepared, Approved Win Griffiths, Chairman and Presented by
Recent Activities:
7 September 2012 Attended Locality/Acute Performance table update meeting, Baglan HQ Met with First Minister visiting Resource Centre “UNICEF UK BFI Award” 10 September Ward visits, Princess of Wales Hospital 11 September Admin. 13 September Met with John Palmer/Sue Thompson, National Programme Board. Ward visits, Morriston Hospital 14 September Admin. 17 September Admin. Briefing for South Wales Plan – Changing for the Better, Baglan HQ. Attended EWS “Free to Lead/Free to Care” Cohort Programme, Princess of Wales Hospital 18 September Together for Health South Wales Plan Programme Board Meeting, Welsh Government, Cardiff 19 September Finance & Information Workgroup Pre-meeting with Director of Service, WAST. Attended Patient Transport Board Meeting, Cardiff Met with Edward Roberts, Vice-Chair Telephone conference call with Audiology Department Attended Health Board AGM, Neath Port Talbot Education Centre 20 September Equality & Human Rights Strategy Group, Neath Port Talbot Locality Office Admin 21 September Met with Dr Ruth Hussey, Liberty Stadium Attended Changing for the Better Event, Liberty Stadium 24 September Admin. Attended Diabetes Unit, Singleton Hospital All Wales Chairs Pre-Meeting with Health Minister, Cardiff Bay. All Wales Chairs Meeting with Health Minister, Cardiff Bay Attended All Chairs Dinner, Cardiff 25 September All Wales Chairs’ Peer Group: Development & Educational Programme, Llandough Hospital 26 September Admin. ABMU Special Board Meeting, Waterton Technology Centre, Bridgend Attended Staff Open Forum, Princess of Wales Hospital ______Chairman’s Activities 1
Visit to Stroke Ward, Princess of Wales Hospital Attended World’s “Biggest Coffee Evening” – Wales Macmillan Cancer Support, Cardiff Bay. 27 September Admin. 28 September Admin. 1 October Admin. Met with Paul Roberts 2 October Attended Launch of “Butterfly Scheme”, Singleton & Gorseinon Hospitals 3 October Admin Walkround, Princess of Wales Hospital 4 October Admin. Attended Q&S Board Development Programme, Baglan HQ Attended Charitable Funds Trustees Meeting, Baglan HQ 5 October Met with Sierra Leone elective, Singleton Hospital Met with Consultant Radiologist, Princess of Wales Hospital 8 October Ward visits, Princess of Wales Hospital Attended Bridgend Care Partnership Meeting, Bridgend 9 October Children in Wales Policy Council Meeting Children in Wales AGM, Cardiff 10 October Admin. Attended Library launch “Health & Wellbeing Campaign”, Pyle 12 October Admin 15 October Met with Lesley Griffiths, Health Minister, Cardiff Bay 16 October Together for Health: South Wales Plan Programme Board, Cardiff Visit to YMCA, Porthcawl 17 October Met with Chief Executive & Chair Cwm Taf HB Met with AAC Burns & Plastics Candidate, Baglan HQ
______Chairman’s Activities 2
SUMMARY REPORT ABM University Health Board Health Board Meeting On 1st November 2012
AGENDA ITEM: 1(VII) Subject Chief Executive’s Report Prepared by Steve Combe, Board Secretary Approved & Paul Roberts, Chief Executive Presented by Purpose This report is aimed at updating the Board on issues impacting on the Decision Health Board Approval Information x Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance X X X X X X Executive Summary The report provides a summary of a range of issues, both locally and from Welsh Government Key Recommendations The Board is asked to note the report and approve meeting dates for 2013 Assurance Framework The report provides an update on the full range of Board activities
Next Steps Actions will be taken forward, where relevant as set out in report
Corporate Impact Assessment Quality and Safety HCS 1 Financial To be assessed Implications Legal Implications N/A Equality & Implementation of Welsh Government Diversity requirements
1 MAIN REPORT ABM University Health Board Health Board Meeting On 1st November 2012
AGENDA ITEM: 1 (VII) Subject Chief Executive’s Report Prepared by Steve Combe, Board Secretary Approved & Paul Roberts, Chief Executive Presented by
1. PURPOSE To advise Board Members of issues impacting on the Health Board
2. KEY ISSUES Changing for the Better As Members will see from the separate Board report the engagement on Changing for the Better has commenced and we have already held some drop in sessions in community venues. These will continue throughout November and early December, together with similar drop in seeions for our staff.
Planning for 2013/14 Work is now starting on planning for 2013/14 and guidance has been issued to Directorates and Localities on planning assumptions for next year. The aim is to develop a first draft Plan for 2013/14 for consideration by the Board in January 2013.
Financial Position The financial position of the Health Board for Month 06 (September) is an overspend of £9.7m. This is a reduced level of overspend in month but the overall financial position remains a cause of great concern. Further details are included in the Finance report later on the agenda.
Medical Director Members will know that the scheduled interviews for the Medical Director post were cancelled and that following discussion with Board Members it has been agreed that the post be filled on an interim basis for 6 months and be advertised in the Spring of 2013. It is hoped that the name of the person appointed to this interim post can be announced at the Board meeting.
Members will also appreciate this is the last Board meeting to be attended by Bruce Ferguson. I would like to record my personal thanks to Bruce for all the help and assistance he has provided and for his immense contribution to health services locally and nationally.
Review of National Leadership and Innovations Agency for Healthcare Members will be aware of the ongoing review of the functions of the National Leadership and Innovations Agency for Healthcare (NLIAH) which has been the subject of consultation. As a result of this review it has been agreed that its functions should be transferred to the following bodies with effect from 1st April 2013
______2 • Public Health Wales for the Improvement Function and for the Centre for Equalities & Human Rights • Shared Services Partnership for Workforce functions • ABM for Intervention functions (the Delivery and Support Unit) • Welsh Government for Leadership Development and Offender Health
Currently the Board hosts NLIAH and the DSU and this arrangement will mean we will cease to act as host for NLIAH from 31st March 2013 but will retain responsibility for the DSU.
‘Together for Health’ – ‘Delivering End of Life Care – A Delivery Plan up to 2016 for NHS Wales and its partners’ – Consultation. The Welsh Government commenced consultation on 13th September 2012 on the above draft document which sets out the Welsh Government’s vision for providing end of life care; ambitions for what NHS services will look like by 2016; the themes for action up to 2016 through local end of life care services delivery plans and how success will be measured.The delivery plan is supported by a shorter more ‘public facing’ publication, which sets out what everyone can expect of end of life care in NHS Wales.
Silver Award In October the Health Board welcomed three assessors from the Welsh Government to assess the Health Board for the Corporate Health Standard Award. The assessors were extremely impressed by the work the Health Board which is being undertaken to support staff to improve their Health & Well-being. I am pleased to report that the organisation has been awarded the Silver Corporate Health Standard. Initial feedback has highlighted a number of areas of best practice such as a strong vision from the top, excellent catering facilities, impressive work being taking forward by the Health & Safety Department, an excellent Well-being through Work Service and a sense of community and team working across the organisation.
The full report will be sent shortly with the recommendation that with some focused work on the areas for development, the Health Board should be re-assessed for the Gold Corporate Health Standard within the next six months
Reports Circulated For Information A briefing on the Mental Health (Wales) Measure 2010 will be circulated to Board Members under separate cover along with an update on the Families First Programme.
Meetings 2013 The dates for Health Board Meetings in 2013 have been confirmed as:- • 24th January • 7th March • 2nd May • 28th May (provisional date for receipt and approval of Annual Accounts) • 4th July • 5th September • 18th September (provisional date for Annual General Meeting) • 7th November
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Chairman’s last meeting As this is the last meeting that Win Griffiths will attend as Chairman I would like to record my personal thanks to Win for the support he has provided me since becoming Chief Executive. He has succesfully led ABM since it was established and prior to that was Chair of the ABM and Bro Morgannwg Trusts. He has made a huge contribution not only to the NHS but to public life in Wales.
3. RECOMMENDATION The Board is asked to note the issues set out in the report and to approve the planned meeting dates for 2013.
______4 YOUR LOCAL NHS IS CHANGING... PLEASE GET INVOLVED!
There are big challenges facing the NHS in Wales, and we need to change the way we deliver healthcare to make sure we can meet those challenges. From 26th September to 19th December ABM University Health Board is carrying out public engagement to talk to you about our ideas, and hear what you think of them.
To find out more about these ideas, please visit our website: www.changingforthebetter.org. uk where you will find a range of information, including documents and videos; plus details of how you can feedback your views.
And please come and meet us – we’re holding a series of information drop-in days, (details below) across Swansea, Neath Port Talbot and Bridgend. Please refer to the website for details.
Mae eich GIG lleol yn newid… cymrwch ran!
Mae’r GIG yng Nghymru yn wynebu heriau mawr, ac mae angen i ni newid y ffordd rydym yn darparu gofal iechyd i wneud yn siŵr y gallwn oresgyn yr heriau hynny. O 26 Medi tan 19 Rhagfyr mae Bwrdd Iechyd Prifysgol ABM yn ymgysylltu â’r cyhoedd i drafod ein syniadau ac i glywed eich barn amdanynt.
Am ragor o wybodaeth am y syniadau hyn, ewch i www.chang- ingforthebetter.org.uk lle mae dogfennau a fideos, yn ogystal â manylion am sut y gallwch roi adborth.
Dewch i gwrdd â ni – rydym yn cynnal cyfres o ddiwrnodau galw heibio, Port Talbot a Phen-y-bont ar Ogwr. Ewch i’r wefan am wybodaeth bellach.
Venue / Venue Time/Amser Date/ Dyddiad
The Pavillion, Porthcawl, Bridgend / Y Pafiliwn, Porthcawl, Pen-y-bont ar Ogwr 11am - 7pm 17 Oct / Hyd Scout & Guide Headquarters, Brynmill, Swansea / Pencadlys y Sgowtiaid a’r Geidiaid, Brynmill, Abertawe 11am - 7pm 22 Oct / Hyd Carnegie Hall, Skewen, Neath / Carnegie Hall, Sgiwen, Castell-nedd 11am - 7pm 26 Oct / Hyd Pyle Life Centre, Bridgend / Canolfan Bywyd y Pîl, Pen-y-bont ar Ogwr 11am - 6pm 29 Oct / Hyd Maesteg Leisure Centre, Bridgend / Canolfan Hamdden Maesteg, Pen-y-bont ar Ogwr 11am - 7pm 31 Oct / Hyd Croeserw Community Centre, Port Talbot / Canolfan Gymunedol Croeserw, Port Talbot 11am - 7pm 2 Nov / Tach Gorseinon Centre, Swansea / Canolfan Gorseinon , Abertawe 11am - 7pm 8 Nov / Tach Grand Theatre, Swansea / Theatr y Grand, Abertawe 11am - 7pm 13 Nov / Tach Arts Centre, Pontardawe, Neath / Canolfan y Celfyddydau, Pontardawe, Castell-nedd 11am - 7pm 16 Nov / Tach Princess Royal Theatre, Port Talbot / Theatr y Dywysoges Frenhinol, Port Talbot 11am - 7pm 19 Nov / Tach ARC Centre, Bridgend / Canolfan ARC , Pen-y-bont ar Ogwr 11am - 7pm 22 Nov / Tach St. Hilary’s Church Hall, Killay / Neuadd Eglwys St Hilary, Cilâ 12pm - 7pm 26 Nov / Tach Morriston Leisure Centre, Swansea / Canolfan Hamdden Treforys, Abertawe 11am - 7pm 28 Nov / Tach Neath Town Hall, Neath / Neuadd y Dref, Castell Nedd 11am - 7pm 30 Nov / Tach Bridgend Brewery Field, Bridgend / Cae Bragdy Pen y Bont ar Ogwr, Pen y Bont ar Ogwr 11am - 7pm 4 Dec / Rhag Gendros Community Centre, Swansea / Canolfan Gymunedol Gendros, Abertawe 11am - 7pm 6 Dec / Rhag
Changing For The Better Team, ABMU Headquarters, One Talbot Gateway, Baglan, Port Talbot, SA12 7BR Tim Newid Er Gwell, Pencadlys ABM, Un Porthfa Talbot, Baglan, Port Talbot, SA12 7BR Phone / Ffon: 01792 704019 Email / Ebost: [email protected] You can share your views and find out more at: www.YouTellUs.org Gallwch rannu eich barn a chael rhagor o wybodaeth yn Or Tweet us: / Neu ar Twitter: @ABMhealth #ABMC4B Or on Facebook: / Neu ar Facebook: Facebook.com/ABM.healthboard ABM University SUMMARY REPORT Health Board Health Board 1st November 2012 Agenda item 2(i) Subject Changing for the Better Update Prepared by Joanne Davies, Asst Director of Planning (Service Planning) Approved by Hamish Laing, Director of Clinical Strategy Presented by Hamish Laing, Director of Clinical Strategy
Purpose To provide an update report on Changing for the Better and the Decision South Wales Programme Approval Information X Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance X X X X X Executive Summary The report provides an update on progress with the Changing for the Better programme. Key Recommendations The Board is asked to note progress Assurance Framework The report provides assurance to the Board of the inclusive process adopted in developing its strategic plan in line with the Minister’s requirements in Together for Health Next Steps Engagement arrangements are continuing
Corporate Impact Assessment Quality and Safety Due to the breadth of the Clinical strategy there will be links to components of all standards. Financial In line with similar major change programmes, Implications there is a requirement for funding to support the work involved. Legal Implications N/A Equality & As part of the programme, equality impact Diversity assessments are being carried out on any changes proposed in line with the Health Board’s agreed EqIA process.
1 ABM University MAIN REPORT Health Board
st Health Board 1 November 2012 Agenda item 2(i) Subject Changing for the Better Update
Prepared by Joanne Davies, Assistant Director of Planning Approved by Hamish Laing, Director of Clinical Strategy
Purpose This report describes progress in the Changing for the Better programme since the Board meeting of 26th September 2012 when our own engagement document Changing for the Better – Our Ideas for your Local NHS…Have Your Say! and related documents from the South Wales Programme were approved for publication.
Our engagement document has now been printed and a copy of the booklet and the shorter leaflet are attached. We have commenced distribution of 38,000 booklets and 84,000 leaflets to voluntary organisations (with thanks to the Council of Voluntary Services for their help with this), primary care and hospital sites as well as civil interest groups, community councils, libraries, Youth Forums, Local Authorities and Partners, AM’s and MP’s. A note has been included in all payslips for staff asking them to get involved in the engagement and put forward their views, and we are making the booklets available to them via Team briefing mechanisms as well as at the drop in sessions. All versions (below) are also available on the intranet / internet. It is intended to have completed distribution by end October 2012 as set out in our plan.
In addition to the booklets (in English and Welsh) and leaflets (bilingual) a number of other formats are available / in production: • Frequently Answered Questions (in Welsh and English) • Braille (in Welsh and English) • Talking Book (in Welsh and English) • British Sign Language • Easy Read (Welsh or English) • Large Print Version (Welsh or English)
A short film about our ideas has also been produced and is available in both Welsh and English versions with or without subtitles on the ABMU YouTube channel. A BSL version of the video is also being produced.
Engagement Process The Board received our engagement plan which included eleven drop-in sessions for the public and eight for staff. We are now able to confirm that additional dates have been added: at Pyle Life Centre, Princess Royal Theatre Port Talbot, St Hilary’s Church Hall Killay, Neath Town Hall and Bridgend Brewery Field. In total therefore there are now 16 sessions for the public and 8 for staff. Details of the staff sessions are included below, and the public information days are listed on the attached poster.
2 Staff Information Sessions:
5th November 2012 Singleton Hospital Canteen 11am – 3pm
6th November 2012 Morriston Hospital Canteen 11am – 3pm
7th November 2012 Princess of Wales Hospital Canteen 11am – 3pm
12th November 2012 Neath Port Talbot Hospital Canteen 11am – 3pm
19th November 2012 Gorseinon Hospital Conservatory 11am – 3pm
20th November 2012 Gellinudd Hospital Conservatory 11am – 3pm
21st November 2012 Maesteg Hospital Board Room 11am – 3pm
29th November 2012 Cimla Hospital Conference Room 11am – 3pm
The posters for the public events are being circulated widely and adverts for these sessions are being placed in local newspapers. We are also asking people as they attend events how we can do even better in publicising the engagement.
Feedback from first Drop In Event – Porthcawl The first drop in session in Porthcawl was held on 17th October 2012 at the Grand Pavilion from 11am to 7pm. Although the Health Board had advertised the sessions in the local newspaper, it became clear that the majority of people attending had heard about it by word of mouth. Over 140 members of the public attended the event and they were able to watch the video, see the presentation slides, review the proposals on posters around the venue as well as ask clinical and non-clinical staff any questions they might have. Each member of the public was given an engagement booklet and feedback form to fill in at the event and were asked to complete the questionnaire in the booklet and either send it back via the Freepost address or complete it and post it in the box made available at the venue. For any issues raised which could not be resolved / answered by staff at the event, an “issues log” was completed and we will be responding to these. The information from these is being collated. People were asked to rate the information available and helpfulness of staff and the majority scored both of these as either good or excellent. We will continue to learn from feedback for subsequent events.
South Wales Programme – Matching the Best in the World – Challenges Facing Hospital Services in South Wales As the Board will be aware, the proposals outlined in the South Wales Programme have been incorporated into the Changing for the Better engagement document and so are being discussed as part of the wider engagement process on our ideas for all services.
Discussions are continuing between the Health Boards involved in the South Wales Programme over the further work required of the programme and how this will be achieved to ensure the agreed timescales are met.
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The planned clinical workshop on Trauma Services was held on 17th October 2012 and this will lead to further discussions on the future provision of these services. How this information will be fed into the current engagement was discussed by Directors of Planning and Medical Directors on 18th October.
Capturing the views We have asked ORS to provide us with regular reports of emerging themes and will add to these the views captured from staff meetings, the Board’s rumour line and direct communication to the C4B team to create a regular internal report.
Recommendations The Health Board is asked to:
• Note progress with the engagement process since approving the documents on 26th September and the additional public drop-in events that have been arranged
• Receive a further update verbally reflecting the drop-in events to be held before the Board meets and any themes reported from engagement
4 SUMMARY REPORT ABM University Health Board Health Board Meeting On 1st November 2012
AGENDA ITEM: 2 (II) Subject ABMU HB Public Health Strategic Framework Prepared, Sara Hayes, Director of Public Health Approved and Presented by Purpose To inform Health Board members of the 2012/13 mid-year progress Decision in the priority areas of the refreshed Public Health Strategic Approval Framework. Information X Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance X X Executive Summary The ABMU HB Public Health Strategic Framework (PHSF) has been refreshed to take account of published information on health inequalities and developments in the Health Board, particularly Changing for the Better. Each priority area has been reviewed and mid-year progress has been reported. Key Recommendations The Health Board is asked to note the mid-year progress in setting up programmes to implement the PHSF. Assurance Framework Monthly meetings between the PHW Lead for each Priority Area and the Director of Public Health have been initiated to monitor progress and outcomes. Next Steps The PHSF will be refreshed in the New Year to take account of Health Board developments and the progress of Changing for the Better. There will be a new emphasis on tackling the social determinants of health, with actions to improve children’s health and health behaviours across the priority areas. In April 2013 the ABM Public Health Team will look at a range of measures for evidence of improved population health and health behaviours, and will report the results to the Board.
1 Corporate Impact Assessment Quality and Safety All programmes entail partnerships between different organisations. Individuals are responsible for working within the principles of their own organisation with respect to quality and safety. Each initiative will be carefully assessed for safety before being progressed. Financial There are no unfunded financial commitments Implications within this framework but some programmes will require additional funding. Where resources are needed, they will be applied for through formal mechanisms. Partnership funding will be welcomed. Legal Implications None identified Equality & The Framework has been produced to tackle Diversity inequality. Diversity is respected and welcomed.
2 MAIN REPORT ABM University Health Board Health Board Meeting On 1st November 2012
AGENDA ITEM: 2 (II) Subject ABMU Public Health Strategic Framework Prepared, Sara Hayes, Director of Public Health Approved and Presented by
1. PURPOSE To inform Health Board members of the 2012/13 mid-year progress in the priority areas of the refreshed Public Health Strategic Framework.
2. INTRODUCTION The ABMU HB Public Health Strategic Framework (PHSF) has been refreshed (a copy of the Framework will be available at the meeting but is not appended due to its size) to take account of newly published information on health inequalities, the vision of the WHO European Healthy Cities Network and developments in the Health Board, particularly in pathway development and Changing for the Better. Each priority area has been reviewed and mid-year progress has been reported.
The Framework is being used as the main driver for progressing public health programmes to improve population health. It will help drive wider Health Board developments. The Annual Report of the Director of Public Health was based on the refreshed Framework. Progress is being made in establishing work programmes in the six priority areas with particular focus on tobacco control, obesity and workplace health, which are priority areas for the Board. It is too early to demonstrate population health outcomes for most of these priority areas. The reports demonstrate there are some areas where change would be desirable but the drivers to deliver these are outside the direct control of Public Health Wales (PHW) or the Health Board.
The PHSF will be further refreshed in the New Year to take account of emerging public health evidence, Health Board developments and the progress of Changing for the Better. There will be a new emphasis on actions to improve children’s health and health behaviours across the priority areas.
In April the ABM Public Health Team will look at a range of measures of population health and health behaviours. The results of this will be reported to the Board.
PROGRESS IN PRIORITY AREAS This section provides a summary of progress in priority areas.
1. Tobacco With support from Health Board colleagues, ABM Public Health Team has developed a two year Tobacco Control Strategic Action Plan. A steering group was established
______3 in September 2011 and performance against the year one action plan is monitored on a quarterly basis.
Secondary driver Update September 2012 Adult social norms around smoking Smoke-free homes DVD and resource pack completed. Smoke-free homes brief advice training for professionals being developed. Access to smoking cessation and Continued delivery of brief intervention for smoking pharmaceuticals cessation training to key Health Board frontline workers. Continued delivery of Stop Smoking Wales services and pharmacy schemes. ABMU HB occupational health staff have received Every Contact Counts Brief Opportunistic Advice e- learning training. Attitudes and knowledge around Smoke-free homes DVD and resource pack risks of smoking completed. Smoke-free homes brief advice training for professionals being developed. Fresh Start Wales smoking in cars campaign continues to be implemented by WG. Enforcement across settings ABMU HB refreshed smoke free environment policy launched. Signs erected in key strategic sites. Publicity material sent to all GP practices across the ABMU HB area. Audit of smoking behaviour in key hotspots being undertaken.
2. Obesity (physical activity and nutrition) ABM Public Health Team has recently helped convene an integrated ABM Obesity group, chaired by the Director of Public Health, which will meet quarterly. The group has a diverse membership which includes staff from across ABMU Health Board, the three Local Authorities and the Third Sector. There are a lot of initiatives being undertaken within the localities of Bridgend, Neath Port Talbot and Swansea which are aimed at helping to halt the increasing obesity trend. The formation of the ABM Integrated Obesity Group will provide clear leadership and coordination of action through a multiagency approach to address the high levels of overweight and obesity.
Secondary driver Update October 2012 Built and spatial environment which Active Transport Plan out for consultation does not promote incidental physical activity Availability and affordability of Welsh Government have recently produced energy dense food guidance on healthier food and drink for youth services, which will influence the availability of energy dense foods in vending machines High car ownership and usage for short journeys Societal and family norms around MEND programmes are currently operating in NPT Physical Activity and healthy eating and Swansea and this is being extended to include families with children aged 5-7 years. Other programmes which target nutrition and physical
______4 activity include the Families First programme in Bridgend, “Healthy Together” in Swansea funded by the Premier League and LEAF- Learning with Exercise Activity and Food Media representations of food, convenience and physical activity Perceived safety of walking/cycling environment Cognitive factors influencing food Community weight management programmes choice currently running in North Community Network in Bridgend and Swansea Bay Health Community Network. “Foodwise” a structured weight management programme being developed by WG that can be delivered in Tier 1 and 2 of the Obesity Pathway Proportion of mothers breastfeeding ABMU HB is the first Health Board to achieve the UNICEF BFI Award in Wales and it is important to maintain this. Continue to develop ABMUHB Breastfeeding Strategic Action Plan
3a. Substance misuse (alcohol) The ABM Public Health Team is working closely with its partners to reduce the prevalence of binge drinking amongst adolescent and adult population and reduce the prevalence of the adult population reporting drinking over the recommended limits.
