Powys CHC Annual Report
2017-2018
Annual Report, 2017 - 2018
Contents
Message from our Chair ...... 4
Our year at a glance ...... 6
About us ...... 9
Membership ...... 11
Our vision and national standards ...... 12
About our communities ...... 13
Welsh Government White Paper Consultation (June 2017): Services Fit for the Future ...... 15
Continuous engagement ...... 16
How we have made a difference: working locally ...... 18
How we have made a difference: working nationally ...... 27
Advocacy and enquiries ...... 30
Working with others ...... 34
Our plans for next year ...... 35
We are listening to you ...... 39
Appendix 1 - financial statement 2017/2018 ...... 40
Appendix 2 – executive members declarations of interest ...... 43
Appendix 3 – members of Powys CHC 2017/2018 ...... 45
Appendix 4 – External representation 2017/2018 ...... 47
Appendix 5 – Powys CHC staff (2017-2018) and contact details ...... 49
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Message from our Chair
I am particularly pleased to introduce this Annual Report especially as this has been a year of enormous challenge for the organisation. A challenge to which Powys Community Health Council (Powys CHC) has admirably risen. In the following pages you will find the activities Mrs Frances Hunt undertaken on behalf of the people of Powys in the Chair past twelve months. Shortly after I became Chair of Powys CHC - in June 2017 - Welsh Government published its White Paper consultation - “Services fit for the future”. This brought great uncertainty for CHC staff and members and immediately required the organisation to develop its own response as well as contributing to that put forward nationally by the Board of CHCs. Members and staff alike worked hard to engage with the public and other stakeholders to ensure that they too were able to make their contributions to the process. All of this took place whilst the “day job” - “business as usual” - was maintained. Throughout the year we have continued to work closely with a number of external NHS organisations in order to carry out our responsibilities - at all times maintaining our independence and accountability to the communities we serve. Several important consultations and engagements have taken place or commenced during the year. These have included “Fan Gorau - Mental Health Services for older people in North Powys”; the pre-consultation phase of “Future Fit” and the planning phase of Hywel Dda Health Board’s “Transforming Clinical Services”; “A Major Trauma Network for South and West Wales”; developments at Ystradgynlais Hospital and the “Future provision of Adult Thoracic Services in South Wales”. These, together with monitoring and responding to a large number of “short- term” changes in other parts of Wales and across the border in England, plus developing issues surrounding the Out of Hours service provided by Shropdoc, have been complex and required constant diligence and commitment from our small staff team and our volunteer members. Once again, I am proud to say that Powys CHC has worked tirelessly to ensure that the voices and views of patients across our county were enabled to be heard and taken into account.
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Throughout the year members have undertaken a series of visits to NHS premises and our independent Advocacy Service, an integral part of our core functions, has continued to provide support and assistance to users of NHS services across Powys. We also contributed to a number of national reviews undertaken by the Board of CHCs. I am delighted that over the last twelve months we have managed to recruit 4 volunteer members and have been joined by 4 new members nominated by Powys County Council. We continue to seek more members. Further details on how to apply to join us are given in Appendix 5 of this Report and I want to take this opportunity to encourage more people to consider putting themselves forward for this important role. We especially welcome applications from Welsh speakers, younger people and those from minority groups. As we look forward to the future and any changes resulting from the White Paper, we will build on our considerable strengths to enable the views of people in our communities to be taken into account and influence any developments that may take place. I am immensely proud of our members and staff. The way in which everyone has pulled together through this challenging period has been magnificent. I must thank them for their hard work and contribution throughout the year, and also for the support given to me - which has been truly appreciated.
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Our year at a glance
Engagement
We gathered people’s views and experiences on the things that local people told us mattered most. We used what people told us to inform our monitoring and scrutiny of NHS services and to inform the planning of our work programme.
Scrutiny
We attended NHS meetings at all levels, feeding in people’s views and representing the interests of the patients and public.
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Patient experience
We heard from a number of people about their NHS care and we did this by: • visiting 29 services to hear from people whilst they were receiving care • using surveys, face to face meetings and stands in community settings to hear from the broadest range of people • working with other Community Health Councils across Wales, Powys Teaching Health Board (PTHB) and community groups to hear from people about their experiences of NHS services and gather their views about how services should be provided in future.