Secondary driver Update October 2012 • Alcohol misuse amongst the Current gap. Need to establish levels of misuse, older population best practice etc • Night-time economy Swansea Healthy Nightlife action plan 2012-2013
• Young people and risky Part of Healthy Schools Scheme action plans. behaviours Following a needs assessment, Bridgend SMAT has commissioned a tier two, out of hours service for children and young people. This provision has increased children and young people’s access to vital services and has reduced risky behaviour amongst groups of young people across Bridgend Borough. • Availability and pricing of alcohol
• Social norms, attitudes and knowledge in relation to alcohol • Dual diagnosis intervention Current gap
• Timely, available treatment The Children and Young Person’s Out of Hours provision Service is operational across six community hubs. It is hoped that the service will expand into the Garw Valley over the coming months. Many young people are engaging with the service who would not ordinarily access town centre services. There
______5 are excellent examples of improved outcomes for children and young people, including re- engagement with education and employment, improved family relationships and a reduction in harm from substance misuse. Parental satisfaction with the service has also promoted the provision via informal parent networks. This has increased the number of referrals to service from parents and schools. SMAT investment has created an additional 57 treatment places and an additional 20 counselling places for children and young people since April 2012. This is equates to a 50% increase in the number of available treatment places for children and young people. All young person’s services are achieving the Welsh Government’s KPI on waiting times.
Hartshorn House multi-agency base, in Maesteg has been operational since April 2012. Thirteen services are currently operating from the facility which includes: Wallich Homeless Outreach Service, Community Drug & Alcohol Team, NSPCC Caring Dads, Al Anon, WGCADA, Samaritans and Cruise Bereavement. Since July, 159 people from the Llynfi Valley have accessed services at Hartshorn House. All service users have commented positively on the provision managed by G4S.
3b. Substance misuse (drugs) The ABM Public Health Team works closely with partners to reduce the prevalence of illicit drug use.
Secondary driver Update October 2012 • National Legislation • Effective Police Management Current knowledge gap requiring future work • Waiting Times for community Recent WG KPI return has indicated CDAT must drug and alcohol services work further towards reducing the level of unplanned ending from treatment. In partnership with the SMAT it is anticipated that the improvement plan will be developed and implemented within 6 months • Availability and capacity of All 4 tiers available in Bridgend. Capacity within substance misuse services specialist adult services remains strained. across 4 tiers • Knowledge and skills of primary Current gap and will require future work care staff • Enhanced substance misuse The implementation of a pilot GP prescribing service services available in primary care is being undertaken in Neath, Port Talbot currently. An evaluation of the service model will be conducted by the APB with a view, that if successful, the model will be rolled out across the ABM area. The new service objective is to redirect stable, non complex
______6 service users, in receipt of prescribing, to access substitute medication in primary care, creating a greater throughput of complex patients through specialised services. • Diversionary schemes for Current gap and will require future work substance misuses or those at risk of substance misuse • Joined up mental health and Current gap and will require future work substance misuse services • Improved resilience, skills and Hidden Harm social work service based in CDAT in knowledge of children and young both Bridgend and Neath Port Talbot. The service people (particularly those affected work with parents that misuse substances and aims by parental substance misuse) to improve outcomes for children and young people. DASH Yes service, a support service in Bridgend that works with children and young people affected by parents’ substance misuse.
4. Sexual health There is strong association between deprivation and teenage conception. The under 16 and 18 year old conception rate masks inequalities between wards across the ABMU Health Board.
Secondary Update September 2012 as per ABMU Health Board driver Sexual Health Delivery Plan 2012/13 Media SRE training Development of SRE teaching resource in partnership with local teaching staff and agencies (Swansea and NPT) School Health Nurse Service contributes to SRE across ABMU and provides 1:1 advice and information in secondary school drop in sessions.
Development of directory of organisations to support the delivery of SRE within localities
Working party established to pilot SRE curriculum for year 7 and 9 (Swansea)
SRE teaching pack developed for Keystage 3 and 4 (Neath Port Talbot)
SRE training arranged for staff in Keystage 4 education centres to support most vulnerable youngsters (Swansea). National SRE National SRE guidance published in 2010. guidance National guidance for SRE in community settings to be published. Availability and Implementation of Empower to Choose the national programme to accessibility to reduce teenage conceptions through uptake of LARC. Supported by contraception materials and website for professionals and users. inc. LARC www.publichealthwales.org/empowertochoose www.youchoose.wales.nhs.uk Phase 2 currently being scoped and will focus on Looked after Children, care leavers and women within substance misuse services.
______7 The programme is audited by PHW. Returns received from ABMU HB are lower than expected. Based on 2010 conception rates PHW would expect to receive approx 85 returns per quarter, for the period April to end Sept 35 forms have been returned.
Increased provision of sexual health services and access to LARC through the Families First Programme 5 in Bridgend. Information on Local sexual health services included on the Empower to choice local services website. Access to provision of EHC via NHS Wales Direct. Access to National Condom Card Scheme standards launched July 2012. The appropriate Swansea scheme is currently working towards accreditation. A databases and national database supports the C Card Standards, and staff from monitoring across the localities recently attending a national training session. systems Accurate All Wales sexual health surveillance system providing STI data by area recording of residence. Conception maps to support work with partners. systems Multi-agency SRE training as above. Provision of RADS training (NPT) condom working scheme training (Swansea) Clear referral pathways
5. Workplace health There continues to be considerable commitment to promoting and developing a culture that values the health and wellbeing of the staff in ABMU. To continue to improve, ABMU Health Board needs to create an improved health and wellbeing environment for its staff and also act as a beacon / champion within the community.
Secondary Update October 2012 driver Early identification
Facilities that There are a number of grants available for the development of promote health and facilities that promote health and wellbeing. Organisations who are wellbeing involved in the Corporate Health Standard or Small Workplace Health award have a lot of this information provided to them. There is still some considerable progress that can be made with regard to improving the planning of facilities to ensure that they promote staff being physically active in their commute to work, have healthy options available / and promoted to them regarding nutrition. Demands of work There is considerable evidence that it is not just the quantity of work environment that is demanded of an employee that is the indicator of stress and absenteeism but the amount of control that an individual employee has and is able to exercise that is the indictor to increased stress and absenteeism. Employers using flexible employment systems, supporting part time working etc therefore should be encouraged. Policies that Organisations that participate in the corporate health standard or the promote Health & small work place award are challenged / supported to develop Wellbeing policies that both protect and promote the health of employees.
______8 Knowledge Organisations that participate in the corporate health standard or the attitudes & skills of small work place award are challenged / supported to develop employees and knowledge, skills and attitudes of both employees and employers. employers The process of going through the different thresholds supports behaviour / cultural change within an organisation. Availability of ABMU Health Board is in advantageous position through having remedial available the Wellbeing Through Work service. Wellbeing through programmes Work is a project aimed at improving the health and wellbeing of working age people in Bridgend, Neath Port Talbot and Swansea. The project is managed by Remploy and NLIAH (National Leadership and Innovation Agency for Healthcare) and is made possible by EU's Convergence European Social Fund through the Welsh Government. Links with primary Links have been made with Primary care although this has not care and other happened in a systematic, ongoing basis. One Protected Time For providers Learning session prioritised workplace health and the changes that have taken place with regard to absence because of sickness in the last 12 months in one locality. In a number of Primary Care practices Department of Work and Pension staff are based to support those who have been / or are in danger of going on to sickness benefits to find appropriate work. Screening of Staff Some actions regarding this driver have been undertaken, these include the NPT HSCWB Partnership resourcing screening for staff from a range of 3rd sector and private sector organisations. Following the success of this for the last two years this initiative is planned again before the end of this financial year. Similarly Bridgend Council and Partners have run blood pressure drop in sessions for staff with appropriate signposting. In general while there are pockets of good practice, screening systematically of staff is undertaken by few employers.
6. Injuries and falls ABMU Health Board has established an integrated Falls group, chaired by the Executive Director of Therapies, which meets quarterly. The group has a diverse membership which includes staff from across the Health Board, Welsh Ambulance Service, the three Local Authorities and the Third sector. Representatives from NLIAH also attend. ABM Public Health Team is leading the development of Community Falls Prevention.
Secondary driver Update September 2012 Information sharing across Falls Group established and effectively functioning; 3 partnerships priority areas identified; Multiagency partnership workshop held June 2012 Databases fit for purpose and Staff inputting into NLIAH Database – exploration monitoring arrangements required how to access this information and understand agreed if it is inputted consistently Design of built environment While Local Authorities are engaged in the Falls including homes and roads Partnership, generally this is someone associated with social care, exercise referral, older person strategy. Opportunity to work with relevant Local Authority staff regarding built environment and housing.
______9 Services available to improve All 3 areas engaged and working with Care & Repair to home safety and immediate develop safer immediate environments. The priority environment area to standardise falls services will aim to address inconsistency in service such as differentials in telecare support Screening There is currently a Falls Screening Project which is running in Bridgend East Community Network. Some operational issues with the project – PHW are working to resolve these issues. Opportunity to look at other screening projects such as Primary Care Screening work in neighbouring health board. Evidence based community Swansea University have provided a summary of the interventions evidence regarding Community Falls interventions. Consistent and sustained implementation of interventions across ABM region. Knowledge, skills and Need to audit what current training is taking place, confidence of primary care staff, against which standards/best practice community staff and patients NLIAH Programme and This work is being incorporated into the Falls Pathway partnerships development work which is currently the priority which has developed the furthest.
3. RECOMMENDATION The Board is asked to note the progress in delivering the Public Health Strategic Framework.
______10 SUMMARY REPORT ABM University Health Board Health Board Meeting On 1st November 2012
AGENDA ITEM: 2(iii) Subject Developing a Commissioning Programme Prepared, Approved and Sara Hayes, Director of Public Health Presented By Purpose The Board is asked to note and support the establishment of a Decision Commissioning Board to oversee a service prioritisation and Approval planning programme to address population health needs and health Information inequities. Other X Corporate Objectives Safety Quality Efficiency Workforce Health Governance X X X X X X Executive Summary The report sets out proposals to establish a commissioning programme to inform the Health Board of the priorities to meet population health needs and address health inequalities. The Director of Public Health will be the Senior Responsible Officer for the programme. . Key Recommendations The Board notes and supports the proposal to establish a commissioning programme and Commissioning Board. Assurance Framework The Commissioning Board will help ensure that appropriate services are commissioned for local people Next Steps A working group will be established to set up the Commissioning Board and establish the working arrangements to support it.
Corporate Impact Assessment Quality and Safety The commissioning mechanism will incorporate methods to improve quality and safety routinely Financial None directly but will support efficient and Implications effective use of resources. Legal Implications None identified Equality & The commissioning mechanism will explicitly Diversity address inequalities and will ensure services take diversity of the population, patient groups and the workforce into account.
1 MAIN REPORT ABM University Health Board Health Board Meeting On 1st November 2012
AGENDA ITEM: 2(III) Subject Developing a Commissioning Programme Prepared, Approved & Sara Hayes, Director of Public Health Presented by
1. PURPOSE To set out proposals to establish a commissioning programme and Commissioning Board to oversee a service prioritisation and planning programme to address population health needs and health inequities.
2. KEY ISSUES The purpose of ABMU Health Board is “to improve the health of our community and to deliver effective and efficient healthcare in which our patients and users feel cared for, safe and confident”. Since this purpose has been agreed, a report on the marked variation in health status across the ABMU Health Board area has been published by the Public Health Wales Observatory and tackling inequalities has become an important aspect of the Board’s responsibilities.
Members will be aware that the Changing for the Better Programme is concerned with improving health and health services, including developing the capacity for improvements that could be achieved though staying healthy initiatives. Building on the lessons learnt from the Changing for the Better programme, it is now felt to be an appropriate time to take a strategic overview of the range of services ABMU HB provides and the partners it works with to ensure it delivers appropriate services equitably and that it is able to prioritise areas for investment. This requires a commissioning mechanism to be developed and integrated with the other Board functions.
It is proposed to set up a commissioning programme to inform the Health Board of the priorities to meet population health needs and address health inequalities. The programme will be overseen by a newly created Commissioning Board, chaired by the Chief Executive. The Director of Public Health will be the Senior Responsible Officer for the programme. The Commissioning Board will work alongside the Executive Board and will be integrated with routine planning arrangements.
The commissioning programme will support prioritisation of investment options and disinvestment in services, in a transparent manner open to scrutiny and challenge. This new approach will engage with and invest in improving the health of poorer members of our society. The Commissioning Board will consider issues such as the prioritisation of services and support safe and sustainable service development, and equitable demand management.
Moving from cost improvement to value improvement
______2 As part of this programme there is a need to move away from ‘cost improvement’ towards ‘value improvement’ programmes. The challenge of increasing financial constraints year by year can only be met in the long term by improving the engagement of the population in making better choices and managing their own conditions.
Partnership working Looking beyond the NHS, the concept of health in all policies, in line with the WHO Healthy Cities Network, needs to be taken forward with communities and local authorities, notably social care and education, but also housing, environment, transport and leisure departments. Services delivered in partnership with other agencies need to be tightly defined and aimed at achieving health gain for the poorest citizens. The Health Board is making excellent progress in these areas through its Locality Teams and the development of Community Networks. This needs to be supported at an ABMU level.
Support for prioritisation In December 2011 the All Wales prioritisation framework was approved by the All Wales Chief Executives Group. The framework outlines a clear, rational approach and a fair, transparent process to ensure that evidence-based health gain for the local population and value for money are maximised. The framework advocates that each Health Board adopts a systematic approach to service review and design. This will be incorporated into the commissioning programme.
What is already being done within ABMU There is wide engagement with the Changing for the Better and South Wales Programmes, which will lead to service changes across S Wales. Changing for the Better recognises the challenges of improving individual health and creating more robust communities. A Service Transformation Team has been set up to redesign pathways around the Health Board priorities of improving services for cardiovascular health and older people, and improving access. There are several mechanisms for restricting services for which the evidence of effectiveness is poor:
• The Health Board has an Individual Patient Funding Request (IPFR) panel. Applications for exceptional treatments are made to the panel. The panel operates to the All Wales Policy on Making Decisions on Individual Patient Funding Requests (IPFR).
• The Health Board’s Interventions Not Normally Used (INNU) Policy is currently in the process of being updated and approved. The policy provides details of those interventions which are not to be normally used. Interventions are on this list because, for instance, there is evidence they are not effective (or there is a lack of evidence on their effectiveness) or more effective interventions are available.
What needs to be done now Investment will be needed to achieve change but, in the present financial climate, it will need to be able to deliver bigger savings. To do this there is a need to establish a formal commissioning process, taking on board lessons learnt from elsewhere in
______3 Wales, the UK and the wider international literature. It is suggested that the Board’s commissioning system has the following components:
• A Commissioning Board to provide advice on which services to commission, based on potential gaps and opportunities. It needs clinical and managerial involvement and should learn from national (UK and Welsh) developments in best practice and advice from Welsh Government. It should examine activity at interfaces between directorates, healthcare settings and with other agencies as these offer scope for streamlining and improving care. It should advise on which services to decommission based on demonstrated low value together with clear timescales for releasing funding. • Epidemiological and informatics support to develop the case for change, drawing on information from the Board itself and from the PHW Observatory, NWIS, local authority, Welsh Government, University and other agencies’ information systems. • Criteria by which any options will be assessed for suitability and closeness of fit to the proposed service. • A variety of impact assessment tools (e.g. Health Impact Assessment, Equity Impact Assessment, sustainability and carbon footprint) to assess and minimise adverse impacts on the most disadvantaged groups such as prisoners, homeless and gypsy/traveller populations. • Procurement tools to facilitate sound purchasing. • Processes and skilled staff for developing service specifications, implementing new programmes, monitoring results, managing the transition phase and closing down redundant services, with appropriate human resources support. • A communication strategy for consultation and engagement with the public, organisational partners, staff and Welsh Government.
A working group will be set up to establish the commissioning programme, including the Commissioning Board.
3. RECOMMENDATION The Board is asked to support the establishment of a Commissioning Board, chaired by the Chief Executive, to oversee a new commissioning programme, integrated into existing planning, pathway and prioritisation mechanisms, to address population health needs and health inequities.