Advocacy
Powys CHC’s Independent Complaints Advocacy Service: • Gave information to 108 people, signposting to other services or supporting people to resolve issues informally • Opened 83 new cases to support people to raise formal concerns through the NHS Concerns Procedure known as Putting Things Right (PTR) • Supported 104 people who had raised their concerns during the previous year through the NHS Concerns Procedure • Closed 102 cases once the concern had been resolved or the process ended • Supported 40 complainants to take their formal concerns to either the Public Services Ombudsman for Wales or the Parliamentary and Health Service Ombudsman (England).
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National themes
We heard from Powys residents about issues that are common through the NHS in Wales or cross-border in NHS England (where the care was commissioned by PTHB) and used this to drive national policy.
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About us
‘What we do’ Powys CHC is the independent watchdog of NHS services provided for people living in Powys. We monitor NHS services in Wales and in England. We encourage and support people to have a voice in the design and delivery of NHS services. Powys CHC seeks to work with the NHS and inspection and regulatory bodies. We provide an important link between those who plan and deliver NHS service, those who inspect and regulate it, and those who use it. Powys CHC hears from the public in many different ways. We visit NHS services to talk to patients and carers. We talk to people at events, and through community groups. We use surveys, apps and social media. Our Advocacy Service helps people who want to raise a concern about NHS care or treatment. Our four main functions can be described as:
Systematically Continuously visiting and engaging with scrutinising local the communities health services; we represent and the health service providers serving those communities;
Enabling users of the NHS to raise concerns Representing the about the interests of patients services they and the public in receive through the planning and an independent agreement of NHS complaints service developments advocacy service. and changes;
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Membership
Our membership At 31 March 2018, Powys CHC had 22 members: • 5 appointed through a public appointments process • 5 nominated by the 3rd sector • 6 nominated by the local authority • 6 co-opted members recruited directly from local communities. Our members are all local people who give their time for free. If you are interested in becoming a member contact us by using the details at the back of our report (Appendix 5).
Our governance The way in which we organise ourselves to carry out our activities is set out in regulations passed by the National Assembly for Wales. The activities we carry out are co- ordinated and overseen by two Local Committees (Montgomeryshire and Radnorshire& Brecknock). These Local Powys CHC Committees make up our Full Council. We also have an Executive Committee which is ultimately responsible for what we do and how we do it. In addition, Powys CHC holds regular Services Planning Committees which are also attended by PTHB’s Director of Planning and Performance. It is the responsibility of this committee to consider the planning and development of, proposals for and changes to, the delivery of health services within the district of Powys CHC. This includes services which are commissioned by PTHB from NHS service providers in both Wales and England. The Chair and Chief Officer of Powys CHC and the Chair and Chief Executive of the PTHB meet every 6 weeks.
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Our vision and national standards
Our vision People in Powys know that they can share their views of the NHS easily and recognise that doing so can have a real influence on the shape of healthcare services. People understand and value the role played by Powys CHC in supporting them to be heard and in representing the collective interests of patients and the public.
Our national standards 1. CHCs act in the interests of the public and patients across Wales 2. CHCs work effectively with others to safeguard and promote the welfare of people who use NHS services 3. CHC activities and services meet the needs of and are accessible to all 4. CHC activities are open, transparent and inclusive 5. CHC activities are properly led, resourced and supported 6. CHCs plan and carry out their activities in a way that maintains their independence and demonstrates their accountability to the communities they serve 7. CHCs strengthen the voice of patients and the public by working together and with others 8. CHCs reflect the views and experiences of patients and the public about NHS services 9. CHCs share the results of their activities in a balanced and timely way 10. CHCs evaluate the impact of their actions and apply the learning to future activities.
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About our communities
The area that we serve Powys is one of the most rural counties in the UK. It covers a quarter of the landmass of Wales but has a population of less than 5% of the whole population of Wales. The Public Health Wales Observatory notes:
Total population 132,700
Population aged 75 and over (%) 11.4
Life expectancy at birth – males 80.2 years
Life expectancy at birth – females 83.6 years
The population of children and young people in Powys is predicted to decrease within the next ten years, mainly due to an on-going trend for young people to leave the county in favour of more urban areas, as well as the reduced birth rate across Powys. However, the number of those aged over 65 and 85 will rise faster in Powys compared with Wales. The 65+ age group in Powys is projected to increase by 37% by 2033 and the 85+ population is estimated to increase by 121% over the same time period in Powys. (Source: Powys Teaching Health Board Annual Report 2017/18). The geography and rurality of the area means that health and care services are more fragile and access can be more difficult. Travelling around Powys can be difficult. Powys has only one short section of dual-carriageway which forms the Brecon by-pass. Otherwise the county is served by trunk roads, A-class roads, B-class roads and many unclassified roads. Public transport is relatively limited. There are two railway lines – the Heart of Wales line which operates between Shrewsbury and Swansea (stopping at Knighton, Llandrindod Wells, Builth Road and Llanwrtyd Wells in Powys) and the Cambrian line which operates between Shrewsbury and Aberystwyth (stopping at Welshpool, Newtown, Caersws and Machynlleth in Powys). The health services in Powys are provided by and commissioned by
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PTHB. It commissions services on behalf of the Powys population from a wide range of providers, including primary care contractors (GPs, Dentists, Pharmacists and Optometrists), independent sector care homes and ambulance services. There is no district general hospital in Powys so the PTHB commissions those services and specialist health services from Health Boards and NHS trusts in Wales and in England including Shrewsbury and Telford Hospital NHS Trust, Aneurin Bevan UHB, Wye Valley NHS Trust, Abertawe Bro Morgannwg UHB, Robert Jones and Agnes Hunt Orthopaedic Hospital, Hywel Dda UHB, Betsi Cadwaladr UHB, Gloucestershire Hospitals NHS Foundation Trust, Cardiff and Vale UHB and Cwm Taf UHB. PTHB also directly provides healthcare services across Powys, including 9 community hospitals, a health and social care centre, district nursing services, midwifery and health visiting, therapies, mental health and services for people with a learning disability. PTHB is increasing the range of consultant, nurse and therapy led outpatient sessions, day theatre and diagnostics available in its community facilities, bringing care out of the acute hospital setting and closer to home. Increasingly, services are jointly provided by PTHB and Powys County Council.
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Welsh Government White Paper Consultation (June 2017): Services Fit for the Future
In June 2017, the Welsh Government launched its White Paper Consultation: Services Fit for the Future – Quality and Governance in Health and Care in Wales. This Paper proposed changes to a number of services and roles within NHS organisations, regulatory bodies (Healthcare Inspectorate Wales and Care & Social Services Inspectorate Wales) and Community Health Councils. In respect of Community Health Councils, the proposal was to replace the current councils with a new independent Citizen Voice body that can represent the voice of the citizen across both health and social care services. Importantly, the consultation gave CHCs the opportunity to work together, with a common position, and to draw up some outline proposals for a new people’s voice body which provides a strong framework on which to base future arrangements in Wales. CHCs agreed that, whatever a new organisation looked like, it should have the strength of statutory powers, be independent and truly be able to carry the voice of the citizen forward in regards to both health and social care. During the consultation period for the White Paper, Powys CHC undertook extensive engagement with members of the public at a number of events over the summer period. Powys CHC used this opportunity to signpost people to the Welsh Government consultation document, to encourage responses to it and to raise the profile of the Powys CHC. Powys CHC staff and members also engaged with people in their own local communities, local councillors, Assembly Members and local MPs. Powys CHC was delighted with the overwhelming support it received and it was pleased to note the number of responses which were made to Welsh Government.
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Continuous engagement
Patient and public engagement: working with CHCs across Wales CHCs have a responsibility to represent the interests of patients and the public within the geographical areas they serve. Often, the priorities identified by patients and the public will be local to a particular CHC area or even to a specific hospital or service. There will, however, always be themes and priorities that are common to CHCs across Wales. When this happens, CHCs work together to ensure that the views and experience of patients and the public are reflected both locally and nationally; providing a strong patient voice to influence the development of national policy and local delivery.
Our national reports are available on our website: www.communityhealthcouncils.org.uk
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How we have made a difference: working locally
One of the key priorities of the Chief Officer for 2017/18 was to review the governance arrangements for all Powys CHC’s committees, to ensure that there was not duplication of work, to make best use of the time given to the CHC by our volunteer members and to make sure that the focus of everything that Powys CHC does is the individuals and communities of Powys and making a difference. A review was also carried out of the policies, procedures and documentation for the Advocacy Service and for the Monitoring and Scrutiny activity.