______4 Abertawe Bro Morgannwg University Health Board
OCTOBER HEALTH BOARD MEETING
ACCESS
Current Month score Current Target Month Tolerance Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 YTD Max Type HCS Ref Target Score Score Commentary EMERGENCY DEPARTMENT A&E WAITING TIMES 1 4 Hour Wait - Major Tier 1 95% 90% 92.6% 91.1% 90.3% 90.3% 89.2% 88.2% 88.2% 88.4% 87.8% 88.0% 83.1% 87.9% 83.3% 1 4 Hour Wait - Minor Tier 1 95% 90% 96.7% 96.4% 94.6% 95.4% 94.1% 92.7% 94.2% 92.5% 93.8% 92.9% 94.0% 95.6% 99.6% 1 4 Hour Wait ABMU Tier 1 95% 90% 93.6% 92.3% 91.3% 91.5% 90.4% 89.2% 89.7% 89.4% 89.3% 89.2% 85.7% 89.5% 86.5% 1 8 Hour Wait - Major Tier 1 99% 99% 98.3% 97.7% 97.3% 96.4% 94.7% 93.7% 95.3% 94.4% 94.8% 94.4% 94.4% 97.0% 94.5% 1 8 Hour Wait - Minor Tier 1 99% 99% 99.7% 99.5% 99.3% 99.3% 98.8% 98.4% 99.2% 98.4% 98.6% 98.6% 98.8% 99.2% 99.8% 1 8 Hour Wait ABMU Tier 1 99% 99% 98.6% 98.2% 97.8% 97.0% 95.6% 94.8% 96.2% 95.4% 95.8% 95.4% 95.5% 97.5% 95.5% AMBULANCE HANDOVER TIMES 1, 6 No. Waiting >15 mins Tier 2 100% 95% 75.7% 75.6% 75.6% 67.6% 61.6% 55.7% 54.8% 54.4% 52.5% 53.1% 60.2% 63.7% 50.7% 1, 6 No. Waiting > 30 mins Local 100% 100% 93.7% 91.9% 92.1% 87.8% 84.3% 78.3% 79.5% 77.4% 76.4% 76.8% 83.2% 87.9% 75.9% REFERRAL TO TREATMENT WAITING TIMES % Waiting over 26 weeks 1 All Specialties Tier 1 100% 95% 92.3% 93.2% 93.2% 92.3% 93.1% 93.8% 95.1% 94.5% 94.3% 94.7% 94.5% 93.6% 93.7% Number >36 Weeks (all stages) 1 All Specialties Tier 1 0 0 999 924 840 778 611 555 236 266 272 296 302 311 322 Number of Stage 1 over 26 weeks 1 All Specialties Local 0 0 1897 1440 1178 1169 936 627 0 20 17 46 161 729 444 ENDOSCOPY % Waiting < 8 weeks 1 Al Specialties Tier 2 100% 95% 72.8% 85.2% 85.2% 73.1% 67.3% 73.7% 73.1% 69.8% 69.7% 64.9% 64.2% 62.7% No of Patients Waiting >= 8 Weeks 1 All Specialties Tier 2 0 0 401 204 248 519 649 564 581 662 690 782 838 853 DIAGNOSTIC WAITING TIMES % Waiting < 8 Weeks 1 All Procedures AQF 100% 95% 91.8% 95.4% 99.3% 97.9% 98.4% 99.9% 99.1% 98.7% 97.8% 96.1% 96.0% 92.6% No of Patients Waiting >= 8 Weeks 1 All Procedures AQF 0 0 596 309 45 142 110 6 67 102 172 320 335 594 THERAPY WAITING TIMES % Waiting < 14 Weeks 1 All Therapies AQF 100% 95% 99.3% 99.0% 99.4% 99.1% 97.3% 94.8% 96.4% 95.6% 93.7% 91.0% 95.3% 96.9% No of Patients Waiting >= 14 Weeks 1 All Therapies AQF 0 0 32 46 28 43 131 265 197 235 338 485 234 142 CANCER WAITING TIMES 31 Days from Diagnosis to treatment 1 All Tumour Sites Tier 1 98% 93% 98.0% 98.4% 98.6% 97.2% 96.4% 99.3% 97.6% 96.7% 96.8% 95.3% 94.3% 95.7% 92.3% 62 Days - Screening Refs to 1st Treatment 1 All Tumour Sites Tier 1 95% 90% 88.2% 86.6% 90.0% 88.4% 91.8% 80.5% 72.5% 63.5% 77.7% 80.5% 75.5% 73.1% 75.0% DTOC - Based on Residence 1, 6 Non Mental Health Patients Tier 2 Reduce Reduce 48 48 43 40 47 33 45 37 34 34 33 28 32 1, 6 Non Mental Health Days Delayed Tier 2 Reduce Reduce 2852 2852 2139 2228 1846 1551 2290 2116 1822 1702 1416 1309 950 1, 6 Mental Health Patients Tier 2 Reduce Reduce 27 28 29 23 25 28 31 25 27 18 22 22 20 1, 6 Mental Health Days Delayed Tier 2 Reduce Reduce 2989 2904 3434 2969 2756 2976 3594 3764 4056 3776 3233 1952 1939 DTOC - Based on Hospital 1, 6 Non Mental Health Patients - Based on Hospital Tier 2 Reduce Reduce 63 55 54 48 51 46 56 47 30 42 39 32 40 1, 6 Non Mental Health Days Delayed - Based on Hospital Tier 2 Reduce Reduce 4828 3983 2913 3044 3685 3236 3456 3584 3213 3161 2840 1807 1813 1, 6 Mental Health Patients - Based on Hospital Tier 2 Reduce Reduce 32 33 34 21 29 30 33 27 43 19 23 23 19 1, 6 Mental Health Days Delayed - Based on Hospital Tier 2 Reduce Reduce 3760 3947 4409 4083 3982 3741 4429 4666 4613 4328 3813 2560 1973 CARE AND TREATMENT THROUGH CPA 94% 97% 97% 6, 7 Enhanced CPA must have an agreed care plan AOF 100% 100% 93% 95% 96% New metrics to be reported under 6, 7 Standard CPA must have an agreed care plan AOF 95% 95% Mental Health measure Appropriate patients on Enhanced CPA will receive an assessment from 100% 100% 100% 100% 100% 100% 100% 6, 7 AO service AOF 95% 95% Abertawe Bro Morgannwg University Health Board
OCTOBER 2012 HEALTH BOARD MEETING WORKFORCE
Current Month score Current Target Type Month Tolerance Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Max Score Commentary HCS Ref Target Score MANDATORY TRAINING % Staff received Standard precaution infection control training in last 12 months Tier 2 90% 85% 73.0% % Staff received POVAappropriate training level in lastof Safe 3 years Guarding children training (3 yrly) Statutory 90% 85% 60.0% Source: Directorates % Staff received POVA training in last 3 years Tier 2 90% 85% 68.0% & Localities % Staff trained in MCA/DOLS Statutory 90% 85% 64.0% APPRAISALS 24 Non-Medical Appraisals completed by due date Statutory 100% 95% 50.0% 57.0% 89.0% 24 Medical Revalidation Statutory 100% 95% Under development CONSULTANT JOB PLANS 24 Consultant Job Plans Completed Statutory 100% 95% Under development 24 SAS Job Plans Completed Statutory 100% 95% Under development ABSENCE MANAGEMENT 24 Sickness Rate - In-month Local 5.08% 5.08% 5.58% 5.98% 6.14% 6.04% 6.05% 6.05% 5.86% 5.61% 5.76% 5.70% 6.02% 24 Sickness Rate - Rolling 12 Month Tier 1 5.08% 5.08% 5.36% 5.41% 5.46% 5.43% 5.43% 5.50% 5.58% 5.62% 5.67% 5.69% 5.73% n/a Percentage that is long term sick - In-month Local Monitor Monitor 3.18% 3.17% 3.07% 3.20% n/a Percentage that is long term sick Local Monitor Monitor 2.57% 2.62% 2.66% 2.70% 2.72% 2.75% 2.78% 2.82% 2.86% 2.88% 2.89%
Note: Sickness Absence information is retrospective and delayed by 2-3 months due to the payroll processing schedule. Abertawe Bro Morgannwg University Health Board
OCTOBER 2012 HEALTH BOARD MEETING SAFETY & QUALITY
Current Month score Current Target type Month Tolerance Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Max HCS Ref Target Score Score Commentary/Source RISK 1, 22, 25 No of risk score > 20 Local Reduce Reduce 42 40 41 31 33 40 CONCERNS Incidents: 23 Number of Never Events Local 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23 Number of incidents reported Local Reduce Reduce 1,184 1,420 1,216 1,288 1,230 1,209 23 Number of Serious Incidents reported Local 0 0 4 23 Number of incidents remaining not approved Local 0 0 9 (11) 9 (18) 14(31) 13(78) 30(296) 186 23 Number of incidents reported with harm (patient / staff) Local Reduce Reduce 122(123) 137(138) 119 (123) 139(139) 136(139) 122 23 % of investigated incidents with harm (patient / staff) Local 100% 100% 33%(30%) 27%(26%) 20%(19%) 23%(20%) 22(15%) 18% 23 Number of incidents resulting in harm to patient / staff Local Reduce Reduce 12(12) 13(13) 10(10) 8 (6) 10 7
POVA - Attributed to Health Board or Health Board Staff Statutory 0 0 12 20 9 6 9 8 23 23 Inpatient Falls Local Reduce Reduce 199 209 243 204 259 204 211 243 210 215 212 210 190 Source: Care Metrics Complaints: Monitor Monitor 108 123 123 146 141 136 1, 5, 23 Number of complaints received Tier 2 End of month figures 30 1, 5, 23 Number of complaints received (green and yellow only) Tier 2 Monitor Monitor 96 105 111 129(131) 129 121 working days in arrears. Number of responses sent within 30 working days Monitor Monitor 64 83 90 86 Future populated 1, 5, 23 (green/yellow graded concerns) Tier 2 1, 5, 23 Percentage of Complaints Closed Within Timeframe Tier 2 100% 90% 67% 79% 81% 67% Satisfaction Survey's Number of Patient Responses Local Monitor Monitor 176 423 318 458 322 602 Average Patient Satisfaction Percentage Local 95% 90% 94% 91% 93% 91% 91% 93% MORTALITY 6 Actual in-hospital deaths Tier 1 N/A N/A 270 271 275 346 307 302 292 284 260 248 291 262 254 Only reported when coding 100 100 122 111 112 120 111 105 108 112 100 6 Risk Adjusted Mortality Index (RAMI 2012) Tier 1 > 95% 100% 36% 33% 31% 6 % Stage 1 Forms Completed Local 100% No data prior to June 2012. 6 Number of Mortality Reviews to be Undertaken Local N/A N/A 6 7 2 Percentage will increase as reviews get signed off 6 Percentage of Mortality Reviews Undertaken Local 100% 100% Under development CONDITION SPECIFIC INDICATORS Stroke: Compliance with Stroke Bundles 6 1st Hour Tier 1 95% 95% 76% 69% 78% 76% 82% 88% 97% 92% 84% 92% 99% 94% 93% 6 1st Day Tier 1 95% 95% 75% 77% 89% 73% 66% 74% 89% 72% 56% 57% 81% 89% 72% 6 3 Days Tier 1 95% 95% 97% 100% 98% 92% 94% 100% 99% 87% 93% 94% 100% 97% 96% 6 7 Days Tier 1 95% 95% 96% 98% 98% 98% 100% 100% 99% 95% 95% 100% 97% 97% 100% 6 Stroke Mortality (actual in-hospital) Tier 1 N/A N/A 20 10 11 16 19 17 16 18 15 15 11 20 7 % Discharged to usual place of residence (within 56 days Increase Increase 50.7% 48.2% 52.1% 58.9% 44.3% 38.1% 51.3% 50.8% 52.3% 61.8% 69.1% 35.3% 6 of Admission) AQF 6 Number of stroke admissions Local N/A N/A 70 71 65 72 78 61 74 78 82 65 72 66 52 Myocardial infarction: 6 Call to Balloon Times <150 mins AQF TBA TBA 80.0% 71.0% 75.0% 74.0% 88.6% 68.2% 76.6% 75.0% 60.0% 57.6% 73.2% 67.6% 6 MI Mortality (actual in-hospital) AQF Monitor Monitor 1 4 5 8 3 8 9 3 5 3 8 1 2 Fractured Neck of Femur 6 # Neck of Femur - % within 24 hrs AQF 90% 90% 94.2% 85.5% 86.8% 95.6% 90.7% 81.1% 62.7% 75.0% 75.6% 89.8% 100.0% 84.6% 78.9% 6 # NOF Mortality (actual in-hospital) Tier 1 Reduce Reduce 8 5 9 6 7 6 7 4 6 5 7 7 6 % Discharged to usual place of residence AQF Increase Increase 37.9% 51.7% 37.1% 41.0% 52.4% 28.6% 51.7% 50.9% 46.9% 61.8% 46.3% 52.9% 6 Number of #NOF Admissions Local Monitor Monitor 52 69 68 68 86 53 51 49 82 57 77 52 Acute Only INFECTION CONTROL Healthcare Attributed MRSA Bacteraemia (Community & Tier 1 Reduce Reduce 2 4 3 4 5 2 5 4 2 2 4 2 Source: Infection Control 13 Healthcare Acquired) Healthcare Attributed MSSABacteraemia (Community & Tier 1 Reduce Reduce 15 13 13 16 15 20 9 11 10 19 15 11 13 Healthcare Acquired) Source: WHAIP Report 13 Healthcare Attributed C-Diff (Inpatients aged 66+) Tier 1 Reduce Reduce 17 14 10 13 19 22 23 20 9 9 8 13 Local 100% 95% 87.0% 83.6% 81.9% 85.3% 82.9% 92.0% 84.1% 79.8% 83.2% 87.9% 85.4% 86.1% 88.2% 13 Hand Hygiene Audits - compliance with WHO 5 moments Source: Care Metrics 13 Monthly Infection Control Environmental Audit Score Local 85% 75% 91.6% 91.9% 91.1% 92.5% 92.1% 91.5% 92.1% 90.5% 91.5% 92.1% 92.2% 91.6% 92.2% Surgical Site Infections 6 C-Section SSI Rate AQF TBA TBA 8.9% 9.2% 5.8% 6.1% 6 Hip Arthroplasty SSI Rate AQF TBA TBA 3.5% 3.7% 2.4% 1.3% Reported Quarterly 6 Knee Arthroplasty SSI rate AQF TBA TBA 0.9% 1.2% 2.8% 2.6% PATIENT OBSERVATION & DETERIORATION % Patients with Completed NEWS Score and Appropriate 100% 95% 95.9% 96.2% 95.5% 97.0% 96.4% 97.1% 96.9% 95.2% 95.3% 94.3% 96.1% 96.2% 88.6% 13 Responses Actioned Local QUALITY 6 Incidents of Healthcare Acquired Pressure Ulcer Tier 1 0 0 12 11 15 8 8 8 7 14 10 4 14 9 8 n/a Discharge Summary Completeness Local 100% 95% 24.5% 25.9% 23.9% 21.2% 23.7% 22.3% 23.8% 21.8% 21.9% 22.2% 22.4% 22.9% 16.3% Discharge Sunmmary - Minimum Standard Compliance Local 100% 95% 23.7% 23.0% 21.8% 21.3% 21.4% 20.4% 20.5% 20.3% 21.7% 20.8% 20.4% 22.1% 17.1% n/a % Clinical Coding Completeness Local 95% 95% 98.5% 98.3% 98.3% 98.2% 98.5% 98.5% 98.2% 97.2% 95.1% 90.8% 79.9% 1 Readmissions within 28 Days Local 5% 5% 6.7% 7.1% 7.1% 6.8% 6.4% 6.3% 7.1% 6.5% 6.3% 6.9% 6.7% Number of Follow Ups over target date: 1 All Specialties Local Reduce Reduce 32,829 33,728 34,502 35,811 36,355 Data being validated VACCINATIONS & IMMUNISATIONS BGD - BGD - 94.2% NPT - 89.3% SWA - BGD - 93.3% NPT - 94.8% SWA - % coverage level of MMR at age 2 AQF 95% 90% BGD - 93.8% NPT - 93.9% SWA - 93.9% PH 90.4% NPT - 90.8% 93.5% BGD92.0% - BGD - 96.3% NPT - 93.9% SWA - BGD - 95.7% NPT - 94.1% SWA - % coverage level of MMR at age 5 (1 dose) AQF 95% 90% BGD - 95.3% NPT - 95.7% SWA - 95.4% PH 94.3% NPT - 93.7% 96.7% BGD94.1% - BGD - 85.8% NPT - 83.5% SWA - BGD - 86.3% NPT - 87.1% SWA - % coverage level of MMR at age 5 (2 doses) AQF 95% 90% BGD - 85.4% NPT - 86.1% SWA - 88.5% PH 83.8% NPT - 86.5% 90.3% BGD84.1% - BGD - 96.9% NPT - 97.0% SWA - BGD - 96.9% NPT - 96.4% SWA - BGD - 96.6% NPT - 96.11% SWA - % coverage level of 5 in 1 vaccine at age 1 AQF 95% 90% PH 98.9% NPT - 96.2% 97.0% 97.7% 96.5% Abertawe Bro Morgannwg University Health Board
OCTOBER 2012 HEALTH BOARD MEETING EFFICIENCY & PRODUCTIVITY
Current Month score Current Target Type Month Tolerance Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 YTD HCS Ref Target Max Score Score Commentary INPATIENTS Average Length of Stay: Elective 1, 6 General Surgery AQF 3.3 3.3 3.2 3.3 3.7 4.3 3.5 3.8 3.6 3.8 3.4 4.0 3.6 3.8 3.7 Provided by NWIS, 1, 6 Urology AQF 2.2 2.2 2.6 2.5 2.5 2.3 2.4 3.1 2.4 2.7 2.3 2.2 2.2 1.6 2.1 reported 1 month in 1, 6 Trauma & Orthopaedics AQF 3.2 3.2 3.8 3.5 3.6 3.9 3.2 3.4 3.0 3.8 3.6 3.3 3.5 3.6 3.6 1, 6 ENT AQF 0.9 0.9 1.1 1.2 1.1 1.4 1.3 1.4 1.2 1.2 1.4 1.1 1.4 1.4 1.3 1, 6 Plastic Surgery AQF 3.2 3.2 3.6 3.2 3.5 3.9 3.7 2.8 2.8 3.8 2.7 2.4 2.7 3.5 3.0 1, 6 Gynaecology AQF 2.4 2.4 3.5 3.3 2.8 3.3 2.5 4.0 3.5 3.0 2.6 2.9 3.2 2.5 2.9 Average Casemix Length of Stay: Elective 1, 6 Hip Replacements AQF 6.1 6.1 6.3 5.6 5.8 6.5 5.0 4.9 5.8 6.2 6.1 4.9 6.0 7.9 6.1 1, 6 Knee Replacement AQF 6.5 6.5 5.4 4.9 4.5 5.8 4.8 5.0 4.7 5.0 5.2 5.1 4.1 5.2 4.8 1, 6 Upper Genital Tract - Major AQF 4.0 4.0 5.4 4.3 4.0 4.0 3.7 6.3 5.4 4.2 3.3 4.2 4.0 3.8 3.9 1, 6 Large Intestine - Very Major AQF 9.7 9.7 10.2 9.5 9.8 9.9 8.4 10.2 8.3 10.6 9.7 8.2 8.4 7.8 9.3 Average Length of Stay: Emergency 1, 6 General Surgery Tier 1 6.0 6.0 5.6 6.1 5.9 5.6 6.2 7.1 6.4 7.0 7.6 6.3 7.0 6.3 6.9 1, 6 Urology Tier 1 3.2 3.2 4.9 3.8 3.3 2.9 3.4 3.4 4.7 3.5 3.6 3.4 3.6 2.1 3.2 1, 6 Trauma & Orthopaedics Tier 1 10.0 10.0 13.6 13.3 12.9 14.7 15.0 15.1 14.7 14.3 13.6 12.3 12.4 13.9 13.3 1, 6 Plastic Surgery Tier 1 2.3 2.3 1.6 1.7 1.5 1.6 1.5 2.0 2.3 2.0 1.7 1.8 2.2 2.5 2.0 1, 6 Gynaecology Tier 1 2.2 2.2 3.4 3.4 2.9 3.1 3.4 2.6 2.8 2.1 2.2 3.4 2.1 3.1 2.6 1, 6 Combined Medicine Tier 1 9.9 9.9 10.5 10.8 10.8 10.7 10.8 12.0 11.4 11.9 10.8 11.1 11.1 9.8 10.9 Average Casemix Length of Stay: Emergency 1, 6 Respiratory AQF 7.4 7.4 7.6 6.7 7.8 8.0 7.7 7.4 9.1 8.8 9.1 5.6 7.5 6.1 7.8 1, 6 Cardiovascular AQF 9.2 9.2 12.9 12.3 12.2 10.2 12.8 13.8 11.9 12.0 13.5 10.7 11.8 13.1 12.2 1, 6 Musculoskeletal AQF 9.1 9.1 8.0 7.4 7.9 8.2 8.4 9.2 10.0 8.8 10.7 9.6 9.2 7.7 9.4 1, 6 Diabetes AQF 6.9 6.9 11.7 16.2 4.8 8.3 7.3 13.2 6.0 10.0 12.3 8.1 10.2 8.3 9.9 1, 6 CVA AQF 17.3 17.3 17.9 17.7 21.8 17.7 17.6 18.3 18.9 21.3 16.9 17.6 19.9 16.5 18.6 1, 6 Atrial Fibrillation AQF 6.1 6.1 3.9 9.0 4.6 5.8 5.7 3.7 8.1 9.8 6.7 5.4 4.1 8.1 6.8 1, 6 Fracture Neck of Femur AQF 24.7 24.7 32.5 28.4 26.3 31.0 26.8 30.4 33.3 29.7 25.2 22.7 31.1 27.8 26.7 Elective Admissions With No Procedure 1, 6 Day Cases Tier 1 3.8% 3.8% 4.9% 4.1% 4.5% 3.8% 4.1% 4.1% 3.9% 5.2% 4.6% 3.5% 2.8% 2.4% 3.9% 1, 6 Inpatients Tier 1 2.7% 2.7% 4.6% 4.0% 4.1% 4.1% 4.1% 5.3% 4.7% 5.2% 5.2% 4.1% 1.9% 2.2% 4.2% Electives Undertaken As A Day Case 1, 6 General Surgery Tier 1 55% 55% 46.5% 47.4% 45.1% 50.3% 45.6% 54.4% 51.1% 51.1% 52.4% 48.1% 44.6% 33.1% 46.8% 1, 6 Urology Tier 1 81% 81% 72.8% 77.2% 76.3% 76.7% 76.9% 77.0% 77.6% 76.1% 80.5% 76.7% 72.0% 68.0% 75.2% 1, 6 Trauma & Orthopaedics Tier 1 56% 56% 48.4% 49.0% 47.4% 47.3% 45.9% 49.7% 49.3% 51.0% 46.0% 51.2% 49.2% 46.0% 48.7% 1, 6 ENT Tier 1 47% 47% 39.3% 42.0% 39.3% 42.3% 35.5% 44.4% 45.8% 37.2% 49.0% 38.7% 50.2% 28.1% 41.5% 1, 6 Ophthalmology Tier 1 100% 100% 93.5% 93.9% 95.0% 94.4% 93.4% 94.9% 94.9% 96.1% 95.2% 95.9% 93.5% 96.1% 95.3% 1, 6 Oral/Maxillo Facial Surgery Tier 1 90% 90% 48.5% 51.8% 47.3% 49.5% 59.4% 45.8% 44.4% 41.6% 45.5% 56.6% 48.7% 32.5% 44.9% 1, 6 Gynaecology Tier 1 72% 72% 74.7% 71.1% 70.2% 73.2% 70.6% 78.4% 72.8% 72.8% 71.3% 73.0% 73.6% 71.9% 72.5% 1, 6 BADS 50 Tier 1 80% 80% 76.0% 77.9% 75.7% 77.8% 75.6% 78.2% 75.9% 80.4% 79.6% 77.5% 80.4% 81.9% 79.9% Operations On The Day of Admission 1, 6 General Surgery Tier 1 62% 62% 56.1% 52.2% 49.2% 55.1% 55.9% 58.5% 51.8% 51.7% 56.2% 61.2% 56.2% 63.7% 57.2% 1, 6 Urology Tier 1 75% 75% 72.5% 69.9% 68.7% 67.3% 63.5% 70.0% 68.1% 67.2% 73.5% 77.2% 78.5% 79.7% 74.7% 1, 6 Trauma & Orthopaedics Tier 1 64% 64% 55.8% 58.8% 57.4% 65.9% 75.0% 76.8% 76.0% 72.8% 67.4% 71.2% 77.4% 75.6% 72.7% 1, 6 ENT Tier 1 96% 96% 89.7% 88.0% 88.3% 90.7% 90.1% 90.5% 93.8% 92.9% 93.8% 94.1% 92.1% 92.1% 93.2% 1, 6 Ophthalmology Tier 1 87% 87% 32.0% 30.8% 34.8% 42.1% 18.8% 31.6% 44.0% 21.4% 30.0% 40.0% 9.1% 50.0% 27.7% 1, 6 Oral/Maxillo Facial Surgery Tier 1 83% 83% 30.7% 33.3% 23.3% 31.8% 32.3% 21.7% 31.9% 29.5% 31.6% 37.0% 24.3% 45.2% 32.4% 1, 6 Gynaecology Tier 1 76% 76% 68.6% 72.1% 67.8% 74.8% 62.7% 64.9% 71.2% 68.9% 74.1% 80.0% 81.7% 75.4% 75.8% Short Stay Basket of Procedures 1, 6 Anterior Colporrhaphy Tier 1 80% 80% 82.4% 81.3% 76.9% 100.0% 100.0% 100.0% 92.9% 84.6% 68.75% 100.0% 88.9% 100.0% 85.2% 1, 6 Arthroscopy of Knee Tier 1 90% 90% 89.0% 78.7% 85.4% 85.9% 77.7% 81.6% 81.7% 84.8% 85.56% 87.0% 78.8% 74.6% 82.4% 1, 6 Bunion Operation Tier 1 90% 90% 76.9% 80.8% 87.5% 87.5% 90.9% 76.0% 83.9% 84.2% 83.33% 73.9% 70.0% 87.5% 79.4% 1, 6 Circumcision Tier 1 90% 90% 95.5% 83.3% 81.3% 86.7% 90.9% 83.3% 85.7% 94.4% 94.4% 85.7% 90.9% 71.4% 90.7% 1, 6 Combined Procedures Tier 1 100% 100% 100.0% 100.0% 92.9% 88.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 1, 6 Combined Varicose Veins Procedures Tier 1 90% 90% 88.0% 79.0% 88.9% 95.0% 76.9% 84.6% 46.2% 75.0% 88.9% 86.7% 88.5% 80.0% 85.9% 1, 6 Diagnostic Laparoscopy Tier 1 85% 85% 73.9% 76.5% 46.2% 92.3% 85.7% 66.7% 77.3% 84.6% 69.2% 66.7% 92.3% 83.3% 80.4% 1, 6 Endoscopic Resection of Prostate Tier 1 80% 80% 81.3% 75.0% 46.2% 77.8% 66.7% 37.5% 71.4% 66.7% 93.8% 100.0% 80.0% 87.5% 85.2% 1, 6 Endoscopic Resection/Lesion of Bladder Tier 1 75% 75% 72.7% 81.8% 80.0% 70.7% 55.3% 64.5% 54.4% 77.8% 59.0% 78.6% 75.0% 57.1% 69.8% 1, 6 Laparoscopy and Therapeutic Procedures Tier 1 70% 70% 87.9% 87.5% 89.5% 70.3% 76.5% 84.2% 94.1% 89.5% 93.8% 89.2% 96.2% 88.9% 92.1% 1, 6 Laparascopic Cholecystectomy Tier 1 85% 85% 75.4% 66.1% 71.4% 81.8% 74.6% 71.7% 81.5% 80.0% 80.0% 80.0% 78.1% 71.4% 78.9% 1, 6 Operations to Manage Female Incontinence Tier 1 85% 85% 100.0% 70.0% 62.5% 50.0% 88.2% 87.5% 83.3% 70.0% 85.7% 80.0% 81.0% 85.7% 80.7% 1, 6 Primary Repair of Inguinal Hernia Tier 1 85% 85% 61.8% 66.2% 67.7% 81.3% 62.2% 79.0% 79.4% 66.7% 70.6% 67.7% 65.1% 48.0% 64.6% 1, 6 Repair of Umbilical Hernia Tier 1 80% 80% 53.3% 87.0% 73.3% 93.8% 87.5% 77.8% 70.6% 54.6% 89.5% 90.0% 71.4% 77.8% 79.5% 1, 6 Septoplasty of Nose Tier 1 95% 95% 88.9% 100.0% 100.0% 100.0% 100.0% 100.0% 84.2% 92.3% 100.0% 88.9% 83.3% 100.0% 93.8% 1, 6 Simple Mastectomy Tier 1 75% 75% 42.9% 84.2% 50.0% 40.0% 66.7% 92.9% 70.6% 71.4% 82.4% 73.3% 76.2% 61.1% 72.8% 1, 6 Tonsillectomy Tier 1 100% 100% 97.4% 100.0% 96.6% 97.2% 98.6% 91.7% 92.5% 100.0% 96.2% 93.2% 94.7% 88.2% 95.5% 1, 6 Therapeutic operation On The Uterus Tier 1 90% 90% 87.9% 87.5% 89.5% 70.3% 76.5% 84.2% 94.1% 89.5% 93.8% 89.2% 96.2% 88.9% 92.1% THEATRES 1 Late Starts Tier 1 13.5% 13.5% 21.3% 25.3% 25.4% 20.8% 22.2% 25.2% 1 Early finishes Tier 1 20.6% 20.6% 24.4% 31.6% 28.0% 27.2% 25.4% 26.5% Abertawe Bro Morgannwg University Health Board
OCTOBER 2012 HEALTH BOARD MEETING FINANCE
YEAR TO DATE Current Month score ANNUAL Max Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 HCS Ref PLAN Score Score Commentary PERFORMANCE AGAINST BUDGET CUMULATIVE VARIANCE n/a Non Contract Income (296) (470) (622) (668) (604) (684) (2,830) (90) (111) 422 465 536 844 n/a Pay 2,692 2,854 3,422 3,357 3,422 3,861 4,047 546 1,071 1,513 1,489 1,751 1,861 n/a Non Pay 3,084 2,567 2,622 2,881 495 (2,568) (7,264) (1,348) (1,860) (3,157) (3,798) (4,998) (6,449) n/a CIPs 2,581 3,100 3,569 4,059 4,522 5,339 5,930 2,711 4,884 7,160 9,311 11,360 13,485 VARIANCE TOTAL 8,061 8,051 8,991 9,629 7,835 5,948 (117) 1,819 3,984 5,938 7,467 8,649 9,741 0 WORKFORCE COSTS n/a Pay -Basic 41,625 42,128 42,480 42,689 42,533 42,187 42,823 43,720 43,964 43,956 44,246 44,022 43,641 24 Pay - Bank 488 532 511 541 513 420 500 524 666 508 500 535 526 24 Pay - Overtime 384 398 576 366 407 405 436 361 428 296 300 312 260 24 Pay - Agency 681 773 653 520 578 513 613 506 597 547 453 427 437 24 Pay - Other Variable Pay 860 721 837 729 732 726 821 758 864 828 623 710 667 TOTAL PAY COSTS 44,038 44,552 45,057 44,845 44,763 44,251 45,193 45,869 46,519 46,135 46,122 46,006 45,531 CIPs n/a Plan 3,110 3,116 3,277 3,240 4,582 4,863 4,603 632 1,731 3,846 5,381 6,970 8,772 3,727 n/a Actual 3,016 3,116 3,080 3,222 3,579 3,540 2,929 425 1,119 3,051 4,377 5,871 7,491 Variance (94) 0 (197) (18) (1,003) (1,323) (1,674) (207) (612) (795) (1,004) (1,099) (1,281) % Variance -3.0% 0.0% -6.0% -0.6% -21.9% -27.2% -36.4% -32.8% -35.4% -20.7% -18.7% -15.8% -14.6%
TOTAL MONTHLY PAY SPEND NON PAY PAY BY TYPE 48,500 70,000 1000
900 48,000 60,000 800 47,500 50,000 700 47,000 40,000 600 46,500 30,000 500 46,000 400 CIP 20,000 Plan 45,500 300 Actual 10,000 45,000 200 Workforce 44,500 0 100 Plan Basic 44,000 0 Bank Overtime Axis Title Agency Other Variable Plan Actual Plan Actual Pay - Bank Pay - Overtime Pay - Agency Pay - Other Variable Pay Total ABM University SUMMARY REPORT Health Board Health Board Date 01.11.2012 Agenda item 3(i)(a) Subject Health Board Integrated Performance Report Prepared by Darren Griffiths, Assistant Director of Planning Approved by Paul Stauber, Director of Planning Presented by Alex Howells, Chief Operating Officer Vicky Franklin, Director of Nursing Services Bruce Ferguson, Medical Director Andy Phillips, Director of Therapies and Health Sciences Debbie Morgan, Director of Workforce and OD
Purpose This report updates the Health Board on the most recently available Decision performance information for key performance areas. Approval Information X Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance X X X X Executive Summary The report provides trend based analysis of the Health Board’s performance against key performance measures along with an assessment of their relative level of delivery against national target levels and local target levels where applicable.
Key Recommendations The Board is asked to receive the updated performance position across the Health Board.
Assurance Framework The report provides assurance that performance management arrangements are in place for the Health Board.