Scrutiny and engagement: local priorities During 2017/2018 we set local priorities. We looked at the issues that people told us were most important to them and responded to concerns raised through our activities and those of others.
Scrutiny Powys CHC has continued to monitor and scrutinise the performance of PTHB and other providers of health services that are available to Powys residents. We do this by receiving presentations from healthcare providers at Powys CHC meetings and by attendance at many Boards and Committees (see Appendix 5 for an example of the meetings attended). When Shropdoc, the provider of the out-of-hours GP services, was facing some significant challenges in 2017, the CHC worked closely with PTHB to assure patients that the priority was to ensure people had continued access to a safe and sustainable service. PTHB established a Programme Board and Powys CHC has observer status on this Board. Powys CHC has received (and continues to receive) regular updates on developments.
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Monitoring Visits Over the past year our members have conducted 43 visits to 29 different services. These included community hospital wards, minor injuries units, GP surgeries, renal dialysis units, emergency departments at Royal Shrewsbury Hospital, Princess Royal Hospital, Wrexham Maelor Hospital, Nevill Hall Hospital and Bronglais Hospital, the oncology unit at Cheltenham General Hospital and the radiotherapy unit at Hereford County Hospital. Most of the visits conducted were announced visits. The visits to GP surgeries also include a patient survey which is distributed in advance of the visit. The majority of visits have found patients to be complimentary about staff delivering care. Powys CHC members were impressed with the state of the art equipment in use at the renal dialysis units and were pleased to see that Powys patients were benefitting from such a high standard of services provided within the county. The visits to the Oncology Department at Cheltenham General Hospital and the Radiotherapy Centre at Hereford were enlightening. Again, members were impressed by the facilities and services provided. Following each visit, the Powys CHC produces a report which includes an action plan with recommendations. The action plans are used by the service provider to list what action they will take and Powys CHC then uses this information to follow up and check that actions have been completed.
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Some examples of Powys CHC recommendations and the action taken are: • After receiving a report that the automatic main entrance door at Llandrindod Wells Hospital did not allow enough time for a patient with a walking aid to get through it, PTHB arranged for the timer to be adjusted so that the door stays open for longer. • Powys CHC conducted a follow-up visit to the Centre for Long Term Conditions Management at Bronllys Hospital in November 2017, in order to check on progress made on recommendations from the previous visit. At that time, members noted that access was unacceptable for people with disabilities. They also felt that the residential accommodation was poor and they recommended that remedial work was required (both internally and externally), that kitchens and bathrooms should be refurbished to bring them up to required standards and that a routine programme of minor maintenance and generally tidying was required. • At the follow-up visit, members were pleased to note that there was improved signage and that the heating system had been replaced. It was reported that the pain and fatigue management residential programme was now being held at a central hotel in the Brecon. Members considered that this was an improvement for patients as the hotel is in the centre of a busy market town with lots of facilities for patients to use in relation to the programme and there are improved opportunities for community interaction. • Powys CHC made further recommendations about access for people with disabilities and subsequently PTHB has put forward a plan of action for reconfiguration of the Centre in Bronllys.
Engagement For the first time, during the summer of 2017, Powys CHC made use of the distinctive ‘purple tent’ and took it to four local shows around the county. We attended Brecon County Show, Guilsfield Show, Berriew Show and Sennybridge Show. We used the opportunity to tell people about the work of Powys CHC, to gather people’s views about NHS services, to talk to people about becoming Powys CHC members and also to raise awareness of the Welsh Government White Paper consultation.
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• The events proved to be a positive experience for both staff and members alike. • Overall members of the public gave positive feedback of their experience of NHS services. • The concerns expressed by members of the public related mainly to difficulty obtaining GP appointments, waiting times, lack of mental health services and lack of dentists. • A number of people expressed an interest in becoming a member of Powys CHC and one person was later co-opted as a member. • A significant number of people were interested in the White Paper consultation and stated that they would be submitting a response.
Nadine Johnson, Powys CHC and members of the public talking to CHC staff and members on a very wet day at Brecon Show, August 2017
Representatives of Powys CHC attended the three day workshops organised by PTHB and Powys County Council in order to develop the Health and Care Strategy for Powys. The priorities of the Health and Care Strategy will be incorporated into Powys CHC’s Operational Plan for 2018-2019. During this year, Powys CHC has increased its use of social media. We have a member of staff who is regularly posting on Facebook and on Twitter.
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Service Change In line with its statutory duties, Powys CHC continued to ensure that Health Boards and Trusts engaged appropriately with patients and the public who may be affected by changes to services. There were a number of significant service changes that Powys CHC was involved in during the year and they include: • Fan Gorau Inpatient Assessment Unit in Newtown In June 2016, PTHB took the decision to temporarily close the unit due to safety concerns arising from the inability to maintain safe 24-hour staffing. A Dementia Home Treatment Team was established in North Powys to provide home-based support for people with dementia, along with a ‘crisis bed’. Between February 2017 and July 2017, Powys CHC worked closely with PTHB to ensure that an extensive engagement and consultation exercise took place with patients and the public. There was support for the new model of care and this resulted in a service change from a single location based model to a community /home based model - the Dementia Home Treatment Team became permanent resulting in more people being able/ supported to remain at home or close to home for longer.
• Closure of Coelbren Branch Surgery of Dulais Valley Primary Care Centre Powys CHC liaised with PTHB and Abertawe Bro Morgannwg UHB (ABMUHB) when Dulais Valley Primary Care Centre applied to close its branch surgery in Coelbren. The CHC was involved in the engagement process with the patients in Powys who were affected by this proposed closure. Unfortunately, the branch closed on 30 April 2017. A community transport service was introduced for patients who would otherwise have difficulty travelling to the surgery at Seven Sisters; this was funded by ABUHB.
• NHS Future Fit Programme NHS Future Fit is about improving the hospital services provided at the Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford to meet the needs of the communities across Shropshire, Telford & Wrekin and mid Wales.
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The proposal is for one hospital to become an Emergency Care site and the other hospital to become a Planned Care site, with a 24-hour Urgent Care Centre at both hospitals. Throughout the year, Powys CHC worked closely with the Future Fit Engagement Team, PTHB, Powys County Council and Powys Association of Voluntary Organisations (PAVO) to undertake a number of pre-consultation engagement events and to develop the plan for an extensive consultation exercise once agreement was given for the consultation to go ahead. Powys CHC is an observer representative on the Future Fit Programme Board and the Joint Committee and has also taken part in the Integrated Impact Assessment workshops and events. Although the proposals relate to hospital services in England, the NHS Trusts must adhere to the Welsh Regulations and the Welsh Government Guidance on Engagement and Consultation because the services are used by Welsh residents. Powys CHC’s role is to ensure that this happens.
• Hywel Dda University Health Board ‘Transforming Clinical Services’ Powys CHC worked with PTHB to ensure that the voice of Powys patients was sought, listened to and represented in relation to the plans which Hywel Dda UHB is developing. A public and stakeholder event was held in Machynlleth on 13 September 2017. Powys CHC members have attended a number of other events in Powys relating to this proposed service change.
• Major Trauma Network for South and West Wales and South Powys The proposals to develop a major trauma network for South and West Wales and South Powys went to public consultation in November 2017. Powys CHC worked with PTHB to provide the opportunity for the patients and public in Powys to share their views and included these in its response.
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• Proposals for Improvements to Thoracic Surgery Services in South Wales Following a recommendation from the Royal College of Surgeons that there should be one site rather than two for specialist thoracic surgery, the Welsh Health Specialised Services Committee (WHSSC) undertook a period of stakeholder engagement. Powys CHC worked with the PTHB to give patients and the public in Powys the opportunity to share their views.
Short Term Service Changes There were a number of short term service changes which affected Powys residents. They include: • In February 2017, Shrewsbury & Telford Hospital NHS Trust had to suspend new referrals for non-specialised ophthalmology, adult squint surgery and glaucoma. Powys Teaching Health Board worked with The Practice Group, which is an experienced provider of NHS ophthalmology services, to provide a community clinic in Welshpool. Where a specialist referral is needed, they are made to an alternative district general hospital whilst the services are not available at Shrewsbury. This temporary measure remained in place until 31 March 2018. Powys CHC continues to monitor the situation.