Next Steps The Health Board performance report will be developed to include more robust measures for Primary Care performance which are currently under development with localities.
1
Corporate Impact Assessment Quality and Safety The Report link to the following standards: - • 1 – governance and accountability framework. • 6 – participating in quality improvement initiatives • 7 – safe and clinically effective care.
Financial There are no specific resource impacts in Implications preparing this report but delivery of the measures within the report could release resource and increase quality of care.
Legal Implications N/A
Equality & N/A Diversity
2 ABM University MAIN REPORT Health Board Health Board Date 01.11.2012 Agenda item xx xx Subject Health Board Performance Report Prepared by Darren Griffiths, Assistant Director of Planning Approved by Paul Stauber, Director of Planning Presented by Alex Howells, Chief Operating Officer Vicky Franklin, Director of Nursing Services Bruce Ferguson, Medical Director Andy Phillips, Director of Therapies and Health Sciences Debbie Morgan, Director of Workforce and OD
Purpose The aim of this report is to inform the Health Board of the organisation’s position against key performance indicators.
This report updates the Health Board on the full range of Welsh Government Tier 1 and Tier 2 performance priorities along with additional measures which have been identified as important to the organisation which are outside of mandatory reporting requirements.
The Health Board level Performance Statement is attached as Annex A and the narrative which follows in this report reflects the measures included within the Statement.
Key Issues The Health Board Performance Statement is divided into five domains: -
• Access • Workforce • Safety and Quality • Efficiency • Finance
The performance narrative draws from the Performance Statement at Annex A. The rationale for selecting areas for further narrative description below is where there is a key performance exception or where it has been agreed that measures require the Health Board’s attention.
______3 Access
Emergency Department Access Unscheduled care performance was under significant pressure during September, again due to the acuity of demand which created pressures right through the system from the front door to critical care. In parallel with this the changes from the Neath Port Talbot service change have also been settling down and have required new ways of working on each of the other acute sites. The improvement programme has been reviewed to ensure that there is a continued focus on improving quality and access for emergency patients. Additional improvements are coming on line on a staged basis over the next few months in line with recruitment of staff to both community and hospital teams, completion of the redevelopment of Morriston Emergency Department and new operational processes.
Referral to Treatment waiting times (RTT) At the end of September, the Health Board reported 93.7% against the 95% 26 week target and had 322 patients waiting beyond the 36 week maximum wait.
Within the 322 patients, it is pleasing to note that Cardiac Surgery numbers continue to improve with 23 patients now waiting over 36 weeks, 2 within the profile agreed with the Welsh Health Specialised Services Commission (WHSSC). In addition to this, Plastic Surgery numbers over 36 weeks continue are currently at 177, 3 above the agreed profile, but with locum appointments made as per the Plastic Surgery Delivery plan agreed with WHSSC, further improvement in future months will take place.
There remain waiting times pressures in General Surgery and Oral Surgery with 62 and 37 patients waiting over 36 weeks respectively for these specialties. Plans are currently being developed to ensure that these positions are recovered in a sustainable way as previous plans to recover the performance have not fully resolved the pressures in these two specialties.
Cancer Access The Health Board was previously advised of the existence of the Cancer Access Times Improvement Plan which has been developed to recover the cancer access waiting times to the required target levels.
The plan set out that sustainable delivery of the cancer targets would be in place during October, Whilst the scorecard reports red to the end of August, this as a result of the backlog of breach patients being cleared and the measure will remain red until November figures are reported when the backlog is clear and sustainability has been achieved for both targets. At the end of September the numbers of patients waiting beyond their breach date has halved and good progress continues to be through the implementation of the improvement plan.
______4 Endoscopy An Endoscopy Improvement Board has been set up to address specific issues of waiting times and to progress the Health Board’s endoscopy units toward accreditation. Plans are being developed to increase capacity to undertake endoscopy, as there are currently insufficient sessions available, and they often compete with on-call duties and other elective work. The Board is chaired by Dr Jon Hughes, Clinical Director for Clinical Support Services.
Delayed Transfers of Care (DTOC) The general trend is improving, particularly in relation to bed days used, although there are still too many delayed transfers which have a considerable impact on the quality of patient care, as well as an impact on the unscheduled care pressures. There are some particularly long waits within these figures which are being escalated.
Workforce
Training The Mandatory Training section of the report is under development. From November 2012 the Health Board will be in position to report on staff compliance and competency refresher period for the core elements of mandatory training including: Fire, Manual Handling, Violence and Aggression, POVA, Child Protection, MCA/DOLS.
Appraisals Personal Development Reviews (PDR) trends show an improvement in the recording of PDR and ensuring timely delivery of PDRs continues to be an objective for all managers. Data is collected to reflect the percentage of PDRs completed each month.
Sickness Absence Previous Health Board performance reports have highlighted the work underway in respect of active support of Directorate and Locality Managers, Policy compliance audits and ongoing sickness management training sessions across all Directorates and Localities. This work in respect of supporting delivery teams to improve sickness absence levels continues, with individual Directorates and Localities with sickness levels above target levels now preparing local plans to reduce sickness absence levels. Sickness absence levels have increased by 0.04% in July.
Safety and Quality
Mortality Measures During the October round of performance reviews, major focus has been placed on improving reporting and reviewing mortality within the Health Board. The levels of completed stage 1 mortality review forms are unacceptable and every Directorate and Locality have been tasked with reviewing their mortality
______5 review processes to ensure that all deaths have a stage 1 form completed. In tandem with this, the reporting of reviews to be undertaken and their completeness is being scrutinised to ensure that accurate performance reporting is in place to highlight where improvements need to be made. The Mortality section of the Performance Statement will evolve over the next quarter.
Stroke Stroke performance has been disappointing and has been affected by the unscheduled care pressures. Localities have been asked to refocus on prioritising care for these patients and complying with the care bundles. There are weekly processes which investigate the root causes of every breach against the standards in order to identify ways of improving care.
Fractured Neck of Femur (#NOF) Compliance against the 90% target for operations to be carried out within 24 hours is reported as being 78.9% for September. The directorate is currently reviewing its time to theatre processes, as performance at Morriston Hospital is generally better than Princess of Wales Hospital, to determine which elements of practice could be transferred to improve performance.
Follow Up Not Booked (FUNB) The level of patients waiting over their clinical target date for follow up is a significant concern for the Health Board. All Directorates and Localities are taking forward implementation plans to reduce the level of follow up patients waiting, this work includes reviews of capacity and demand the variation in follow up requirements and the plans will not only address the numbers but will look to develop sustainable solutions going forward.
Discharge Summary Completeness In the October round of performance reviews, Directorates and Localities have been charged with improving their discharge summary completeness rates by engaging the junior medical staff responsible for preparing these important documents.
Efficiency
The efficiency page of the Performance Statement includes a wide range of measures which are routinely reported to Welsh Government as part of the routine monitoring of the Health Board. These are largely measures considering bed usage, day surgery work, theatre performance and outpatient performance. Areas worthy of note are: -
• British Association of Day Surgery (BADS) 50 Day Surgery Rate - Latest rolling 12 month figure against 80% target is 76.1% indicating that the Health Board is marginally behind target for the range of short stay surgery procedures. Directorates have been instructed to make sustainable improvements in efficiency measures given the financial position of the Health Board.
______6 • Case-mix Length of Stay: Elective – This measure shows that for specific procedures such as hip and knee replacement, low lengths of stay are sustainably delivered. • Theatre Performance – Late starts and early finished remain outside of target levels and appear to be levelling out in terms of improvement. Focus is now being given to the whole of the surgical pathway as it has been identified that theatre efficiency is affected by a number of complex inter-related elements along the surgical pathway, not just practice within theatres themselves.
Finance The last page of the Performance Statement build up the financial trends for the Health Board mapping cumulative spend, in month spend for pay and delivery of Cost Improvement Programmes. A comprehensive update will be provided by the Director of Finance in a separate report to the Health Board.
Next Steps Work is ongoing with Information colleagues who continue to work with colleagues in each of the Localities to develop Primary and Community Care indicators which can meaningfully depict performance and service change impacts within these key areas.
Recommendation
The Board is asked to note the Performance Statement for the Health Board, the actions in place to improve performance and the areas where performance has improved to required levels.
______7 ABM University SUMMARY REPORT Health Board Health Board Date 1st Nov 2012 Agenda item 3 (i) b Subject FINANCIAL REPORT – MONTH 6 Prepared by Samantha Lewis, Assistant Director of Finance and Eifion Williams, Director of Finance Approved & Eifion Williams, Director of Finance Presented by Purpose To advise Board members of the overall financial position of ABMU Decision Health Board as at 30th September 2012 Approval Information x Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance X Executive Summary The report provides the Health Board with the following updates:- i. the financial position of the Health Board to 30th September 2012 ii. an update of the Capital Programme current position iii. the Performance against the PSPP 30 day target iv. the Debtors Position as at 30th September 2012 v. the Cash Position as at 30th September 2012 and year end forecast Key Recommendations The Health Board is asked to note:- i. The Financial Position of Health Board to 30th September 2012 and the actions required to improve financial performance; ii. The forecast position of the Capital Financial Plan for 2012/13; iii. The Performance against the P.S.P.P 30 day target; iv. The Debtors Position as at 30th September; and v. The Cash Position as at 30th September 2012
1 ABM University MAIN REPORT Health Board st Health Board 1 November 2012 Agenda Number 3 (i) b Subject Financial Report – Month 6 Prepared by Samantha Lewis, Assistant Director of Finance Approved by Eifion Williams, Director of Finance Presented by Eifion Williams, Director of Finance
1 PURPOSE 1.1 To advise Board Members of the overall financial position of ABMU Health Board as at 30th September 2012. The report provides the year end position of the following:-
(i) the Financial Position of the Health Board to 30th September 2012; (ii) an update of the Capital Programme; (iii) the Performance against the P.S.P.P. 30 day target; (iv) the Debtor’s Position as at 30th September 2012; and (v) the Cash Position as at 30th September 2012 and year end forecast.
2 REVENUE FINANCIAL POSITION 2.1 The Health Board identified the requirement to deliver savings of £45m in 2012/13 to achieve a balanced financial position. This saving is to be achieved against the backdrop of a second year of zero uplift in allocation from the Welsh Government.
2.2 The Health Board has had a challenging start to the financial year and has reported an overspend of £9.461m to the end of September. The September month overspend was £1.092m, the lowest monthly overspend experienced yet this year. The Quarter 1 overspend was £5.94m, this reduced to £3.8m in Quarter 2.
2.3 The Health Board experienced high levels of Unscheduled Care and Trauma service pressures during the early months of this financial year, and the acuity of patients was also greater than normally experienced. This demand reduced during July and August, but has increased again in September, which is impacting on financial performance in key areas.
2.4 The Health Board is continuing to pursue the need to identify savings to meet the 2012/13 Resource Framework requirements. All Directorates and Localities have been tasked with redoubling their efforts in delivering improved service performance and identify further savings opportunities. Target reductions in the use of Agency and Bank staff have been set, alongside reduced levels of Overtime. A Delivery Improvement Programme has been initiated to take forward, in a structured approach, areas for performance improvement and efficiency programmes with Executive Leads to support delivery.
2.5 Further savings opportunities also need to be identified and implemented in order to deliver a balanced outturn at year end.
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2.6 The required actions to achieve a reduction in the use and costs of temporary Bank and Agency staff and also in Overtime costs, contributed to the reduction in the Quarter 2 overspend, when compared to the overspend of the previous quarter. These actions will need to continue throughout the remainder of the year, alongside a reduction in Non Pay Costs and implementation of new Savings Schemes.
3 CAPITAL FORECAST FINANCIAL PLAN 2012-13
3.1 PERFORMANCE TO MONTH 6 The financial position to month 6 is showing an under-committment of £1.066m. Within individual schemes, there are a small number of variances to plan, which at this stage are not anticipated to affect the estimated spend on these schemes during this year.
3.2 FORECAST FINANCIAL PLAN 2012-13 The Capital Investment Committee approved a Capital Plan for 2012-13 on 18th June 2012 which forecast a break even position. The forecast outturn position continues to show a break even position, which assumes that allocations of £3.8m from Welsh Government, for committed expenditure on a number of schemes within the All Wales Capital Programme, are approved.
There is a total of £12.5m of unapproved funding within the Health Board’s Capital Resource Limit (£3.8m committed as above). Discussions are ongoing with Welsh Government about the remaining uncommitted £8.7m, which relates to a number of Business Cases that have been or will shortly be, submitted to the Welsh Government.
4 PUBLIC SECTOR PAYMENT POLICY 4.1 The Health Board has achieved a cumulative compliance level to the end of September of 97.98% of supplier invoices paid within the 30 day target, with an in-month compliance of 98.02%. This represents a key achievement and confirms compliance with the Welsh Government PSPP compliance target of 95%
5 DEBTOR’S POSITION 5.1 The position on debtors across the Health Board as at 30th September 2012 is set out in the table below. The movement on debtor balances, compared to the equivalent figures for the previous month is also shown.
______3 Total Current 31 - 90 91 Days Type Position Outstandin Month Days (£) and Over At g (£) To 30 Days (£) Past Due (£) NHS 30th 4,990,288 3,912,723 1,056,71 20,850 September 4,626,230 4,174,318 5 26,650 31st August 425,262 Non- 30th 2,636,989 1,744,819 361,390 530,780 NHS September 2,048,355 995,253 508,192 544,910 31st August
5.2 The Health Board’s outstanding debts have increased by £0.953m between 31st August and 30th September. NHS debts have increased by £0.364m and non NHS debts by £0.589m. These increases were anticipated as invoices in respect of charges for the second quarter were raised in September for services where the agreement is to invoice quarterly in arrears. During the last two months there has been a significant and sustained reduction in the level of NHS debts, which have historically stood at £9m. This has arisen as a result of significant work with other Health Boards to vigorously pursue outstanding debts under the NHS arbitration procedure. This can also be seen in the very small value of NHS debts over 90 days old. Progress continues to be made in reducing the value of non NHS debts outstanding for more than 30 days. Whilst a significant number of these debts are being paid in monthly instalments, efforts continue to be made to secure payments of those invoices over 30 days old for which no agreements are yet in place.
6. CASH POSITION 6.1 The Welsh Government has set a best practice cash balance figure for Health Boards to achieve at the end of each month, this figure being 1/300th of the combined revenue and capital resource limits. For September 2012 this figure was £2.990m with the Health Board being within this target, with a month end cash balance of £2.513m.
6.2 The Health Board has recently been in discussion with Welsh Government regarding its cash forecasts with particular discussions around the distinction between revenue and capital cash. Historically, the Health Board has each year drawn down from Welsh Government both the full revenue and capital cash drawing limits. Whilst the full capital cash value has not always been required at year end, this cash has been used in April to pay off the year end capital creditors. It has now been agreed with Welsh Government that the Health Board will not in future draw down cash in respect of capital creditors, as this is reducting the true revenue cash position of the Health Board. Welsh Government has confirmed that additional cash will be made available in 2012/13 to cover off the forecast revenue cash shortfall and that the capital cash not drawn down in 2012/13 will be made available in future years.
6.3 The forecast cash deficit for 2012/13 as at the end of September stands at £19.781m. This forecast cash shortfall is higher than the forecast I&E deficit, as a result of a deterioration in working balances since the LHB came into being. This is due to a reduction in the value of creditors and payments in respect of
______4 provisions; the difference broadly equating to the forecast value of the capital creditors for which the cash will no longer be drawn down. The cash position of the Health Board continues to be monitored daily.
7 RECOMMENDATION
7.1 The Health Board is asked to note: - (i) the Financial Position of the Health Board to 30th September 2012 and the actions required to improve financial performance; (ii) The Health Board is asked to note the forecast position for the Capital Financial Plan for 2012-13; (iii) the Performance against the P.S.P.P. 30 day target; (iv) the Debtors Position as at 30th September 2012; and (v) the Cash Position as at 30th September 2012.
______5 ABM University Health SUMMARY REPORT Board Health Board Date: 1st November 2012 Agenda Item: 3 (ii) Subject Seasonal Planning 2012/13 Prepared by Jan Thomas, Assistant Director (Operation Delivery and Development) Approved by Alexandra Howells, Chief Operating Officer Presented by Jan Thomas, Assistant Director (Operation Delivery and Development) Purpose This report aims to provide an outline of the seasonal planning Decision arrangements for 2012/13. Approval Information √ Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance √ √ √ √ √ √ Executive Summary The report clearly defines the objectives of the Seasonal Pressures Plan and the arrangements in place for 2012/13 Key Recommendations The Health Board members are requested to note the Seasonal Planning arrangements in place for 2012/13. Assurance Framework To provide assurance that robust plans are in place to meet seasonal pressures.
Next Steps The seasonal planning arrangements set out in this report will be progressed.
Corporate Impact Assessment Quality and Safety HCS 7,8 Financial The impact will be assessed based on the Implications outcome of the series of actions being progressed. Legal Implications None directly Equality & None directly Diversity
1 ABM University Health MAIN REPORT Board st Health Board Date: 1 November 2012 Agenda Item: 3 (ii) Subject Seasonal Planning 2012/13 Prepared by Jan Thomas, Assistant Director (Operation Delivery and Development) Approved by Alexandra Howells, Chief Operating Officer Presented by Jan Thomas, Assistant Director (Operation Delivery and Development)
1. PURPOSE This paper outlines the seasonal planning arrangements for 2012/13.
2. INTRODUCTION Welsh Government (WG) requires assurance that NHS Wales has plans to manage ‘winter pressures’, and that processes are in place to ensure services are collectively delivered to patients as seamlessly as possible during this period.
The experience and learning from the 2011/12 winter will inform the seasonal plan for 2012/13. The recent reorganisation of acute medical services within the Health Board following the urgent service change at Neath Port Talbot Hospital will also shape the seasonal planning arrangements for 2012/13.
To a large extent the Seasonal Pressures Plan builds on the existing improvement programme in unscheduled care. Performance to date in 12/13 has been challenging, with particular peaks in high acuity demand in May/June and late September/early October. These have caused pressures through the hospital system from the front door services right through to intensive care. The improvement programme is being continually reviewed and adjusted to accommodate these changes in patient profile.
3. KEY OBJECTIVES The key objectives of the Seasonal Pressures Plan are to minimise:
o The number of people catching flu.
o People coming into hospital with Norovirus.
o Waits in the Emergency Department that exceed 4 hours.
2
o Long delays (12 hours) and long ambulance handovers (30 minutes).
o Admissions due to lack of available senior decision maker.
o Outlying patients in other specialty beds.
o Critical care patients nursed outside an appropriate critical care environment.
o Elective cancellations due to capacity pressures.
o Numbers of patients whose discharge is delayed.
4. ARRANGEMENTS FOR 2012/13 In respect of developing the Seasonal planning arrangements for 2012/13, the following key initiatives are being taken forward
• Early planning arrangements with the first meeting of the multi disciplinary/multi agency Seasonal Planning Group held in August. Membership of the group includes representation from Social Services, Mental Health, the Communications team, Infection control team, Consultant Medical staff, the GP Out of Hours service and WAST. • The development of a comprehensive flu vaccination plan led by a dedicated immunisation co-ordinator to improve uptake rates for staff and patients. The programme was launched in the Health Board on 1st October, with sessions being provided at evenings, nights and weekends to facilitate an improved uptake by staff. Members of the public can also access vaccinations this year from a number of designated community pharmacies, in addition to the GP immunisation programme. • A targeted approach on minimising hospital attendances and admissions through a series of actions and initiatives, working with primary care, GP Out of Hours, WAST, Community Resource and Mental Health Teams. This includes the recent introduction of new pathways of care for falls, resolved hypoglycaemic and resolved epileptic patients, and an intention to introduce new pathways for conditions that can more appropriately be managed in the community. Additionally, an Advanced Paramedic Practitioner service commenced on 14th October covering Neath Port Talbot and the North of Swansea, with the aim of resolving a greater number of emergency calls in the community, thereby avoiding the need for attendance at hospital.
3 • The development of a Health Board wide capacity plan based on a review of historical capacity by Directorate and Localities, and the introduction of new models of care in Singleton, Morriston and Bridgend, following the Neath Port Talbot service change. However it should be noted that surge bed capacity options are severely limited on some site this winter as a result of recent service change and also essential refurbishment work. Hence the main focus will be on capacity to reduce avoidable admissions and support timely discharge into the community. • The provision of an agreed Critical Care Escalation plan for the Health Board. This is supported this year with the provision of a critical care nurse bank since July 2012, to enable the service to more readily respond to fluctuations in demand over and above the enhanced capacity that has been supported in 2012. • Confirmation by Localities and Directorates of compliance against the Winter Checklist plan issued by Welsh Government, to inform any outstanding actions required to improve capacity and sustainability of services within the ABMU Health Board plan. • Improved internal Escalation processes, and communication within the organisation. A workshop is planned within the Health Board to test, review and strengthen the Health Board’s processes in line with the National Emergency Pressures Escalation Action Plan. This includes the timing of decisions to cancel elective work and divert to other sites. • The development of a comprehensive Health Board communications plan incorporating key messages, particularly in relation to preventative measures and appropriate use of NHS services, and sharing this widely within the Health Board and local community through a range of media. This year a new initiative to provide information leaflets to schools and colleges within the Health Board on the management of Norovirus is being implemented. The Health board communication plan also complements the WG ‘Choose Well’ campaign. • Numerous staffing initiatives, including a concerted nurse bank recruitment campaign, robust annual leave management and cover arrangements for the Christmas/ New Year period, improved staff training on infection control, targeted/enhanced use of medical manpower particularly at weekends and at bank holidays, and a staff transport plan for adverse weather. The Neath Port Talbot service change has also resulted in strengthening the medical and nurse staffing cover at Morriston, Bridgend and Singleton to support the changes to patient flow to these hospitals.
The Health Board Plan was presented to the All Wales Seasonal Planning Meeting on 24th September 2012, to provide assurance to Welsh
4 Government that plans are in place to deal with the forthcoming seasonal pressures, and was well received. The initiatives described to manage seasonal pressures will be continually reviewed and refined, to ensure that community and hospital services are well placed to respond to the seasonal pressure demands going forward.
5. RECOMMENDATIONS Health Board members are requested to note the Seasonal Planning arrangements in place for 2012/13.
5 ABM University SUMMARY REPORT Health Board st Abertawe Bro Morgannwg University Health Board 1 November 2012 Agenda item 3 (iii) Subject Review of GMS & Community Pharmacy Monitoring Programmes 2011/12 Prepared by Locality Heads of Primary Care & Planning Approved by Alexandra Howells, Chief Operating Officer/Director of Primary, Community & Mental Health Services Presented by Jan Thomas, Assistant Director of Delivery and Development
Purpose To provide a summary of the Primary Care contracting position at Decision the end of 2011/12 and subsequent developments focusing on the Approval 3 monitoring review process for General Medical and Pharmaceutical Information Services. Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance 3 3 3 3 3 3 Executive Summary General Medical Services, Community Pharmacy Services and General Dental Services all operate within national contractual frameworks. The contractual arrangement and associated report, attached, covers the whole pharmaceutical service expenditure of £27 million (2011/12). The General Medical Services [GMS] report relates solely to the Quality and Outcomes Framework [QOF].
This report sets out the results of the monitoring programmes that aim to provide assurance to the Board that robust arrangements are in place to monitor primary care contractual matters and also create a baseline against which progress to improve the utilisation and effectiveness of primary care services in improving healthcare can be assessed.
It is hoped that the further development of the processes associated with the QOF will inform future service development within practices and community networks as the impact of the care pathways agreed and pursued as part of the process becomes evident.
Key Recommendations The Board is asked to note the progress made to standardise arrangements through which the national contracts are being monitored within ABMu and the potential they provide to improve the standard and equity of services.
The Board is asked to note the outcome of the contract monitoring process for 2011/12.
______1 Assurance Framework Both GMS and Pharmacy Contract Monitoring Programmes aim to provide assurance to the Board that there are robust arrangements in place to monitor primary care contractual matters, quality and safety whilst meeting national targets and addressing local need. Next Steps To implement the Monitoring Programmes for 2012/13 and to provide the Board with updates on the GMS Enhanced Services Review, access and Dental Contract Monitoring Programme before the end of the current financial year.
Corporate Impact Assessment Quality and Safety Quality of Services provided and Governance procedures are reviewed. Financial Current levels of funding remain unchanged Implications Legal Implications Managed in accordance with primary care contractual frameworks and Regulations, where relevant Equality & None directly Diversity
______2 ABM University MAIN REPORT Health Board st Health Board Date: 1 November 2012 Agenda Item: 3 (iii) Subject Review of GMS and Community Pharmacy Monitoring Programmes 2011/12 Prepared by Locality Heads of Primary Care and Planning Approved by Alexandra Howells, Chief Operating Officer/Director of Primary, Community & Mental Health Services Presented by Jan Thomas, Assistant Director of Delivery and Development
A. General Medical Services Monitoring Process for the Quality & Outcomes Framework 2011/12 and 2012/13
Introduction The Quality and Outcomes Framework was introduced as part of the new GMS contract in 2004. The framework is an integral part of funding for general practice, and whilst participation in the QOF process remains voluntaryall practices across ABMU are fully engaged in the process.
For 2011/12 a revised process was implemented with locality staff working as a pooled team across the three localities, enabling a broader view of the framework and its management across the Health Board. An end-of-year review meeting in May concluded the 2011/12 process and considered revisions required to the 2012/13 visiting programme. Recommendations from an internal audit report into the 2011/12 process also informed these considerations.
QOF Review Monitoring Programme 2011/12 In September 2011 the year’s visiting programme was agreed, to be underpinned by the following principles:
• ABM-wide shared pool of personnel to undertake practice visits, • Focus on quality of reporting both from the practice and the Health Board with appropriate timescales set out to ensure that evidence was received and visit reports completed in a timely manner. • One third of practices received a visit, practice selection based on reviews of previous year’s exception reports, date of last visit; and local practice information • Common documentation used across ABMU for both clinical and organisational indicators. • Clinician visit was the same for all practices apart from review of exception reporting which is governed by findings from the 2010/11 reports. • agreed set of organisational indicators for scrutiny at QOF visits • All practices required to complete a pro-forma and submit non-clinical evidence for those indicators requested by the Health Board.
______3 Practice Visiting Programme 2011/12 Bridgend NPT Swansea Total
Number of Practices visited 4 8 14 26
Every practice visited submitted evidence for assessment prior to the visit taking place, and each practice had a visit from a Health Board officer (non-clinical assessor) and a clinical assessor. Practices not receiving a visit were required to submit agreed assessment evidence to the Localities by the year end deadlines. Points were deducted from practices that failed to submit this evidence on time, 99% of practices complied with this requirement,
Practice QOF Achievement Practices can achieve a total of 1,000 points, made up of clinical indicators and non- clinical, organisational indicators. Practices score points according to their levels of achievement against these indicators, and practice payments are calculated from points achieved. The value of a point differs between practices on the basis of the practice population, weighted for factors that influence relative needs and costs in order to reflect the differences in workload these factors generate
The table below indicates the QOF categories and associated points
Points Clinical Indicators Based on disease category 661 Organisational Record Keeping, Education & Training, 165.5 Information, Practice management, Medicines management
Quality and productivity Prescribing, Outpatient Referrals & 96.5 [QPI, introduced 2011] Emergency admissions Patient Experience Length of Consultation 33 Additional Services Cervical Screening, Child Health 44 surveillance, maternity Services, Contraception
QOF achievement was signed off by the Health Board on 13 June and amended subsequently once the national information on the prescribing QPI was received .
The table below indicates QOF final achievement by Locality. Bridgend NPT Swansea ABMUTotal Average points per practice 928 969 974 961 Total payment per locality £3.621m £3.341m £5.202m £12.164m
The allocation of points is dependant upon a wide range of variables including practice size and relative deprivation of the local community. The overall position indicates maintenance of a high level of achievement against QOF standards across ABMU.
______4 Review of 2011/12 Process The GMS: QOF report from Internal Audit, published in May 2012 (Ref: 038/2011) demonstrated that the current process offers assurance to the Health Board. A number of areas were identified as needing review, including: • Nomination of a Health Board clinical lead to ensure consistency of indicator review for all clinical assessors • Development of a single form for clinicians to use during the visit when collating information on exception reporting • A review of standards of evidence received for Records and Organisational indicators.
Future arrangements Proposals for 2012/13 will be submitted for approval by ABMU’s Primary Care Development Group. Recommendations are likely to include • Continuation of the the three-year programme using the ABMU – wide team approach and standardised paperwork • Nomination of a single lead across the localities • Development of a visit programme guide to ensure consistency for non- clinical assessors • Locality Clinical Governance teams play a greater role in the reviewing of Significant Events (SEA) to encourage reporting and raise the standard • Review of specific clinical areas, along with any areas where there is significantly high or low exception reporting,
Visits for 2012/13 will take place between late October/November and early March.
CONCLUSION There are a number of benefits identified from working as a pooled visiting team across the three localities however there needs to be a greater focus on the QOF process to ensure consistency in evidence reviews and in raising standards of evidence produced by practices.
______5 B. Community Pharmacy Monitoring programme
Introduction The introduction of the Community Pharmacy Contract introduced in April 2005 provides the contractual framework for community pharmacy to contribute to the achievement of health sector targets on improving access and choice and helping people with long term conditions. Drawing on community pharmacy skills, expertise, experience, presence in the community and a tradition of ready access to all, community pharmacies are now able to provide a greater range of services.
Health Boards have a responsibility to monitor the provision of essential and advanced services as described in the NHS contractual arrangements for community pharmacy. A contract monitoring programme was developed to ensure that all elements of the contract are being delivered appropriately by all pharmacy contractors.
Following the establishment of ABMU Health Board, actions were taken to align the contract monitoring programme across Swansea, Neath Port Talbot and Bridgend. The community pharmacy contract leads in each locality coordinated the development of a unified contract monitoring programme including the documentation sent out to pharmacies, a timetable of when documents are distributed and when visits are carried out.
Under the contract framework services are divided into 3 categories: • Essential Services, which must be provided by all community pharmacies. • Advanced Services, which require both the pharmacist and pharmacy premises to be accredited, and which community pharmacies can choose to provide. • Enhanced Services, which are commissioned locally by HEALTH BOARDs to reflect needs of the local population.
Summary of Enhanced Services Total Enhanced Service Bridgend NPT Swansea ABMU Advice to Care Homes 3 7 9 19 Emergency Hormonal Contraception 25 24 41 90 Smoking Cessation 26 26 50 102 Supervised Consumption 23 31 53 107 Needle Exchange Scheme 8 10 11 29 Swansea Only Supplementary Prescribing Methadone Service 0 0 1 1 NPT Only MAR Charts 0 29 0 29
Although it is not mandatory for the Health Board to monitor the provision of Enhanced Services as part of the contract monitoring visits, pharmacies are checked to see which enhanced services are provided and whether they have the required paperwork and professional qualifications to provide the service. Service Level
______6 Agreements (SLA), Standard Operating Procedures (SOPs) and pharmacist certificates are checked during the monitoring visits.
Key Findings
CURRENT POSITION Following the implementation of the contract, all pharmacies received a visit to establish a baseline assessment of service provision. The localities then developed a three year rolling programme to assess and advise on contractors’ contractual obligations. The Health Board issued each pharmacy with a Self Assessment Questionnaire (SAQ). On completion, contractors should be able to identify those contractual obligations which are being met only in part and take appropriate corrective action.
Based upon the SAQ results the Health Board determines which pharmacies to visit. These include those pharmacies that indicate an above average performance (in order to validate their results), those that indicate under performance, and those that were identified as requiring major improvement during the initial baseline visits. There is also provision for any ad-hoc visits to be carried out, if necessary, during each year.
The monitoring visits consist of a report pro forma, based upon the Community Pharmacy Assurance Framework, derived from www.primarycarecontracting.nhs.uk. Where there are areas of non-compliance, or areas for improvement, these are identified in the report as Action Points along with a timescale for completion. A draft report is then sent out to the pharmacy so that the comments and action points are agreed by both parties. As a stimulus to the development of a successful action plan, the Health Board provides support materials and cites examples of good practice seen elsewhere.
Process for Issues of Non-Compliance The Health Board ensures that any issue of non-compliance have been satisfactorily resolved by further communication or, if necessary, by conducting a follow up visit. Full support is provided by the Health Board to help meet higher standards of service provision. Formal action for a breach of terms of service should be initiated only if the issue has not been satisfactorily resolved within the specified time period.
Under agreement between the Department of Health, NHS Confederation and Pharmaceutical Services Negotiation Committee (PSNC), the contractor has a minimum of three months in which to resolve any issues before any formal action is taken1 if there is no risk to the public. If there is a risk to the public the Health Board should commence formal procedures immediately, maintaining clear audit trails of the actions taken.
The Department of Health also states that this procedure should also be followed in cases where pharmacies are not providing pharmaceutical essential services to a sufficient standard and are therefore not meeting the third condition to provide Medication Use Reviews [MURs] as set out in paragraph 3(5) of the Advanced and Enhanced Service Directions.
1 Department of Health. Pharmacy Contract: Non-compliance and Dispute Resolution. Pharmacy and Prescriptions. July 2006
______7
Compliance Checks/Follow Ups Mechanisms are in place to provide an assurance to the Health Board that all identified actions are reviewed and undertaken. All pharmacies receive a follow up visit after a minimum of 3 months to ensure compliance with the Action Points raised in the visit report (unless urgent matters call for immediate compliance, as a matter of patient/staff safety, i.e. fridge temperatures, stock checking, availability of cytotoxic bin).
Issues such as a lack of a signposting guide, Disability Discrimination Act Guidelines (now replaced by the Equality Act 2010), Child Protection Procedures and Protection of Vulnerable Adult Procedures are rectified immediately following the visit with the necessary documents sent out to the pharmacy with the draft visit report, if they do not have their own.
The issues identified in the ABMU review process in 2011/12 are summarised by locality below
Swansea Locality
• Essential Services Of the 23 pharmacies visited between April 2011 and March 2012, all but one pharmacy had some degree of non-compliance, prevalent within one or more of the Essential Services, around the non-clinical areas indicated above, • Advanced Services: Medicines Use Reviews Of the 23 pharmacies visited, 22 were accredited to provide MURs. There was one instance of non-compliance; the presence of pharmacy drug stock in the consultation room. This could prove a safety issue for pharmacy staff and patients/customers. The pharmacy was advised to store the stock in a suitable location away from the shop floor and the pharmacy was deemed compliant at the follow up visit.
Neath Port Talbot Locality
• Essential Services Of the 11 pharmacies that received a visit, all but one pharmacy had some degree of non-compliance, prevalent within one or more of the Essential Services, but which, as in Swansea, did not concern direct patient care issues • Advanced Services: Medicines Use Reviews Of the 11 pharmacies visited, 10 were accredited to provide MURs. The only issue arising was the updating of the MUR Standard Operating Procedure.
Bridgend Locality
• Essential Services Out of the 14 pharmacies visited, all but two had some degree of non-compliance, prevalent within one or more of the Essential Services concerning signposting, or compliance with availability of guidance or procedures highlighted above, rather than direct provision of care issues.
______8 • Advanced Services: Medicines Use Reviews Of the14 pharmacies visited, 12 were accredited to provide MURs. There was one instance of non-compliance; the first being the consultation room was not sound proofed which proved to be an issue for confidentiality. The pharmacy was advised to improve this situation, they were given 4 months and in the mean time a new consultation room has been installed and the pharmacy was deemed compliant at the follow up visit. The other pharmacy not accredited to do MURs has now been accredited since the visit.
CONCLUSION No pharmacies in ABMU required formal follow up action to secure compliance. All pharmacies co-operated with the visits and any actions raised in their report. All issues of non compliance were addressed within the three-month timescale. The Board can be assured that the appropriate mechanisms are in place for the safe delivery of patient services.
FUTURE ARRANGEMENTS The three year rolling programme will continue within each locality.
The ABMU Pharmacy Operational Group has drafted a Contract Monitoring Process document that outlines the process and timescales for delivery of the contract monitoring programme. This document is intended for the use by ABMU Health Board as guidance and good practice for community pharmacy contract colleagues. The guidance and documents are subject to any changes in Community Pharmacy contract regulations and legislation. This document will also be available for reference to contractors for 2012-13.
Clinical Governance Requirements: Enhanced clinical governance arrangements, for which amending regulations will be made, came into force on 31 December 2011 in England. Transitional arrangements were in place until 31 March 2012 to enable pharmacies to adapt their current systems of clinical governance to accommodate the new requirements. It is anticipated the new criteria will be included in the 2012- 13 programme, once arrangements are made in Wales.
RECOMMENDATION • The Board is asked to note the ABMU-wide arrangements for the annual community pharmacy contract monitoring process and the outcome • To note the ABMU–wide arrangements for the annual QOF/QPI monitoring process and the outcome of the 2011/12 programme.
______9 ABM University SUMMARY REPORT Health Board Health Board 1st November 2012 Agenda item: 3 (iv) Subject Ombudsman’s Annual Letter Prepared by Kate Bloomfield, Investigations & Redress Approved & Andrew Phillips, Director of Therapies & Health Science Presented by Purpose This report provides the Board with information on the Annual Letter Decision of the Public Services Ombudsman for Wales. Approval Information X Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance X X X Executive Summary This report provides the Board with the Annual Letter of the Public Services Ombudsman for Wales and the Health Board’s response following the production of his Annual Report 2011/12. The paper describes specific actions taken to improve service issues commented on by the ombudsman together with actions to improve speed of response to the ombudsman’s requests. Key Recommendations The Board is asked to note the report. Assurance Framework The report aims to provide assurance to the Board on the Health Board’s management of concerns and improvement actions for 2012/13. Next Steps Actions have been taken to improve compliance with the Ombudsman’s timescales for responding to requests for information. . There will be ongoing actions taken throughout 2012/13 to ensure the Health Board implements actions arising from concerns to improve safety and quality and manages its concerns in accordance with the NHS Redress Regulations.
1 Corporate Impact Assessment Quality and Safety The report on the Ombudsman’s Annual Letter relates to a number of Standards.The main standards covered include:
1 - Governance & Accountability 6 - Participating in Quality Improvement initiatives 7 - Safe and clinically effective care. 23 - Managing Concerns
Financial There are no specific resource implications of Implications this report. Legal Implications All matters where failures are identified through the concerns process, including by Ombudsman’s investigation, proceed to consideration of Qualifying Liability in Tort. Those cases where liability is seen to exist are considered under NHS Redress or advised on the Health Board’s assessment of any legal case that may be pursued. Equality & All concerns are subject to the same level of Diversity investigation and consideration. Where identified, any failures surrounding equality or diversity are reported to the Health Boards Equality & Diversity Manager for appropriate action. One of the subjects of Ombudsmans report led to improved equality of access to services for patients with Learning Disability
2 ABM University MAIN REPORT Health Board st Health Board 1 November 2012 Agenda Item 3 (iv) Subject Ombudsman’s Annual Letter 2011/12 Prepared by Kate Bloomfield, Investigations & Redress Approved & Andrew Phillips, Director of Therapies & Health Science Presented by
1. PURPOSE: To set out the Ombudsman’s Annual Letter 2011/12,
2. INTRODUCTION Each year the Ombudsman produces an Annual Report highlighting cases considered by his office during the year so that lessons can be learned. This is supplemented by an Annual Letter to each health organisation on the cases dealt with from patients and their families locally. A copy of the letter issued to ABM is attached at Appendix 1.
3 SUMMARY OF FINDINGS: A detailed report on the Ombudsmans letter was considered by the Quality and Safetty committee at its last meeting.
Some of the points to note are:
• The overall number of ABMU complaints made to the Ombudsman has increased. Similarly, the number of complaints which have been accepted for investigation has also increased. • The number of ABMU complaints referred to the Ombudsman in 2011/2012 is less than the overall average in comparison with other Health Boards across Wales. • The percentage of ABMU complaints which have progressed to investigation has risen, from 27% in 2010/2011, to 35% in 2011/2012. • Of the 65 ABMU cases referred to the Ombudsman, 23 cases progressed to investigation. Of these investigated cases, 9 were upheld (in full or in part). • Of the 65 referred to the Ombudsman in 2010/11, 9 were upheld (13.8%) compared with 8 out of 51 cases (16%) in 2009/10.. • Of the 1386 formal complaints received by ABMU during 2011/2012: o 4.7% were referred by the complainant to the Ombudsman following the Health Board’s response o 1.65% went on to be investigated by the Ombudsman o 0.6% had failures which were upheld by the Ombudsman
On examination of the upheld cases, there were no specific trends identified, although a number did identify delays within the Health Board’s investigation process and response timescales to the complainant. Further apologies were made to complainants where these failings were identified and it is of note that all these
______3 complaints dated back prior to the significant changes in the process of management of concerns.
Table 1 provides detail on the year that the treatment complained of relates to on those upheld cases.
Table 1. Month/Year in which No. of Upheld Ombudsman treatment occurred Investigations
Pre-2009 1 2009 6 2010 0 2011 2
4. KEY ISSUES The Board are reminded that the withdrawal of the Independent Review Process was anticipated to have an impact on the number of concerns which would be referred to the Ombudsman. Overall, the Ombudsman’s Annual Letter suggests that the Health Board is in-keeping with other health bodies across Wales in its volume of concerns and matters upheld.
ABMU Health Board continues to promote focus on the quality of response, timeliness of investigations, and in ensuring appropriate lessons are learned and actions taken. However, the Ombudsman’s Annual Letter highlights a need for improvements in the timeliness of submission of information for the Ombudsman’s investigators to make a decision on proceeding with an investigation, or once a decision has been made to investigate.
The Department of Investigations & Redress co-ordinates the submission of information to the Ombudsman’s investigators and a number of actions have been implemented and are intended to improve the timeliness and effectiveness of this process:
1. The Department Manager for Investigations & Redress will meet on a regular basis with the Ombudsman’s Health Board Representative. This will be an opportunity to clarify deadlines, consider case outcomes and review the progress in their investigations. 2. Electronic provision of Health Records and Concerns Files and engaging the Ombudsman’s office in use of the FileSharing Portal. This will speed up provision of information as it is received by the Department of Investigations & Redress. 3. Improved relationships between the Ombudsman’s investigation team and the DIR enable us to work collaboratively on a number of cases, finding resolution prior to instigation of investigations. 4. Discussion with Directorates and Locality Governance Leads within the Investigation & Redress Sub Group to reinforce the Ombudsman’s purpose and timescales.
______4 5. LEARNING OPPORTUNITIES IDENTIFIED AND ACTIONS TAKEN The lessons and actions that have been developed and implemented by the Health Board following Ombudsman Upheld complaint reports during 2011/2012 were considered in detail by the Quality and Safety Committee. These include: : • Development of an Acute Care Learning Disabilities Care Bundle which incorporated comprehensive training and development. • Implementation of the Pathway & Care Bundles to support patients with a learning disability who enter acute care. The pathway specifically addresses out patients, emergency admission, elective admission, visit to operating theatre, dental and guidelines for the patient undergoing investigation under anaesthesia. • Reinforcement of the NMC Code (2008) Guidance for managing risk in writing to Heads of Nursing. • A mapping exercise was conducted to establish compliance with nursing documentation compliance across Regional Services. • Unannounced spot checks have been made of documentation. • .The Peripheral Vascular and Catheter Care Bundles have been implemented across the medical wards within Neath Port Talbot and is regularly monitored by Senior Nurses. The full roll out plan is underway and is currently being implemented in the Princess of Wales, Singleton and Morriston Hospitals • All wards within the Health Board now carry out a monthly audit on number of performance indicators. One of these indicators is regarding Risk Assessments, incorporating nutritional risk assessment • Health Board Pain Assessment Chart will now be used as standard part of nursing assessment. • Pain levels will be monitored as part of Enhanced Recovery Programme. • As part of the reconfiguration of surgical services surgical admissions are now routed through the Surgical Clinical Decision making Unit. The consultants on call are free of regular clinical commitments during their on call period, this means that they are able to assess, review and prioritise the patients on the intake as they present to the unit, this happens on weekdays and weekends.
6. RECOMMENDATION The Board is asked to note the report.
______5
ABM University SUMMARY REPORT Health Board Health Board Date 1st November 2012 Agenda Item:3 (v) Subject Further Update on Progress with Older Persons Commissioner Report Action Plan Prepare, Andy Phillips, Director of Therapies and Health Science Approved & Presented by
Purpose This report aims to update the Board on progress with the Action Decision Plan relating to the Report from the Older Persons Commissioner Approval for Wales Report into Dignity and Care of Patients in Hospitals in Information X Wales. Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance X X X X X Executive Summary The report provides an update on the progress improving Dignity and Care of Older People in ABMU Hospitals. Significant progress has been made against the agreed actions with specific management action applied to improve care of patients with Dementia and with Continence Management. A number of challenges remain including nurse and therapist staffing and in progressing actions around discharge that had been agreed with the three Local Authorities. Key Recommendations
To note the significant progress achieved and the ongoing challenges in completing implementation of the agreed actions.
Assurance Framework The report provides assurance that the Health Board is committed to ensuring Dignity and Respect of Care of Older People in Hospitals within ABMU Next Steps Implementation of actions within the report will continue to be progressed within the Annual Planning Guidance, Changing for the Better and concerted action across Directorates and Localities. This will continue to be monitored by the Older Peoples Steering Committee.
1 Corporate Impact Assessment Quality and Safety The Report links to the following standards: - • 1 – governance arrangements • 2 – equality, diversity and human rights • 5 – citizen engagement and feedback • 6 – participating in quality improvement activities • 7 – safe and clinically effective care • 8 – care planning and provision. • 9 – patient information and consent • 10 – dignity and respect • 12 – environment • 18 – communicating effectively • 24 – workforce planning • 25- workforce recruitment and retention • 26 – workforce training and organisational development
Financial There are specific funding implications of Implications ensuring appropriate ward staffing levels, recording PREMS and PROMS and for staff training. Legal Implications N/A Equality & Ensuring people are treated with dignity and Diversity respect.
2 ABM University MAIN REPORT Health Board Health Board Date 1st November 2012 Agenda item 3 (v) Subject Further Update on Progress with Older Persons Commissioner Report Action Plan Prepared by Andy Phillips, Director of Therapies and Health Science Approved by Andy Phillips, Director of Therapies and Health Science
1. Situation This purpose of this report is to inform the Health Board of progress with the Action Plan relating to the Report from the Older Persons Commissioner for Wales Report into Dignity and Care of Patients in Hospitals in Wales.
2. Background The Commissioner’s Review focused on hospital inpatient care because of the strength of concerns expressed about the impact on older people of a poor hospital experience. An ICM Poll of 1,500 people of all ages, commissioned by the Older People’s Commissioner for Wales found that only 36% of people were confident that an older person would be treated with dignity in hospital. 31% of those polled were not confident an older person would be treated with dignity. Overall 49% of people said that they, or an older person they know, had a positive experience of care in a hospital setting. 21% said they, or an older person they know, had a negative experience. The Commissioner was also aware that people aged over 60, are significant users of hospitals in Wales, accounting for 47% of inpatient admissions in 2009 and 2010. She focused her Review on the experiences of older people who were, or had been, hospital inpatients for at least five days within the previous two years. This reflected concerns about the long term impact of a loss of dignity and respect during lengthier stays in hospital, rather than during shorter periods, such as in an emergency or outpatients setting. There were over 228,000 cases where an older person spent five or more days in hospital between January 2008 and December 2009.
Ruth Marks, Older People’s Commissioner for Wales concluded “I consider that my Review has highlighted that the treatment of some older people in Welsh hospitals is shamefully inadequate. Organisations must do more to learn from those who are doing things well”. She further commented that fundamental change is needed:
• Patients need to know what quality care is, and staff need to be supported by systems and resources to empower them to meet patient’s expectations. • Poor practice should not be tolerated. The attitudes, behaviour and emotional intelligence of staff on the wards are crucial. We need strong, positive leadership at all levels and a system which builds in dignity and respect as the cornerstone of high quality care.
3 • There are examples of effective leadership and good practice and it is vital these are built on and become regular practice. • There is evidence that efforts to improve standards of care are making a difference and we should take encouragement and learn from this. They demonstrate what is possible and should play a key part in bringing about wider change.
All Health Boards in Wales were asked to respond to the Commissioners report by 14th June 2011. A group of Clinicians, Managers and others with experience in care of older people including Dementia and Continence Specialists met in May 2011 to compile a response to each of the 12 recommendations. The draft report was then approved by the Executive Team before being presented to and discussed with Older Peoples Groups, Voluntary Organisations and Local Authority Partners. Following modification, a final report was submitted to the Older Peoples Commissioner in June 2011 and subsequently an action plan was drafted following wide consultation and submitted in August 2011. An Older Persons Strategy Group was constituted with strong engagement from older people themselves to oversee implementation of the Action Plan and has met on several occasions.
Good progress has been made in implementing many of the actions. Ruth Marks, the then Older People’s Commissioner visited the Health Board in April 2012 to meet with the CEO, Director of Nursing and Director of Therapies and Health Science to discuss progress with the action plan and then to visit a clinical area to talk to staff engaged in caring for older people. The commissioner subsequently gave very positive feedback on the progress made and this was echoed by David Sissling, Director General of NHS Wales in the JET meeting to review progress in 2011/12.