• In March 2017, Shrewsbury & Telford Hospital NHS Trust had to suspend new referrals to neurology because pressures on the service and workforce challenges meant that they were not able to meet demand. PTHB put alternative services in place at New Cross Hospital, through the Royal Wolverhampton Hospital NHS Trust. The alternative services remained in place until 31 March 2018 and Powys CHC continues to monitor this.
• From 1 September 2017, temporary changes came into effect for Paediatric, Maternity and Neonatal services at Nevill Hall Hospital. Some patients were re-directed to Royal Gwent Hospital. Powys CHC continues to monitor this situation.
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• In January 2018, Powys CHC became aware of a proposal by Abertawe Bro Morgannwg UHB (ABMUHB)to withdraw some outpatient services at Ystradgynlais Community Hospital. Powys CHC raised concerns with PTHB that there had been no engagement or consultation with Powys residents. PTHB continues to work with ABMUHB to re-establish services and to clarify the pathway for patients.
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How we have made a difference: working nationally
Non-emergency patient transport In February the Board of Community Health Councils in Wales published a report highlighting the improvements the NHS needed to make in the provision of non-emergency patient transport across Wales. Drawing on patient stories from each of the 7 CHCs in Wales, the report recognised the actions being taken by NHS organisations to improve its non-emergency patient transport services, but identified that there was much more to do. In particular the report concluded that: • arrangements were confusing and letting some people down • Transport arrangements needed to keep pace with changes in the NHS as more care is delivered out of hospital and out of area - transport arrangements need to reflect these changes • A clearer framework was needed so that people in vulnerable situations who need transport for non-medical reasons are treated equitably across Wales • Staff and patients needed clear information about what is available and how to access it - so that nobody slips through the net.
Nationally, both Welsh Government and Welsh Ambulance Services NHS Trust (WAST) agreed with the findings in our report and have advised us that improvements will be taken forward by the Non-Emergency Patient Transport Service (NEPTS) Delivery Assurance Group and WAST.
Our lives on hold: impact of NHS waiting times on patients’ quality of life Between December 17 and March 18 CHCs across Wales asked people to share their experience of waiting extended periods for NHS treatment. The report published in April shares a range of patient stories and highlights the many ways in which waiting for treatment can impact on people’s lives.
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The report set out our expectation that NHS bodies: • Communicate regularly and effectively with people who are waiting for treatment • Make sure people waiting for treatment know who to contact if they have concerns or need support managing their condition.
The report challenged the Welsh Government to take action nationally to reduce long waits. The Welsh Government told us how important it was to use the patient stories to learn lessons and drive improvement. They also told us they were providing more money to help tackle the issue across Wales.
A&E All CHCs visited A&E departments across Wales on the same weekend at the end of January to ask people about their experience. People told us that waiting long periods was harder because of environmental factors such as hard uncomfortable chairs. We also heard about lack of privacy particularly at reception areas and whilst being treated in corridors. In some places people had no access to refreshments and this was a particular concern for those with diabetes. Welsh government have responded by committing to increasing their scrutiny of health board performance on waiting times in A&E. Powys CHC visited the A&E Department at Royal Shrewsbury Hospital (RSH) as this is the nearest A&E unit for residents in north east Powys. Members noted that the patients present at the time of the visit expressed an overall high level of satisfaction with the service. However, concerns were highlighted around privacy levels when patients were in corridor areas.
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GP out of hours During the last part of 2017-2018 the challenges in out of hours (OOH) provision increased. We responded to the issues impacting across Wales by carrying out a short desk top review. We found that all health boards had identified the fragility of OOH services and had put in place a range of mitigating actions that had made little difference and in some cases had the potential to impact negatively on other services. We asked health boards to work together to ensure a Wales wide approach to developing services to ensure that actions taken to improve the sustainability of OOH do not have a negative impact on other areas or other services.
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Advocacy and enquiries
In April 2013 the NHS Wales and NHS Commissioning Board England agreed a Protocol for Cross-border Healthcare Services to ensure smooth and efficient delivery of NHS services for the residents on either side of the Wales / England border.