In June 2012, Sarah Rochira took up post as the Older Peoples Commissioner. She has published her 2012/13 work programme. In terms of Dignity and Respect in hospitals, the Commissioner has committed to:
• Reinforce the need for continued and sustained improvement in hospitals by actively encouraging and supporting the sharing of good practice • Work with Community Health Councils, HIW and others to monitor progress on implementing change following the recommendations made in the report • Publish a progress report on the actions taken to date by the NHS and Welsh Government
Ms Rochira has recently visited ABMU Health Board during the occasion of the roll out of the ‘Butterfly Scheme’ for Dementia care at Morriston Hospital and expressed very positive support for this development. She was particularly supportive of the widespread nature of implementation across whole hospitals, rather than just piloting on a few wards.
4 The commissioner has indicated that in March 2013 she will be requesting a report from Welsh Government outlining the changes that have occurred within NHS organisations as a result of them implementing the recommendations within their action plans. The Chief Nursing Officer for Wales, Dr Jean White has requested that Health Boards submit evidence of the outcomes achieved as a result of implementing the recommendations with the Older Peoples Commissioners report ‘Dignified Care?’. The CNO has suggested that Health Boards consider inviting their local Community Health Council to undertake a thematic review of Older People’s services and submit their report as evidence.
Members of the Executive Team are in discussion around the various sources of independent and objective information that will demonstrate evidence of outcomes achieved. The Internal Audit department will soon commence a review of implementation of actions detailed within the ABMU plan.
3. Assessment The action plan developed to respond to the recommendations of the Older Person’s Commissioner is regularly updated and updates are provided to the Quality & Safety Committee. A full copy of the Action Plan is appended.
The updated action plan demonstrates good progress in many aspects of the plan. In particular, the focus on improving Dementia care and managing continence has led to significant improvements in dignity and care. There remain a number of challenges to completing the action plan. In particular, although there have been significant improvements in discharge planning, there is ongoing work required at the interface with social care to implement the actions agreed with Local Authorities.
4. Recommendation The Board is asked to receive the report and note progress in implementing the action plan.
5 ABMU Health Board-Table of Not Yet Complete Actions in Response to Older People’s Commissioner Report
Recommendation1: Stronger ward leadership is needed to foster a culture of dignity and respect
Area for Action Actions required Lead Individual Reporting to Status as at October 2012 1.11 100 % appraisal • Compliance at ward level to DN Executive Board Included in performance compliance to be be monitored through the General Managers, Q&S committee, review process- most areas achieved in ward metric data Heads of Therapies Health Board, have increased compliance by 2011/12. • Directorate & Locality DWOD Locality and >50% performance to be Directorate monitored through Performance Reviews performance review process and appropriate managerial action taken. 1.12 Agreed data set of • PEU to develop patient PEU Q&S committee, Pilot on PREMS and PROMS information to be experience data set Health Board in course linked to provided to enable development of regular Health Board PREMS activity and reporting members to assure systems themselves about DWOD, DoTHS the day to day • Walkround material to be Examination of feedback quality of patient refreshed to specifically Q&S committee, suggests this requires further care and the explore dignity and care Health Board development. patient experience. issues including dementia, incontinence, confidentiality and discharge arrangements • Ward Sisters and Lead Requires Monitoring Nurses to ensure there is Ward Sisters / Lead Locality/Directorate Local communication of Nurses Board feedback and actions arising from walk rounds
Page 1 of 27 Recommendation 2: Better knowledge of the needs of older people with dementia is needed, together with improved communication, training, support and standards of care
Status as at October 2012 Area for Action Actions required Lead Individual Reporting to 2.1 • Liaise with DWOD Multi Professional Education Universities Board Meeting has been held with regarding provision partner Universities and of training and bespoke Training will be education organized in 2012. Awareness sessions have been arranged
E Learning Package is also under development No change • Improve the interface HoN Localities, Older Persons Strategy Group between Dementia HoN Mental To improve the clinical pathway Nurse Specialists Health Nursing and Midwifery Board of patients who have dementia, and community ADNWE a Task and Finish Group has resource teams been established to develop a • Review the role of fully integrated clinical pathway. the Consultant Nurse aligned with the Advanced Practitioner roles 2.2 Utilise the • All wards to HON`s Nursing & Midwifery Board Phase 4 currently being Transforming implement the 5 S implemented. 61 Wards to date care project element of transforming participating. approach to care to remove ward change ward clutter and improve ward environments environment. 2.3 Develop stronger • Review the function HON`s of localities Nursing and Midwifery Board A Task and Finish Group has links between of the liaison mental and mental health been established to develop a medical and health team Pathway for patients. mental health • Review referral wards processes and in- reach service
Page 2 of 27 Status as at October 2012 Area for Action Actions required Lead Individual Reporting to 2.4 Progress ABMU • Establish current HON`s Older Persons Strategy Group In progress HB Dementia practice on the pilot Plan agreed sites and number of following National patients who are Audit of Dementia identified with and Action dementia Planning Day. • Establish numbers of staff on pilot sites who have had training in dementia
at all grades on that ward Older Persons Strategy Group • Identify if patient and carer experience is Mental Health documented and Directorate how this is used for improvement • Collect information relating to Intelligent Targets for Dementia and use this to improve service quality, patient experience and outcomes • Collect and collate General managers Older Persons Strategy Group Resources required for patient and carer / HON PREMS experience in relation to Dementia care after discharge. • Assessment of need ADPlanning Older Persons Strategy Group Progress through Dementia to determine Group capacity of Dementia Specialists to support newly identified patients
Page 3 of 27 Status as at October 2012 Area for Action Actions required Lead Individual Reporting to • Embed Unified ADNPS Discharge Improvement Group Unified Assessment Assessment Documentation has been Documentation reviewed and updated to include across all agencies full FOC Assessment. This has as a method of been done in conjunction with sharing information LA. Pilot has been undertaken, with social services and implementation is planned ward staff, GP, for April. Implementation of new patient and carer ; documentation continues using a phased approach and is being monitored closely. • Comparative audit Older Persons Strategy Group Progress through Dementia of Length of Stay on Clinical Audit Group the ward of patients Team with and without Dementia Carers Group Follow up action through • Roll out Carers DPCMHS Dementia Group Strategy to emphasise the role and input of carers in people with Dementia • Continue to develop Locality Directors Locality Operational Management Ongoing-Changing For The sustainable service Mental Health Boards Better and Annual Planning models of care of Directorate Mental Health Directorate patients in the community to minimise unnecessary hospital admission 2.5 Implement use of • Baseline audit to Lead Nurses and Nursing and Midwifery Board Butterfly Scheme being rolled "This is me" establish current Ward out across the HB. booklet and the utilization Sisters/Charge Butterfly scheme within the Health Nurses produced by the Board Alzheimers • Roll out across all Society ward areas Page 4 of 27 Recommendation 3: Lack of timely response to continence needs is widely reported and is unacceptable
Status at October 2012. Area for Action Actions required Lead Reporting to Individual 3.1 Positively • Review continence patient Continence Continence Framework and influence the information leaflets Specialist Continence Steering Group guidance has been reviewed . attitude of MDT’s /PEU will be launched in the Autumn.. to the problem of incontinence so • Establish continence user Continence Continence Steering Group Continence Steering that this is not group Specialist Committee established. accepted as an • Review of tools used for Nurses inevitable continence nursing Documentation and Guidance consequence of assessment of patients has been reviwed growing old • Review referral mechanisms to continence specialist Link Nurses identified and nurses successful Training event • Review of current pathway held in February.. and further documentation training has been planned for • Review of training provided 2012. in continence care for link nurses and ward staff • Monitor product usage – product implementation to include user input • Improve screening of physical ability / cognitive function of elderly • Consider implementation of symptom scoring
Page 5 of 27 Status at October 2012. Area for Action Actions required Lead Reporting to Individual • Improve Medical Support Consultant Continence Steering Group for Nurses through Urology Urologists Clinics • Appoint designated Clinician to oversee Continence Service. 3.2 Heads of Nursing • Update the link nurse profile HON Continence Steering Group Link Nurses identified and to improve the for ward areas Continence Training has taken place. system of • Link Nurses to develop a Specialist continence link system of active case finding Nurses nurse appointed for incontinence and ensure to each ward that once detected and after initial assessment that referral pathways are followed with basic continence assessment undertaken as part of a comprehensive geriatric assessment and not in isolation 3.3 Ensure that there • Review existing ADNW&E / Continence Steering Group Discussed with locality is sufficient establishments and service HON Directors, is currently under provision of provision with the HB review specialist nurses • Develop plan to meet service in continence requirements on POWH site Locality care and Director designated leads in each Clinical specialty 3.4 Ensure • Develop and implement a HON / ADNQS Continence Steering Group This has been considered as continence mechanism of monitoring / ADNPS part of the revised Unified assessments compliance with the agreed Assessment Documentation and undertaken on revised continence will be monitored during POINT admission assessment and care Reviews. pathway • Maintain the rolling programme of Spot Page 6 of 27 Status at October 2012. Area for Action Actions required Lead Reporting to Individual verification audits of Metrics data 3.6 Development of • As per 3.1 HON`s Continence Steering Group Guidance requires further overall • Continence Steering Group Continence amendment following Continence Policy to develop policy Specialist consultation including training • Monitoring mechanisms for Nurses needs, implementation to be agreed assessment and audit • Dignity pegs to be fully ADNQS / HON NMB Dignity Pegs have now been 3.7 Roll out Red implemented across all wards implemented in Medicine NPTH Peg Scheme and Morrsiton and Cardiac specialties. Will continue implementation across the HB. 3.8 Reduce distance • .Estates/Planning to review DPlanning Continence Steering Group Under Review patients travel to toilet provision Ward Sisters access toilets. • Ward Sisters/Managers to consider toileting needs in relation to bed location on wards 3.9 Proactive • Ensure pathway for Community Continence Steering Group Community Representation on assessment of assessment and referral is Continence Continence Steering Group, to patients in the understood and implemented Facilitators ensure all standards full community setting within Community Networks. implemented across both who present with Primary and Secondary Care. continence issues New guidance reflects primary care needs.
Page 7 of 27
Recommendation 4: The sharing of patients’ personal information in the hearing of others should cease wherever possible
Status at October 2012 Area for Action Actions required Lead Individual Reporting to 4.1 Improve • Implement NLIAH DWOD Multi Professional Training & Further improvements to communication MDT training Education group communication on wards being on wards framework principles progressed for improving communication. 4.3 Guarantee • MDTs to identify a CD’s / DIM Directorate/Locality Quality and Requires Continuous Monitoring by Patients right to dedicated area and Safety Committees Directorate/Locality Quality and confidentiality commit to taking Safety Committees and privacy when patients to a private discussing area to give them personal “sensitive information” information with or if discussing the ward team matters of a “grave nature”.
• Directorate/Locality Management teams to Examine existing facilities to determine how appropriate and accessible private areas can be made available for private discussion • Each clinical team to agree their own rules for where and when discussions take place and in particular what they consider to constitute grave or sensitive information. (Teams to be made aware of expectations booklet.
• PEU to embed this in PEU / HON Patient Experience Group PEU have developed Outpatient Expectations booklet and In Patient guides which Page 8 of 27 Status at October 2012 Area for Action Actions required Lead Individual Reporting to have been consulted on and are developing a supporting bedside guide and patient charter 4.4 Ward Rounds to • MDTs to review how CDs/DIM Directorate/Locality Quality and Key Principles of Pathfinder Project be conducted in ward rounds are Safety Committees will continue to be implemented a manner by conducted to improve through Discharge Improvement which patients privacy and confidentiality. work. confidentiality is maintained
Page 9 of 27 Recommendation 5: Too many older people are still not being discharged in an effective and timely manner and this needs urgent attention
Status at October 2012 Area for Action Actions required Lead Reporting to Individual
Page 10 of 27 Status at October 2012 Area for Action Actions required Lead Reporting to Individual 5.1 Improve • Sustained improvement in LA & HON Trigger length of stay This work continues as communication discharge planning processes and Discharge indicated. Progress continues links between • Weekly monitoring of trigger improvement group to be monitored through CHC specialties, LA`s lengths of stay for each ward Programme Board and and outside • Follow up of actions from trigger Discharge Improvement agencies of stay meetings Committee.
• Routine Use of Patient Status Boards across the Health Board
• All staff to commit to improve Heads of communication links between Nursing, Heads specialties and agencies, of Therapy, LA documenting outcome of Heads of Adult assessments and the plan in a Services. shared/combined set of notes which reflect the main actions agreed. LA Heads of • Commitment from the Social Adult Services Services staff and from the and HoN Nursing Staff on Wards to develop robust communications that inform/update organisations regularly and in a timely way, including electronically where LA Heads of safe and appropriate, on any Adult Services, update they have Ward Sisters • Social Services to continue to commit to timely allocation and reallocation of social workers for example to cover annual leave and sick leave to take place in line with case priorities including within 2 working days where necessary. Social Services to inform the ward on allocation information as this LA Heads of happens. Ward staff to highlight to the Adult Services, Page 11 of 27 Status at October 2012 Area for Action Actions required Lead Reporting to Individual appropriate social services manager Ward Sisters where there are perceived problems with allocation so these can be LA Heads of resolved. Adult Services, ADIT
Ward Sisters, Social Work Team Managers,ADIT
Ward Sisters, Social Work Team Managers
HoN, LA Heads of Adult Services
HoN, LA Heads of Adult Services
Page 12 of 27 Status at October 2012 Area for Action Actions required Lead Reporting to Individual • Improved e mail access to communication between wards and social workers.
• Commitment to work on electronic transfer of information to WASPI standards between agencies
• Commitment to staff taking messages and returning telephone calls in a timely fashion, and to ensure that affect the transfer of care should be recorded in the shared/combined notes
ABMU and its Local Authority partners to engage about the format content and delivery of MDT meetings to maximise their effectiveness and relevance.
Page 13 of 27 Status at October 2012 Area for Action Actions required Lead Reporting to Individual 5.2 Improve • Examine the potential integration Locality Limited Progress-May be Partnership of budgets to provide a single Directors with Addressed by Western Bay Working between funding stream and congruence Local Partnership ABMU and other of aim between health and social Partnership Statutory and services. Boards Voluntary • Examine the alternatives for Agencies patients who do Not need to be in an acute hospital. Such alternatives may be temporary whilst long term care support is being sought and
funded. The principal of supporting people to return to their own homes if that is their Locality choice will aim to ensure that as Directors with many Local people as possible can return Partnership home to Boards independent living. PEU
• Work with partners to change the perception the public have of acute NHS hospital care to ensure that this facility is only Locality used for Operational acute medical care. Senior Managers, Management to WAST, CVS, support professional staff in Local dealing with Authorities families or carers who are delaying LA Heads of discharge due to inappropriate Adult Services, choice or HoN, DN expectation. PEU to develop this Page 14 of 27 Status at October 2012 Area for Action Actions required Lead Reporting to Individual in expectations booklet.
• Work with WAST and other partners to reduce the amount of time that older people spend waiting for transport to take
them home once discharged. LA Heads of
Adult Services,
Locality • Arrange Meeting to scope out Directors further development of pre-operative assessment to consider discharge plan
arrangements for older people undergoing elective surgical procedures, LA Heads of particularly for people who live Adult Services, alone, or where there is an Locality identified risk of potential loss of Directors, independence including risk of DoTHS not returning home. This will ensure that expectations are realistic and communication prior to hospital is optimal between Health, Local Authorities, patients, families and carers.
• Where there are persistent problems or problems are anticipated with resource allocation and commissioning services the individual LA and HB to work Page 15 of 27 Status at October 2012 Area for Action Actions required Lead Reporting to Individual together and devise solutions (as and when required, with initial discussions to take place within 1 week of anticipated or actual problems)
• Joint Working Group approved by Heads of Services of the HB and 3 LA’s to meet bimonthly monitor, evaluate and report on progress of above recommendations.
5.5 Review Nursing •. Review roles/numbers and Locality Locality Board Workforce Review has been Staffing In capacity of discharge liaison staff Operational undertaken and work Respect of to ensure that there Managers continues to address any Optimising are adequate numbers of ; and in shortfalls. Discharge addition review the administrative support for the existing discharge services to give more time to professional staff to work with
patients their families and carers
and with partners in streamlining Locality Board the discharge processes. Heads of Nursing Heads of • Review nurse and therapy staffing Therapies levels on all rehab wards where older people are cared for to take into account the nurse’s role in rehabilitation to ensure that older people reach their goals quickly and can be discharged quickly
Page 16 of 27
Recommendation 6: The appropriate use of volunteers in hospital needs further development, learning from successful initiatives
Status at October 2012 Area for Action Actions required Lead Reporting to Individual 6.1 Policy and • A Health Board volunteer policy to be PEU / Executive Board out for consultation currently Strategy developed that facilitates the further Operational Development development of volunteering in a consistent Site manner across the organisation. Manager Singleton • A volunteering strategy to be developed that works towards consistency of volunteering provision and meeting current unmet volunteering gaps 6.2 Training of • A HB wide process for accrediting the PEU / Executive Board As 6.1 Volunteers training of Operational volunteers to be developed with interested Site partner organisations. Manager Singleton 6.3 Funding for • Identify the required budget to achieve the PEU Executive Board Development of models being Volunteers Investing in Volunteers Award. undertaken to intoroduce a Schemes common approach to in house volunteering across the Health Board.
This will include a new uniform structure that will need a financial business case. One element of which will be Investing in Volunteers
Page 17 of 27 Recommendation 7: Staffing levels have to reflect the needs of older people both now and in the future
Status at October 2012 Area for Action Actions required Lead Individual Reporting to
7.2 Nurse staffing • ABMU to undertake an ADNWER Nursing & Midwifery In discussion between Chief levels and skill annual review of ward HoNs, Heads of Therapies Board Operating Officer and mix to be staffing levels/skill mix for Director of Nursing monitored within nurses, therapists and ABMU HCSW or more frequently if indicated • A protocol will be ANDWER NMB developed for increasing Draft Policy has been nurse capacity in an developed and discussed at emergency situation NMB in September 2012. (Increased Nurse Capacity Protocol) to be developed and implemented when required
• Winter Plans to DWOD, DPCTMH/ HoN Exec Board Review of Winter Plan recognize and ameliorate demonstrates challenges demand/capacity pressures on Ward staffing
• Develop Plan for Active General Managers Workforce Board Sickness absence currently Sickness Absence above 5.3% requires action Management for Ward Staff to reduce to < 4.2 % on any ward
7.3 Prepare an • Develop community Locality Directors, Locality Board Will be further developed Integrated networks and specialist Community Resource Team through ‘Changing For the Workforce Plan resource teams with Managers Primary and Better’ workstream consistent with appropriate emphasis Community Care change to new being placed on how we Planning Group models of care improve our services which take into for patients with or at account the risk of long term communities we conditions to ensure that Page 18 of 27 Status at October 2012 Area for Action Actions required Lead Individual Reporting to
serve and our patients and carers ageing population receive high quality care and support in an environment which best suits their needs
Page 19 of 27 Recommendation 8: Simple and responsive changes to the ward environment can make a big difference
Status october 2012 Area for Action Actions required Lead Reporting to Individual 8.1 Utilise the • Actions as per 2.2 Being rolled out across HB Transforming care project approach to change ward environments 8.2 Ward • Process to be put in place so AD Planning DPlanning Being progressed through the Environments to that there is a prompt response to (Estates) Infection Prevention Board be fit for purpose requests from ward sisters in relation to ward environmental problems being addressed • Central storage facilities for Locality Heads DPlanning Ongoing equipment and mattresses to be of Operations developed on each site • Review of day room provision HoN Dplanning Ongoing to be undertaken • Design and refurbish facilities DPlanning Older Persons Continuing Programme with Estates to explicitly consider the needs of DoTHS Strategy Group frail older people. In particular : engage patients in design include safe walking spaces and helpful use of colour, lighting and signage to aid orientation ;promote communal spaces for social engagement and activities ; provide adequate space around bed areas for using large hoists ;provide secure accessible storage space for patients belongings ; provide information prior to admission when patients admitted to situations where there are members of opposite gender in adjacent bays or sharing bathing/toileting facilities.
Page 20 of 27
Recommendation 9: Effective communication can raise patient experience and involvement and can improve their hospital experience
Status October 2012 Area for Action Actions required Lead Reporting to Individual 9.1 Develop & • On admission, Ward Ward Older Persons Strategy Group implement ward Sisters/Charge Nurses to Sisters/Charge Being Progressed through level standards explain the dignity statement Nurses Expectations Booklets and and models of making explicit the ADNPS PREMS measurement communication individual’s right to receive quality and dignified care and how to express concerns. The dignity statement to displayed on patient/public information boards on all wards
• Ensure that where Ward Nursing Midwifery Board On Going appropriate, older people Sisters/Charge have access to an advocate Nurses /HON to assist them communicate around issues relating to their care. • Ensure that all ward staff Ward Sisters / Directorate and Locality Core Requires Continuing understand what information Lead Nurses team meetings Update may be communicated to relatives and how to provide information
Page 21 of 27 Status October 2012 Area for Action Actions required Lead Reporting to Individual • Ensure implementation of HoN Directorate and Locality Core Requires Continuing the guidance 'Ensuring Equality teams Update through Effective Communication' on every ward
9.2 Provide • Work with stakeholders to PEU Older Persons Strategy Group Being Progressed through Appropriate develop material to provide a Expectations Booklets and Expectations to set of expectations that older PREMS measurement Patients, families people should have when and carers on entering our hospitals. This will admission to be based on material available hospital from the RCN and hcpc codes of conduct, performance and ethics, the UNISON handbook and the patients association ’10 tips’ leaflet from their paper ‘A Lottery of Care’.
Page 22 of 27 Recommendation 10: The experience of older patients, their families and carers should be captured more effectively and used to drive improvements in care
Status October 2012 Area for Action Actions required Lead Reporting to Individual 10.1 Effectively capture • Explore the Link between experiential PEU / COSG Pilot of PROMs in final stages. the experience of survey activity to Clinical outcomes through DAC/DN PROMS and PREMS part of older people, their trial of a specialist survey organisation Planning Guidance families and carers CoMetrica).
• Explore and pilot implementation of PEU Executive Ongoing PDSA cycles underway new technology approaches to make it Board easier for patients of all ages and abilities to be able to share their experience without having to fill in paper forms
• Develop pilot activity to improve DAC / ADG Health Board Pilot of PROMs in final stages reporting of outcomes and improvements / to patients and the public following a similar MD/DN/DoT model to the English “Quality Accounts” HS model
• Develop an annual targeted programme PEU,Quality Older Persons Being Progressed through of patient surveys to determine the and Safety Strategy Expectations Booklets and PREMS priorities and concerns of patients, Unit Group measurement including older people. Health Board to consider commissioning this from external supplier
Page 23 of 27 Recommendation 11: Good practice should be better identified, evaluated and learnt from to bring about improvements in care
Status at October2012 Area for Action Actions required Lead Individual Reportin g to 11.1 Develop Processes • HB Intranet site to be continued to be used Communication Changing For the Better Resource to enable good as a vehicle for sharing good practice and team NMB to Support practice to be innovation shared and adopted • Liaise with NLIAH to share and implement DWOD Workfor Ongoing national examples of good practice ce Board • All ward / team / Directorate / Locality General Executiv Ongoing meetings to include an agenda item re sharing managers / e Board of good practice HON
11.2 Raise awareness of • All ward / directorate / locality lessons ADG Investiga Ongoing where we have learnt to be collated monthly and disseminated DoTHS tions & failed to deliver high to staff across all areas including actions and HoN Redress quality care compliance with actions, themes & trends. To Group be monitored through Directorate / Locality CGRMG Board and the Investigations &Redress Group. 11.3 Develop capacity for • Develop Faculty of Improvement and DoTHS Exec Ongoing improvement support improvement champions and make DWOD Board access to examples of good practice easier
11.4 Increase • Further develop links with older people and ADPlanning Older Further Engagement through engagement with voluntary groups to plan and develop services Peoples Changing For the Better internal and external Strategy groups to spread Group improvement methodology
• Work with the Universities to develop Research in Progress with Research and Development Programmes that DoTHS Older University of Glamorgan and evaluate interventions and disseminate good Peoples Swansea University and Health practice for improvement in the care of Older Strategy Foundation People. Group
Page 24 of 27 Recommendation 12: All those working with older people in hospitals in Wales should have appropriate levels of knowledge and skill Area for Action Reporting to Status October 2012 Actions required Lead Individual 12.1 Ensure newly • HB to jointly review pre-registration AND W&E Nurse Training Needs analysis has been qualified staff nursing Education undertaken in relation to Dementia have appropriate curriculum with Higher Education Research & Training specifically. skill set and provider for Development This issue has been raised with knowledge base fitness for practice to ensure Group Curriculum Development Group and to meet the appropriate staff there is sufficient content within pre needs of older training leading to enhanced levels people of care reg programmes regarding care of the older person, dignity and dementia. • Any gaps in skill set and knowledge General Multi Further work required on curricula base to be identified through appraisal Managers Professional and appropriate education and Education training put in place, monitored on Group appraisal 12.2 Ensure that every • As per section 7 Dementia Champion and Butterfly ward in which Champions have been identified as older people are above.and have now received cared for has training adequate GAP analysis of skills required by General Therapies Continues to be reviewed numbers of • nursing, therapy and HCSW staff Mangers Forum, therapy and Heads of Nursing and nursing staff Therapies Midwifery available with Board specialist skills in Every ward where there are older Lead Nurse Requires further discussion care of older persons being nursed to have an Nurses/Ward Education people Butterfly Scheme has been older persons champion Identified. Sisters/Charge Research & implemented in POWH and will be Nurses Development launched in a phased approach Group across the HB to ensure Butterfly Champions are available in all Ward Areas. Dementia Champions have been also identified and Training has been delivered.
Page 25 of 27 Area for Action Reporting to Status October 2012 Actions required Lead Individual • The current provision of in house ADNW&E Nurse All in-house programmes contain and post registration training to be Education content relating to the care of the reviewed in the context of the older Research & older person as appropriate. person Development Group 12.3 All staff working • Walkround proforma to be DTHS Older Persons Ongoing Discussion with older people reviewed to include aspects of older Strategy Group feel valued by the persons care and management All organisation • Monitor through annual staff survey DWOD Executive and have Continue to monitor through staff and take appropriate action Board appropriate surveys education, training, skill and time to deliver high quality care
AND PS- Assistant Director of Nursing Professional Standards and Practice
ADNW&E- Assistant Director of Nursing Workforce and Education
ADNQ&S- Assistant Director of Nursing Quality and Safety
HON Head of Nursing
DLN – Discharge Liaison Nurse
DPlanning-Director of Planning
MD -Medical Director
DN -Director of Nursing
DoTHS - Director of Therapies and Health Science
DWOD - Director of Workforce and Organisational Development
Page 26 of 27 ADG - Assistant Director of Governance
CD - CWinical Director of Acute Directorate
DIM - Director of Integrated Medicine
LD - Locality Director
PEU - Patient Experience Unit
DIR - Department of Investigation and Redress
CGRMG – CWinical Governance and Risk Management Group
DAC - Director of Acute Care
DPCMHC-Director of Primary, Community and Mental Health Care
COSG - CWinical Outcomes Steering Group WAST - Welsh Ambulance Service Trust
CVS - Council for Voluntary Services
NOM - Non Officer Member (of Health Board)
LA - Local Authority
ADIT - Assistant Director of Information Technology
LA Heads of Adult Services-Local Authority Heads of Adult Services
ADPlanning (Estates)-Assistant Director of Planning for Estates
Page 27 of 27 Main Report Health Board Meeting On 1ST NOVEMBER 2012
AGENDA ITEM: 4 (I) A Subject Key Issues – Audit Committee Prepared by Wendy Penrhyn-Jones, Head of Corporate Administration Approved by Charles Janczewski, NOM/Chair, Audit Committee Presented by Charles Janczewski, NOM/Chair, Audit Committee
1 PURPOSE To update the Board on issues considered at the Audit Committee at its meeting held on 20th September 2012.
2 INTRODUCTION In order to provide speedier reporting to the Board on key issues considered by the Audit Committee it has been agreed that a summary report on key deliberations of the Committee at its most recent meetings will be considered by the Audit Committee and are available on request from the Board Secretary.
3 KEY ISSUES
1) Workforce Systems Strategic Programme and the review of Electronic Rostering and Time & Attendance Systems The Committee received a progress report regarding the above. It was agreed that enquiries would be made as to whether a national desk top audit had been undertaken in respect of Electronic Staff Record (ESR) systems. Approval was given for the second phase of the pilot to commence. A further report would be received around existing Electronic Rostering and Time & Attendance Systems following a review that was being undertaken. 2) Write Off of Salary Overpayment The Committee received reports in relation to salary overpayments which were approved.
(3) Auditor’s Progress Reports
The Committee received and noted a report from the Wales Audit Office and the Internal Audit & Specialist Services Unit setting out remaining assignments from 2011/12 Plan and work from the 2012/13 Plan. The Committee approved an amendment to the Internal Plan around the follow up review of private patients and the inclusion of health & safety within the 2012/13 Internal Audit Plan.
(4) Local Counter Fraud Progress Report
The Committee received and approved the Counter Fraud Policy & Response Plan and received an update on the recent work of the Local Counter Fraud Specialist Team. The Committee also approved the National Fraud Initiative Policy and Procedure.
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(5) Final Audit Reports
The Committee received the following final audit reports for noting: − Data Quality: Unscheduled Care (yellow rating applied) − Capital & Estates Assurance Reports (yellow rating applied) − Directorate Governance Review: Surgical Services (yellow rating applied) − Pencoed Primary Care Centre – Open Book Audit (amber rating applied) − Medical Equipment (yellow rating applied) (6) Losses & Special Payments for Approval
The Committee received a report providing an update on the losses and special payments for the period 1st July – 31st August 2012 which totaled £1,072,221. The majority of these losses related to Medical Negligence & Personal Injury payments. The Health Board could recover case costs in excess of £25,000 on a case by case basis which left the actual loss in the period as £433,087. The losses were noted by the Audit Committee and the Health Board is now asked to approve the same.
(7) Audit Registers & Action Plans
The Committee received summary extracts of the Audit Registers for the Health Board.
(8) Corporate Risk Register The Committee received an update in relation to the management of risk and in were presented with the risk register which set out instances where risks had been identified as having a score of in excess of 15. The report also set out the actions being taken to mitigate risk. (9) Declaration of Interests The Committee received a report on declarations made since April 2012.
(10) Miscellaneous The Committee dealt with routine items including the Hospitality Register.
4 RECOMMENDATION The Board is asked to:
- Note the content of the report - Approve the losses and special payments detailed under point 6
2 Main Report Health Board Meeting On 1ST NOVEMBER 2012
AGENDA NO. 4 (I) B
Subject Key Issues – Quality & Safety Committee Prepared by Wendy Penrhyn-Jones, Head of Corporate Administration Approved by Cllr Melvyn Nott, Non Officer Member/ Committee Chair Presented by Cllr Melvyn Nott, Non Officer Member/ Committee Chair
1 PURPOSE To update the Board on issues considered at the Quality & Safety Committee at its meeting held on 23rd August 2012.
2 INTRODUCTION In order to provide speedier reporting to the Board on key issues considered by the Quality & Safety Committee it has been agreed that a summary & report on key deliberations of the Committee at its most recent meetings be provided to the Board. The full minutes of the Committee meeting will be considered and are available on request from the Board Secretary.
3 KEY ISSUES
– Presentation – Governance Arrangements The Committee received a presentation from the Learning Disabilities Management Team setting out the frameworks in place to address issues of governance and quality & safety outcomes.
– Patient Story The Committee heard the story of a patient who had been admitted to the Princess of Wales Hospital and reflected the family’s experience of the care episode. Overall the experience was positive and highlighted the importance of good communication.
− Quality & Safety Update Report The Committee received a report setting out changes made to Executive Director responsibilities around issues of quality and safety.
− Quality Statement The Committee received the draft 2011/12 Quality Statement detailing how the organisation was performing in terms of the quality of care being provided, the work planned for 2012/13 and priorities for action. This was subsequently further revised and received by the Health Board at its meeting on 6th September.
– Standards for Healthcare Services in Wales The Committee received a report providing an update on the work undertaken through the Scrutiny Panel.
1 – Quality & Safety Performance Report The Committee received a performance report on a range of quality and safety issues. It was agreed that all data fields would be completed for future reports and that supportive narrative would be provided where particular performance issues were being highlighted.
− Infection Prevention & Control Report The Committee received a report for the period April – June 2012. It was agreed that a further report on the IP & C Committee’s Terms of Reference would be prepared for the next meeting.
− Clinical Outcome Steering Group The Committee received a report on the actual and risk adjusted in hospital mortality for 2011/12.
− Concerns Annual Report 2011/12 The Committee received the Health Board’s first Concern’s Annual Report.
− Public Service Ombudsman’s Annual Letter The Committee considered a report on the Annual Letter detailing the Health Board’s performance in terms of complaints. A copy of the Letter is available on request.
− Medical Revalidation The Committee received a report setting out progress made in terms of the Medical Revalidation process.
− Governance Framework for Advanced Practitioners The Committee received an update on the roll out of the Governance Framework.
− Clinical Effectiveness Group Annual Report The Committee received a summary of the Clinical Effectiveness Annual Report together with the 2012/13 Clinical Audit Plan and progress made in this respect.
− Communication Between Primary & Secondary Care The Committee received a report describing key issues relating to the improvement of systems of communication between primary and hospital care which in particular highlighted the ongoing work to improve discharge information.
− Risk Management Review Group The Committee received an update on the various tools being utilised to manage and reduce risk.
− Internal Audit Report Findings The Committee received a summary of the finding of various internal audit reports which had already been presented to the Audit Committee in full.
− Healthcare Inspectorate Wales (HIW) The Committee were advised that HIW had carried out a Dignity & Essential Care Inspection at the Princess of Wales Hospital. Once the report was 2 received this would be considered by the Committee along with the associated action plan.
− Other Matters A report was received on safeguarding matters, serious incidents and professional issues.
4. RECOMMENDATION
The Board is asked to note the summary of key issues.
3 Main Report Health Board Meeting On 1st November 2012
AGENDA ITEM: 4 (I) C Subject Key Issues – Charitable Funds Committee Prepared by Wendy Penrhyn-Jones, Head of Corporate Administration Approved by Charles Janczewski, NOM / Chair, Audit Committee Presented by Charles Janczewski, NOM / Chair, Audit Committee
1 PURPOSE To update the Board on issues considered at the Charitable Funds Committee at its meeting held on 14th June and 13th September 2012.
2 INTRODUCTION In order to provide speedier reporting to the Board on key issues considered by the Charitable Funds Committee it has been agreed that a summary report on key deliberations of the Committee at its most recent meetings be provided to the Board. The full minutes of the Committee meeting will be considered and are available on request from the Board Secretary.
3 KEY ISSUES – 14th June 2012
TERMS OF REFERENCE (TOR) The Committee received a report around the proposed amendments to the TOR and agreed that the revised version would be considered at the September meeting with a view to approval.
CHARITABLE FUNDS ANNUAL REPORT The Committee received and approved the Annual Report for submission to the Board of Trustees (who in turn ratified this at their meeting on 4th October 2012).
ANNUAL WORK PLAN The Committee received and approved the Annual Work Plan for submission to the Board of Trustees (who in turn ratified this at their meeting on 4th October 2012).
INTERNAL AUDIT REPORT – CHARITABLE FUNDS The Committee received a report confirming the attainment of a substantial level of assurance in respect of expenditure and central systems.
CHARITIES ACT 2011 The Committee received a report setting out key issues arising from the Act which became effective as of 14th March 2012.
CHARITABLE FUNDS FINANCE REPORT The Committee received and noted a report setting out income and expenditure, the performance of the investment portfolio, interest earned on cash held, the overall fund balances and legacies / bequests for the period ending 31st March 2012.
1 DELEGATED FUNDS INCOME & EXPENDITURE REPORT The Committee received and noted a report by delegated fund for the period 1st April 2011- 31st March 2012. It was agreed that a report would be prepared on any funds classed as ‘dormant’ together with a plan of action around these.
INVESTMENT ADVISOR’S REPORT The Committee received and noted a report on investments for the period to 31st March 2012.
CHARITABLE FUNDS INVESTMENT POLICY The Committee received a report setting out the current Investment policy which was approved for submission to the Board of Trustees (who in turn ratified this at their meeting on 4th October 2012).
CHARITABLE FUNDS EXPENDITURE STRATEGY & RESERVES POLICY The Committee received a report setting out the current strategy and policy and which was approved for submission to the Board of Trustees (who in turn ratified this at their meeting on 4th October 2012). . REQUEST TO SUPPORT NEW CHARITABLE FUND The Committee received a report seeking support a new fund around Gastrointestinal Endoscopy Services and Training in Bangladesh. It was agreed that this would be further discussed prior to a decision being reached.
NEW CHARITABLE FUNDS The Committee received a report regarding four new funds that had been approved between 1st April – 30th May 2012.
KEY ISSUES - 13TH SEPTEMBER 2012
TERMS OF REFERENCE The Committee received a report proposing revisions to the TOR and these were approved for ratification by the Board. The TOR are therefore appended to this report for consideration.
CHARITY COMMISSION QUESTIONNAIRE The Committee received an update regarding the responses provided by the Health Board to the questionnaire.
REQUEST TO SUPPORT NEW CHARITABLE FUND The Committee received an update regarding the request for the new fund around Gastrointestinal Endoscopy Services and Training in Bangladesh. Following consideration, the Committee did not support this request but noted it would still be possible for the individuals concerned to take this project forward independently.
CHARITABLE FUNDS INVESTMENT MANAGEMENT CONTRACT The Committee received a report on the options for the existing contract. The Committee approved the proposal that the existing contract be extended subject to the agreement of the provider. .
2 CHARITABLE FUNDS FINANCE REPORT The Committee received and noted a report setting out income and expenditure, the performance of the investment portfolio, interest earned on cash held, the overall fund balances and legacies / bequests for the period ending 30th June 2012.
DELEGATED FUNDS INCOME & EXPENDITURE REPORT The Committee received and noted a report by delegated fund for the period 1st April 2012- 30th June 2012.
INVESTMENT ADVISOR’S REPORT The Committee received and noted a report on investments for the period to 30th June 2012.
REVIEW OF DORMANT FUNDS The Committee received an update on dormant funds.
PROPOSED CONSOLIDATION OF NHS CHARITABLE FUND ACCOUNTS INTO MAIN HEALTH BOARD ACCOUNTS The Committee received a report on the above proposals. Issues around this had yet to be finalised at All Wales level.
CHARITABLE FUND REVIEW The Committee received a report confirming the closure of the Hill House Hospital Fund following the transfer of services to Singleton Hospital and the establishment of a replacement endowment fund.
DIRECTORATE/LOCALITY PRESENTATIONS – USE OF CHARITABLE FUNDS The Committee received a presentation from the Women & Children’s Services Directorate and the Neath Port Talbot Locality setting out how their Charitable Funds monies were being utilised. The Committee encouraged the Fund Managers to make their staff aware of the funds at their disposal and agreed to receive a further update in 12 months time.
CHARITABLE FUND ACCOUNTS FOR YEAR ENDED 31ST MARCH 2012 The Committee received a Statement of Financial Activities (and Auditor’s report) for the year which was approved for submission to the Board of Trustees (who met and approved the Accounts on 4th October 2012).
GOLAU CANCER FOUNDATION FUND The Committee received a report setting out progress made since the Foundation had been launched in May 2012. The Committee requested six monthly reports which included income and expenditure to be prepared.
USE OF RADIOTHERAPY FUND TO REFURBISH ONCOLOGY AND TELEMEDICINE ROOMS The Committee received a report seeking authority to utilize the associated funds which was approved in principle subject to further clarity around the final total cost.
3 INTERNAL AUDIT REPORT – CHARITABLE FUND DONATIONS The Committee received the findings of an Internal Audit Report. It noted good progress had been made in terms of the required actions and that more departmental checks had provided reassurances that appropriate processes and procedures were being maintained.
4 RECOMMENDATION The Board is asked to note the foregoing and ratify the revised Terms of Reference for the Charitable Fund Committee.
Charitable Funds Committee
Terms of Reference & Operating Arrangements
Approved by the CFC September 2012
4
1. INTRODUCTION 1.1 The Local Health Board (LHB)’s standing orders provide that “The Board may and, where directed by the Assembly Government must, appoint Committees of the LHB either to undertake specific functions on the Board’s behalf or to provide advice and assurance to the Board in the exercise of its functions. The Board’s commitment to openness and transparency in the conduct of all its business extends equally to the work carried out on its behalf by committees”.
1.2 In accordance with standing orders (and the LHB’s scheme of delegation), the Board shall nominate annually a committee to be known as the Charitable Funds Committee “the Committee”. The detailed terms of reference and operating arrangements set by the Board in respect of this committee are set out below.
2. CONSTITUTION 2.1 The ABMU University LHB was appointed as corporate trustee of the charitable funds and its Board serves as its agent in the administration of the charitable funds held by the LHB.
2.2 The purpose of the Committee is to make and monitor arrangements for the control and management of the LHB’s Charitable Funds.
3. SCOPE AND DUTIES 3.1 Within the budget, priorities and spending criteria determined by the LHB as trustee and consistent with the requirements of the Charities Act 1993, Charities Act 2006 (or any modification of these acts) to apply the charitable funds in accordance with their respective governing documents.
3.2 To ensure that the LHB policies and procedures for charitable funds investments are followed. To make decisions involving the sound investment of charitable funds in a way that both preserves their value and produces a proper return consistent with prudent investment and ensuring compliance with:- Trustee Act 2000 The Charities Act 1993
5 The Charities Act 2006 Terms of the fund’s governing documents
3.3 To receive at least twice a year reports for ratification from the Director of Finance and investment decisions and action taken through delegated powers upon the advice of the LHB’s investment adviser.
3.4 To oversee and monitor the functions performed by the Director of Finance as defined in Standing Financial Instructions.
3.5 To monitor the progress of Charitable Appeal Funds where these are in place and considered to be material.
3.6 To monitor and review the LHB’s scheme of delegation for Charitable Funds expenditure and to set and reflect in Financial Procedures the approved delegated limits for expenditure from Charitable Funds.
4. DELEGATED POWERS AND DUTIES OF THE DIRECTOR OF FINANCE 4.1 The Director of Finance has prime responsibility for the LHB’s Charitable Funds as defined in the LHB’s Standing Financial Instructions. The specific powers, duties and responsibilities delegated to the Director of Finance are:-
Administration of all existing charitable funds To identify any new charity that may be created (of which the LHB is trustee) and to deal with any legal steps that may be required to formalise the trusts of any such charity
Provide guidelines with respect to donations, legacies and bequests, fundraising and trading income. Responsibility for the management of investment of funds held on trust Ensure appropriate banking services are available to the LHB Prepare reports to the LHB Board including the Annual Account
5. AUTHORITY 5.1 The Committee is empowered with the responsibility for:-
6
Overseeing the day to day management of the investments of the charitable funds in accordance with the investment strategy set down from time to time by the trustee and the requirements of the LHB’s Standing Financial Instructions.
The appointment of an investment manager (where appropriate) to advise it on investment matters and may delegate day-to-day management of some or all of the investments to that investment manager. In exercising this power the Committee must ensure that:
a) The scope of the power delegated is clearly set out in writing and communicated with the person or persons who will exercise it b) There are in place adequate internal controls and procedures which will ensure that the power is being exercised properly and prudently c) The performance of the person or persons exercising the delegated power is regularly reviewed d) Where an investment manager is appointed, that the person is regulated under the Financial Services Act 1986 e) Acquisitions or disposal of a material nature must always have written authority of the Committee or the Chair of the Committee in conjunction with the Director of Finance
Ensuring that the banking arrangements for the charitable funds should be kept entirely distinct form the LHB’s NHS funds. Ensuring that arrangements are in place to maintain current account balances at minimum operational levels consistent with meeting expenditure obligations, the balance of funds being invested in interest bearing deposit accounts The amount to be invested or redeemed from the sale of investments shall have regard to the requirements for immediate and future expenditure commitments The operation of an investment pool when this is considered appropriate to the charity in accordance with charity law and the directions and guidance of the Charity Commission. The Committee shall propose the basis to the LHB Board for applying
7 accrued income to individual funds in line with charity law and Charity Commissioner guidance Obtaining appropriate professional advice to support its investment activities Regularly reviewing investments to see if other opportunities or investment services offer a better return.
5.2 The Committee is authorised by the Board to:
investigate or have investigated any activity within its Terms of Reference and in performing these duties shall have the right, at all reasonable times, to inspect any books, records or documents of the LHB relevant to the Committee’s remit. It can seek any relevant information it requires from any employee and all employees are directed to co-operate with any reasonable request made by the Committee;
obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary, subject to the Board’s budgetary and other requirements; and by giving reasonable notice, require the attendance of any of the officers or employees and auditors of the Board at any meeting of the Committee.
6. MEMBERSHIP Members
6.1 A minimum of five (5) members, comprising:
Chair Independent member of the Board (Charles Janczewski)
Vice Chair Independent member of the Board (Paul Newman)
Members A minimum of 1 other Independent member of the Board (Gaynor Richards) and 2 Executive Directors, to include the LHB’s Director of Planning and
8 Director of Finance. There will also be additional independent ‘external’ members1 which have yet to be confirmed. Attendees 6.2 In attendance The Committee may require the attendance for advice, support and information routinely at meetings from:
E.g., Charitable Funds Accountant [or equivalent] LHB Investment Advisor Secretariat 6.3 Secretary As determined by the Board Secretary
Member Appointments 6.4 The membership of the Committee shall be determined by the Board, based on the recommendation of the LHB Chair – but should always include the Chairman of the Audit Committee and the Independent Member of the Board appointed for their legal expertise. The LHB chair shall also appoint any other independent members of the Board taking account of the balance of skills and expertise necessary to deliver the committee’s remit and subject to any specific requirements or directions made by the Assembly Government.
6.5 The Chairman of the Audit Committee and the independent Member appointed for their legal expertise should be permanent members of the Committee with any other Independent members appointed to hold office for a period of one year at a time, up to a maximum of 3 consecutive years. During this time a member may resign or be removed by the Board.
6.6 Terms and conditions of appointment, (including any remuneration and reimbursement) in respect of co-opted independent external members are determined by the Board, based upon the recommendation of the LHB Chair {and, where appropriate, on the
1 In order to demonstrate that there is a visible independence in the consideration of decisions and management of charitable funds from the LHB’s core functions, the Board should consider extending membership to the Committee to independent members outside of the Board. For LHBs, one option might be to seek nominations from the Stakeholder Reference Group.
9 basis of advice from the LHB’s Remuneration and Terms of Service Committee}.
Support to Committee Members 6.7 The Board Secretary, on behalf of the Committee Chair, shall:
Arrange the provision of advice and support to committee members on any aspect related to the conduct of their role; and ensure the provision of a programme of organisational development for committee members as part of the LHB’s overall OD programme developed by the Director of Workforce & Organisational Development.
7. COMMITTEE MEETINGS Quorum
7.1 At least three members must be present to ensure the quorum of the Committee. Of these three, two must be independent members (one of whom is the Chair or Vice Chair) and one must be the Director of Finance or his representative.
Frequency of meetings 7.2 Meetings shall be held no less than twice a year and otherwise as the Committee Chairs deems necessary - consistent with the LHB’s annual plan of Board Business.
Withdrawal of individuals in attendance 7.3 The Committee may ask any or all of those who normally attend but who are not members to withdraw to facilitate open and frank discussion of particular matters.
8. RELATIONSHIP & ACCOUNTABILITIES WITH THE BOARD AND ITS COMMITTEES/GROUPS 8.1 The Committee is directly accountable to the Board for its performance in exercising the functions set out in these terms of reference.
10 8.2 The Committee, through its Chair and members, shall work closely with the Board and, [where appropriate, its committees and groups], through the:
joint planning and co-ordination of Board and Committee business; and appropriate sharing of information in doing so, contributing to the integration of good governance across the organisation, ensuring that all sources of assurance are incorporated into the Board’s overall risk and assurance framework.
8.3 The Committee shall embed the LHB’s corporate standards, priorities and requirements, e.g., equality and human rights through the conduct of its business.
9. REPORTING AND ASSURANCE ARRANGEMENTS
9.1 The Committee Chair shall agree arrangements with the LHB’s Chair to report to the board in their capacity as trustees. This may include, where appropriate, a separate meeting with the Board.
9.2 The Board Secretary, on behalf of the Board, shall oversee a process of regular and rigorous self assessment and evaluation of the Committee’s performance and operation.
10. APPLICABILITY OF STANDING ORDERS TO COMMITTEE BUSINESS
10.1 The requirements for the conduct of business as set out in the LHB’s Standing Orders are equally applicable to the operation of the Committee, except in the following areas : Quorum Notice of meetings Notifying the public of Meetings Admission of the public, the press and other observers
11. REVIEW 11.1 These terms of reference and operating arrangements shall be reviewed annually by the Committee with reference to the Board.
11 ABM University MAIN REPORT Health Board st Health Board 1 November 2012 Agenda No: 4 (i) D
Subject Key issues – Partnership Forum Prepared by Kim Clee, Assistant Workforce Manager Approved by Geraint Evans, Assistant Director of Workforce Presented by Geraint Evans, Assistant Director of Workforce
PURPOSE To set out the key issues considered by the Partnership Forum at its meetings on 26th July and 27th September 2012
KEY ISSUES
• Changing for the Better and the South Wales Plan. The Chief Executive and the Director of Clinical Strategy attended the meeting on 27th September, and gave a presentation on Changing for the Better and the South Wales plan, as part of the engagement process. The engagement process will include a series of staff and public meetings and road shows. Staff were encouraged to participate in the engagement events and give their views on the engagement document via the YouTellUs website.
• Financial Position The Partnership Forum received an update on the Health Board’s financial position. The Assistant Director of Finance reported that although there has been evidence of some operational savings the Health Board is still forecasting a large overspend at the end of the financial year. Further work is required to identify savings in order to allow the Health Board to reach a break even position.
• Nursing update The Partnership Forum was given an update on the Nursing position. It was reported that the Chief Operating Officer and the Director of Nursing had established regular meetings with Localities and Directorates to monitor plans regarding nurse staffing levels in acute wards. A Safer Nursing Care Tool is being piloted and a review of District Nursing caseloads is being undertaken. Within 1000 Lives, training is underway on “Recognising the Acutely Ill Patient” and a Pathway for Patients with Learning Disabilities has been introduced,
• Joint Statement At its meeting on 26th July the Partnership Forum agreed a joint statement which reinforced the importance of working together to protect the employment of substantive employees wherever possible, given the challenging time ahead. The statement was subsequently agreed and signed following the meeting.
______1 • Deployment Protocol The Partnership Forum was asked to agree a Deployment Protocol which had been developed with staff side to provide a robust mechanism for short term deployment of staff to meet the needs of the service. The protocol was agreed and will be monitored by the Partnership Forum to ensure consistency and fairness in its application.
• Corporate Health Standard update The Partnership Forum was given an update on progress in relation to the Corporate Health Standard and informed that a two day assessment visit was planned for 9th and 10th October.
• Staff survey update The Partnership Forum was informed that there were plans in place for an All Wales staff survey which it was expected would take place early in the New Year.
• Policy Update The Induction Policy and Violence and Aggression Policy, which had been fully consulted on, were presented for agreement prior to being submitted to the Executive Board for formal ratification.
RECOMMENDATION The Board is asked to note the report.
______2 Main Report Health Board Meeting
1st November 2012
AGENDA ITEM: 4 (I) E Subject Health Professional Forum Prepared by Steve Combe, Board Secretary Approved by Alan Stevenson, Chair Health Professional Forum Presented by Alan Stevenson, Chair Health Professional Forum
1 PURPOSE To update the Board on issues considered by the Health Professional Forum
2 KEY ISSUES FROM THE MEETINGS HELD IN AUGUST AND OCTOBER 2012
1. Membership The level of attendance at meetings of the Forum was a matter of concern and it was agreed that deputies be sought to attend meetings where Forum members were unable to attend. It was also agreed to further review the Terms of Reference of the Forum.
2. Changing for the Better Hamish Laing, Director of Clinical Strategy attended both meetingss to discuss Changing for the Better and the South Wales Programme.
The role of professional bodies at an All Wales and local level in engaging people in the need for change was discussed and a number of issues were raised regarding the engagement process.
It was agreed that this item be retained as a standing item on the agenda.
3. National Joint Professional Advisory Committee Alan Stevenson reported on the issues discussed at the last meeting of the National Joint Professional Advisory Committee. This included discussion on the stages of development of Health Professional Forums across Wales.
4. Working Arrangements The working arrangements for the Health Professional Forum were discussed and the possibility of holdig joint meetings with other professional groups within the Health Board is being considered.
The need for meeting arrangements to remain flexible to allow for consideration of Changing for the Better and the emerging Annual Plan for 2013/14 was agreed.
______Health Professional Forum 1 Health Board November 2012
5. Hot Topic The development of the Welsh Eye Care Initiative and the role community based optometrists were playing in being able to refer patients to secondary care and deal with follow up patients was discussed.
It was ageed this would be the subject of a further report at the next meeting
6. Preparing for Francis report It was agreed the Forum would consider this at the next meeting
3 RECOMMENDATION The Board is asked to note the foregoing.
______Health Professional Forum 2 Health Board November 2012
Main Report Health Board Meeting On 1ST NOVEMBER 2012 AGENDA ITEM: 4 (I) F Subject Key Issues – Pharmacy Applications Committee Presented by Steve Combe, Board Secretary
1 PURPOSE To update the Board on issues considered at the Pharmacy Applications Committee from its three meetings on 4th October and 6th December 2010 and 23rd May 2011. A further meeting of the Committee took place on 19th July which will be reported upon in due course, the next meeting is scheduled for October.
2 INTRODUCTION In order to provide speedier reporting to the Board on key issues considered by the Quality & Safety Committee it has been agreed that a summary & report on key deliberations of the Committee at its meetings be provided to the Board. The full minutes of the Committee meeting will be considered and are available on request from the Board Secretary.
3 KEY ISSUES 4th October 2010
Bridgend Locality • Application by Lloyds Pharmacy Ltd for a minor relocation from 106 Nolton Street Bridgend to Riversdale Surgery, Merthyr Mawr Road, Bridgend.
The Committee were satisfied that the application met the criteria necessary for it to be considered as a minor relocation as specified in Regulation 4 (3) (a) of the NHS (Pharmaceutical Services) Regulations 1992 as amended and therefore determined that the application be granted. However the Committee wished the applicant to confirm there would be no reduction in the opening hours of the pharmacy.
Neath Port Talbot Locality • Application by Lloyds Pharmacy Ltd for inclusion on the Pharmaceutical list at Unit 2, Neath View Retail Centre, Dwr Y Felin Road, Waunceirich Neath.
The Committee determined the application by Lloyds Pharmacy for a new pharmacy contract is refused as being neither necessary nor desirable in accordance with regulation 4(4) of the NHS Pharmaceutical Regulations 1992 as amended.
Swansea Locality • Application by Assura Pharmacy for Preliminary Consent for inclusion on the Pharmaceutical list at the proposed Primary Care Centre in the SA1 Development in Swansea application Received 27th August 2008.
The Committee determined the application by Assura Pharmacy Ltd for Preliminary Consent, be refused as neither necessary nor desirable in
1 accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
• Application by Ysgol Street Pharmacy for Preliminary Consent for inclusion on the Pharmaceutical list at the proposed Primary Care Centre in the SA1 development in Swansea. Application received 4th September 2008.
The Committee determined the application by Ysgol Street Pharmacy Ltd for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
• Application by National Co-op Chemists Ltd for a change of premises on the Pharmaceutical list from 160 Port Tennant Road, Swansea to the proposed Primary Care Centre in the SA1 development in Swansea. Application received 10th October 2008.
The Committee determined the application for a change of premises by National Co-op Chemists Ltd was approved as being desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations (as amended)
• Application by Lloyds Pharmacy Ltd for Preliminary Consent for inclusion on the Pharmaceutical List at the proposed Primary Care Centre in the SA1 development in Swansea. Application received 11th May 2009.
The application Lloyds Pharmacy Ltd for Preliminary Consent be refused as neither necessary nor desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
• Application by Mr. D.R Jones & Miss B. Patel for Preliminary Consent for inclusion on the Pharmaceutical List at the proposed Primary Care Centre in the SA1 development in Swansea. Application received 13th May 2009
The Committee determined the application by Mr. D.R Jones & Miss. B. Patel for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
• Application by Unicare Pharmacy Ltd for inclusion on the Pharmaceutical List at 80 Cwmbach Road, Fforestfach
The Committee determined the application by Unicare Pharmacy Ltd for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
• Application by Unicare Pharmacy Ltd for Preliminary Consent for inclusion on the Pharmaceutical List in the vicinity of Cockett
2 The Committee determined the application by Unicare Pharmacy Ltd for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
KEY ISSUES 6th December 2010
Neath Port Talbot Locality • Application by D.R Cecil Jones & son Ltd for a Minor relocation from 101 High Street, Glynneath to the proposed new Vale of Neath Primary Care Centre, Glynneath Application received 3rd July 2007
The Committee determined the application by DR Cecil Jones & son Ltd for a Minor Relocation is refused as it did not satisfy the criteria for a Minor Relocation in accordance with Regulation 4 (3) (a) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
• Application by D.R Cecil Jones & son Ltd for a Change of Premises on the Pharmaceutical List from 101 High Street, Glynneath to the proposed new Vale of Neath Primary Care Centre, Glynneath Application received 3rd July 2007
The Committee determined the application for a Change of Premises by DR Cecil Jones & son Ltd is approved as being desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations (as amended)
• Application by Mr. D.C Jenkins for Preliminary Consent for inclusion on the Pharmaceutical List at the proposed Vale of Neath Primary Care Centre. Application received 9th January 2008
The Committee determined the application by Mr. D.C Jenkins for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4(4) of the NHS Pharmaceutical Services regulations 1992 (as amended)
Swansea Locality • Application by National Co-op Chemists Ltd for Preliminary Consent for inclusion on the Pharmaceutical List in Victoria Road, Gowerton/Waunarlwydd. Application received 1st July 2010.
The Committee determined the application by National Co-op Chemists Ltd for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4(4) of the NHS Pharmaceutical Services regulations 1992 (as amended).
• Application by Mr. Gareth Harlow for Preliminary Consent for inclusion on the Pharmaceutical List in Victoria Road, Gowerton/Waunarlwydd. Application received 12th July 2010.
The Committee determined the application by Mr. Gareth Harlow for Preliminary Consent .be refused as neither necessary nor desirable in
3 accordance with Regulation 4(4) of the NHS Pharmaceutical Services regulations 1992 (as amended).
• Application by Unicare Pharmacy Ltd for Preliminary Consent for inclusion on the Pharmaceutical List in Victoria Road, Gowerton/Waunarlwydd. Application received 31st July 2010.
The Committee determined the application by Unicare Pharmacy Ltd for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4(4) of the NHS Pharmaceutical Services regulations 1992 (as amended).
• Application by Unicare Pharmacy Ltd for Preliminary Consent for inclusion on the Pharmaceutical List in the vicinity of Dunvant
The Committee determined the application by Unicare Pharmacy Ltd for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4(4) of the NHS Pharmaceutical Services regulations 1992 (as amended).
• Application by Acentric Pharmacy Ltd for Preliminary Consent for inclusion on the Pharmaceutical List at 13 Orchard Street, Swansea
The Committee determined the application by Acentric Pharmacy Ltd for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4(4) of the NHS Pharmaceutical Services regulations 1992 (as amended).
• Application by Unicare Pharmacy Ltd for Preliminary Consent for inclusion on the Pharmaceutical List in the vicinity of Penllergaer
The Committee determined the application by Unicare Pharmacy Ltd for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4(4) of the NHS Pharmaceutical Services regulations 1992 (as amended).
• Application by Unicare Pharmacy Ltd for Preliminary Consent for inclusion on the Pharmaceutical List in the vicinity of Llangyfelach
The Committee determined the application by Unicare Pharmacy Ltd for Preliminary Consent is refused as neither necessary nor desirable in accordance with Regulation 4(4) of the NHS Pharmaceutical Services regulations 1992 (as amended).
• Application by Lewis Chemists for a Minor relocation from 493 Brynhyfryd Road, Swansea to the proposed new Brynhyfryd Surgery
The Committee determined the application by Lewis Chemists for a Minor Relocation be approved (a) as it satisfied the criteria for a Minor Relocation in accordance with Regulation 4 (3) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
4 KEY ISSUES 23rd May 2011
Bridgend Locality • Determination of the controlled/non controlled area of Bettws
The Committee determined that the Local Authority ward of Bettws is determined as a controlled (rural) area with the exception of the village of Bettws which is determined as non controlled (urban) and the Local Authority Ward of Llangeinior is determined as controlled (rural)
KEY ISSUES 19th July 2012
Swansea Locality • Application by Rushport Pharmacy LLP for Preliminary Consent for inclusion on the Pharmaceutical list in the vicinity of Samlet Road & Nantyffin Road, Swansea
The Committee determined the application by Rushport Pharmacy LLP for preliminary consent, be refused as neither necessary nor desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
Neath Port Talbot Locality • Application by D.R Cecil Jones & son Ltd for a Change of Premises on the Pharmaceutical List from 101 High Street, Glynneath to the proposed new Vale of Neath Primary Care Centre, Glynneath
The Committee determined the renewal of the application by DR Cecil Jones & son Ltd for a change of premises is approved as being desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations (as amended)
• Application by Davies Chemists (Briton Ferry) Ltd for a Minor Relocation from 29 Hunter Street, Briton Ferry to the new Briton Ferry Healthcare Centre, The Quays, Briton Ferry
The Committee determined the application by Davies Chemists (Briton Ferry) Ltd for a minor relocation is refused as it did not satisfy the criteria for a minor relocation in accordance with Regulation 4 (3) (a) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
• Application by Davies Chemists (Briton Ferry) Ltd for a Change of Premises on the Pharmaceutical List from 29 Hunter Street, Briton Ferry to the new Briton Ferry Healthcare Centre, The Quays, Briton Ferry
The Committee determined the application by Davies Chemists (Briton Ferry) Ltd for a change of premises is approved as being desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations (as amended)
5 • Application by Lloyds Pharmacy for a Change of Premises on the Pharmaceutical List from 187 Western Avenue, Sandfields, Port Talbot to the new Briton Ferry Healthcare Centre, The Quays, Briton Ferry
The Committee determined the application by Lloyds Pharmacy for preliminary consent, be refused as neither necessary nor desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
• Application by Boots UK Ltd for Preliminary Consent for inclusion on the Pharmaceutical List the new Briton Ferry Healthcare Centre, The Quays, Briton Ferry
The Committee determined the application by Boots UK Ltd for preliminary consent, be refused as neither necessary nor desirable in accordance with Regulation 4 (4) of the NHS Pharmaceutical Services Regulations 1992 (as amended)
RECOMMENDATION
The Board is asked to note the summary of key issues
6 Main Report Health Board Meeting 1st November 2012
AGENDA ITEM: 4 (II) Subject Changes to Primary Care Contractors Arrangements
Prepared by Locality Heads of Primary Care & Planning
Approved by Alexandra Howells, Chief Operating Officer
1. Purpose To advise the Board of the changes to the principal and supplementary lists for independent contractors from August 2012 to September 2012.
2. Changes to Independent Contractor Services Lists The changes to the principal and supplementary lists for independent contractors are attached at Appendix 1.
The process used to include new performers in the LHB Lists is managed on behalf of every LHB in Wales by the Contractor Services Division of the NHS Wales Shared Services Partnership. Changes to the list as reported have been undertaken in accordance with regulations and the processes employed for the management of the Medical, Dental, Ophthalmic and Supplementary Ophthalmic Lists.
3. Recommendation The Board is asked to note the changes to the independent contractor service lists from August 2012 to September 2012.
Appendix 1
Medical - Aug 12 to Sep 12
Practice Type of Effective LHB Area Title Surname Forename(s) Address Application Date Locality
GP Registrar to ABMU Dr Afzal Mehnaz n/a Non principal 31/07/2012 Bridgend
Non principal ABMU Dr Afzal Mehnaz n/a resignation 28/08/2012 Bridgend
GP Registrar to ABMU Dr Conlon Fiona Veronica n/a Non principal 16/08/2012 Bridgend
New Non princiapl from ABMU Dr Edmunds Tania n/a Cardiff & Vale 02/08/2012 Bridgend
Non Principal/Locum ABMU Dr Egan Sheena Portway to Salaried GP 10/08/2012 Bridgend
Benjamin GP Registrar to ABMU Dr Frost Malcolm n/a Non principal 30/07/2012 Bridgend
New GP ABMU Dr Jones Ffion Elen New Surgery Registrar 22/08/2012 Bridgend
New Street New Contractor ABMU Dr Khan Noreen Mahpara Surgery Partner 17/08/2012 Bridgend
Melville- GP Registrar to ABMU Dr Jones Rebecca n/a Non principal 30/07/2012 Bridgend
GP Registrar to ABMU Dr Mullan James n/a Non principal 26/07/2012 Bridgend
Contractor Partner Death ABMU Dr Savage Catherine Woodlands in Service 26/08/2012 Bridgend
GP Registrar to Contractor ABMU Dr Simpson James Stuart Tyn-Y-Coed Partner 04/07/2012 Bridgend
Salaried GP to ABMU Dr Main Rebecca J N Alfred Street Salaried GP 02/07/2012 Bridgend / NPT
Salaried GP to Contractor Bridgend / ABMU Dr Venkatraman Vijay Sway Road Partner 01/09/2012 Swansea
GP Registrar to ABMU Dr Davies Alun Lloyd n/a Non principal 09/08/2012 NPT
GP Registrar to ABMU Dr Davies Kate Elizabeth n/a Non principal 08/08/2012 NPT
New GP ABMU Dr Hughes Suzanne Emily Dyfed Road Registrar 01/08/2012 NPT
Non Mohammad Principal/Locum ABMU Dr Islam Waliul Dulais Valley to Salaried GP 13/08/2012 NPT
New GP ABMU Dr Moss Sebastian T E Kings Surgery Registrar 01/08/2012 NPT Contractor Partner Llysmeddyg, Pension 28/09/2012 ABMU Dr Patel Yusuf A Sandfields Retirement and 30/9/12 NPT
GP Registrar to ABMU Dr Price Laura May n/a Non principal 06/08/2012 NPT
GP Registrar to ABMU Dr Rees Cathryn Ann n/a Non principal 30/07/2012 NPT
GP Registrar to ABMU Dr Sabtu Nursabrina n/a Non principal 30/07/2012 NPT
Non Principal GP to Salaried ABMU Dr Browne Veena Cymmer GP 01/08/2012 NPT/Bridgend Strawberry Place / Contractor Cwmfelin Partner to ABMU Dr Bamber Catherine Sarah Surgery Salaried 11/05/2012 Swansea
GP Registrar to ABMU Dr Bhatt Seema n/a Non principal 27/07/2012 Swansea
GP Registrar to ABMU Dr Chow Sally n/a Non principal 09/08/2012 Swansea
GP Registrar to ABMU Dr Duane Niamh n/a Non principal 30/07/2012 Swansea
GP Registrar to ABMU Dr El-Sharkawi Lamah n/a Non principal 25/07/2012 Swansea
GP Registrar to ABMU Dr Evans Timothy James n/a Non principal 31/07/2012 Swansea
Registrar ABMU Dr Fitchett Jason n/a resignation 31/07/2012 Swansea
New GP ABMU Dr Jha Nisha Clydach PCC Registrar 01/08/2012 Swansea
Non Principal GP to Salaried ABMU Dr Jones Sara Esyllt Sketty & Killay GP 23/07/2012 Swansea
GP Registrar to ABMU Dr Kerrigan James Michael n/a Non principal 25/07/2012 Swansea
Non Principal (resignation to ABMU Dr Pradeepan Baminee Ystradgynlais Powys) 17/08/2012 Swansea
Non Principal ABMU Dr Ratnalikar Geetanjali n/a GP Resignation 20/09/2012 Swansea
Ty'R Felin New GP ABMU Dr Reid Jessica Louise Surgery Registrar 28/08/2012 Swansea
GP Registrar ro ABMU Dr Richmond James Nathan Uplands Salaried GP 10/08/2012 Swansea
Non principal ABMU Dr Roberts Owain R L n/a resignation 12/08/2012 Swansea
Retainer GP to ABMU Dr Rolles Betsan Elin Fforestfach Locum 26/09/2012 Swansea
Salaried ABMU Dr Shanon Davina St Helens Resignation 29/06/2012 Swansea
Locum ABMU Dr Sharma Neeraj n/a resignation 13/09/2012 Swansea
Registrar to Locum/non ABMU Dr Siripurapu Suneetha n/a principal 12/09/2012 Swansea
Salaried GP to ABMU Dr Southall James St Helens Non Principal 21/07/2012 Swansea
GP Registrar to ABMU Dr Taneja Sonia n/a Non principal 26/07/2012 Swansea
GP Registrar to ABMU Dr Thornley Holly Frances n/a Non principal 25/07/2012 Swansea
Dental Aug 12 - Sept 12
Effective LHB and Locality Name Address Type of App Date ABM UHB (NPT) Kristian JM Davies DTU Resource Centre, Port Talbot Inclusion 01/08/2012 ABM UHB (NPT) Mathew Kurian Gardenside Dental Centre Inclusion 11/09/2012 ABM UHB (Swansea) Philemon Dordoe Cwmtawe DP, 36 High St Inclusion 01/08/2012 ABM UHB (Swansea) Fiona I Nobles St Teilo Dental Centre Inclusion 01/08/2012 ABM UHB (Swansea) Harveer Hyare Compton House Dental Practice Inclusion 01/08/2012 ABM UHB (Swansea) Danesh S Bagga Chapel St Dental Practice, Mumbles Inclusion 01/08/2012
Pharmaceutical Contractor Amendments August to September 2012
HB Effective Area Locality Applicant Address Type of App Decision Date
Neath Port Lloyds 187 Western Avenue, ABMU Talbot Pharmacy Sandfields Change of Premises Refused - no appeal n/a
Neath Port ABMU Talbot Boots UK Ltd The Quays, Briton Ferry Preliminary Consent Refused - no appeal n/a
*OL Ophthalmic Contractor *SOL Supplementary Assistant *CO Ophthalmic Body Corporate
MAIN REPORT ABM University Health Board Health Board Meeting On 1st November 2012
AGENDA ITEM: 4 (III)
Subject RATIFICATION OF CHAIRMAN’S ACTION
Prepared by Shân Morgan, Service Development Manager Approved by Paul Stauber, Director of Planning Presented by Paul Stauber, Director of Planning
1. Purpose This paper is to seek ratification where Chairman’s Action was sought and approved for urgent matters in accordance with Clause 2.1.1 of Section B of Standing Orders and to seek ratification of such approvals.
2. HVS Phase 1B Project, Morriston Hospital In late July the Health Board was advised that the Full Business Case for the project had been approved by the Welsh Government on the basis of a Works Cost of £38,434,909. Subsequent negotiations reduced the agreed cost to £37,532,555.
On the basis of this agreed target cost and with the approval of officers of Welsh Government a Project Managers Instruction was issued to the SCP for mobilisation activities e.g. site set up & trade package order placement and the contract was formally awarded to Bam Construction Ltd with a start and completion date of 3rd September 2012 – 12th September 2014.
3. Refurbishment of Neonatal Unit, Singleton Hospital Previously approval had been given to proceed with the enabling work and demolition phase of the refurbishment of the Neonatal Department at Singleton Hospital to a value of £500,000. In order to maintain the momentum of the project, ensure orders could be placed for items of plant with a long lead in time and obtain commitments on workforce levels approval was sought to extend the approval level to £900,000.
4. Approval In accordance with the Health Board’s Standing Orders – Reservation and Delegation of Powers (September 2009) Section 2.1.1, the Chairman, Chief Executive and two Non- Officer Members undertook Chairman’s Action which the Board is now asked to ratify. . 5. Recommendation The Board is asked to ratify Chairman’s Action in respect of this matter.
______1 Main Report Health Board Meeting On 1st November 2012
AGENDA ITEM: 4 (IV) Subject Affixing of the Common Seal Prepared by Steve Combe, Board Secretary Approved by Steve Combe, Board Secretary Presented by Steve Combe, Board Secretary
1. PURPOSE To report on documents to which the Common Seal has been affixed since the last meeting of the Health Board.
2. INTRODUCTION In line with Standing Orders a routine report on documents to which the Common Seal has been affixed is required.
3. REGISTER OF SEALINGS Attached at Appendix 1 are details taken from the Seal Register. All documents have been signed by the Chairman, or Vice Chairman, and an Executive Director/Board Secretary, in line with the requirements of Standing Orders.
4. RECOMMENDATION The Board is asked to note the foregoing.
1 Appendix 1
REGISTER OF SEALINGS Register Date Name of Document No Signed 894 29.08.12 Children’s Development Centre, Singleton Hospital 895 17.09.12 Phase 8 – New Low Secure Facility, Glanrhyd Hospital 896 25.09.12 Flying Start – Swansea Children’s Centre, Eppynt Road, Penlan 897 26.09.12 Hill House Hospital transfer to Gower College 898 10.10.12 Service Centre Development, Morriston Hospital 899 10.10.12 Children’s Development Centre, Singleton Hospital 900 10.10.12 Reshaping Mental Health Services. Phase 8 Low Secure Unit, Glanrhyd Hospital 901 10.10.12 Deed of Variation, 1st Floor Lease, 1 Talbot Gateway, Baglan 902 10.10.12 Lease of Coelbren Health Centre 903 12.10.12 Project Neonatal Unit, Singleton Hospital 904 12.10.12 Pathology Laboratory alterations, Princess of Wales Hospital
2