Powys patients also access health services from: -
Cheshire North Wales
Telford & Wrekin
Powys Shropshire
Ceredigion
Herefordshire
South Wales
Powys CHC provides independent complaints advocacy support and advice for anyone living in their area who wants help to raise a concern about NHS services whether provided in Powys or in the acute general hospitals outside of Powys.
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During 2017/18 we assisted 100 people to resolve concerns by offering initial advice, signposting or supporting people to resolve issues informally. We also offered support and advice throughout the NHS Concerns Procedure known as Putting Things Right (PTR). We opened 83 new cases offering this support. Every concern is different and people wanted and needed different levels of support to take their concern forward. We helped by explaining the concerns process and helping people to think about what they wanted and expected to happen as a result of raising their concern. We provided practical support to those who wanted it, including helping people write letters, going with them to meetings, helping people understand the information and response provided by NHS organisations. Advocacy is an integral part of Powys CHC’s core functions. Our case work provides important information about NHS services and issues and we used this to inform our other activities. Our clients are always at the very heart of our service. As a result of concerns raised by clients, changes are often made which have a wider benefit.
What we have achieved: • As the result of complaints/concerns we have been instrumental in governance and clinical practice changes as well as staff training. • communication improvements • treatment/second opinion for treatment • an apology to the complainant from the NHS provider • an explanation as to why the event occurred • reduced incidence of similar issues arising again • improved patient safety • better experience for people wishing to raise a concern • reduced the number of concerns that are escalated
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Cross-border issues with NHS England We have supported over 40 people who have received treatment and care from an acute general hospital outside Powys to raise formal concerns through the NHS concerns process. These acute general hospitals were located in: • South Wales • Shropshire • Telford and Wrekin • Herefordshire.
At the end of the complaints procedure we provide the complainant with our Complaints Advocacy Service User Satisfaction Survey.
Comments that we have received include:
“As a family we were “I was completely completely unaware that happy with their the Advocacy Service was service. The available. The Health Board Advocate was very gave us the contact details sympathetic and for Powys Advocacy Service helpful” who provided us with excellent support”
“My concerns were “Fantastic service. met with complete I was accompanied professionalism. The to each meeting by Advocate was very a very dedicated knowledgeable, kind and Advocate” approachable. I was put at complete ease. Thank you” “Thank you for your help, it was very much appreciated”
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Working with others
Healthcare Inspectorate Wales (HIW) We meet with HIW on a regular basis to share information and inform our work programme. During the year there were two occasions when Powys CHC raised specific clinical concerns with HIW.
Third Sector We continue to strengthen our relationships with the voluntary sector in Powys including Powys Association of Voluntary Organisations (PAVO) attending events, workshops and meetings to raise the profile of Powys CHC and to encourage community groups to become more involved with Powys CHC.
Healthwatch We met on a regular basis with Healthwatch Shropshire, Healthwatch Telford & Wrekin and Shrewsbury & Telford Hospital NHS Trust in order to keep updated and informed about hospital services in Shropshire and Telford & Wrekin.
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Our plans for next year
In order to make our vision a reality the CHC movement in Wales agreed a strategic framework incorporating five key priorities for a three year period. These priorities underpin all our planned activities for 2018-2019. They are:
• Making every voice count; • Improving our influence and reputation; • Building and developing an effective learning and values based culture; • Valuing our members and staff; and • Strengthening our national voice.
In deciding Powys CHC’s activities for 2018-2019 we asked people to tell us what mattered most to them about NHS services in Powys. We did this by speaking to people directly at a range of local events, via social media and through our website. Powys CHC is keen to align its priorities for 2018-2019 with a number of key strategic documents including: • Welsh Government White Paper: Services Fit for the Future • Powys Health and Care Strategy • Powys Joint Area Plan • Mid Wales Joint Committee for Health & Social Care • Powys County Council – Vision for 2025 • PTHB – Intermediate and Medium Term Plan (IMTP).
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During 2018-2019 we will focus specifically on working with partners to hear about:
• Young people’s and children’s experience of NHS services in Powys • Accessibility of health services relating to cancer, circulatory diseases, respiratory diseases and mental health problems (Powys Health and Care Strategy) • Health services for people with dementia • Accessibility and provision of health services by the homeless, gypsy traveller communities, those who experience domestic violence/abuse • Availability of overnight family accommodation given the significant range of services commissioned outside of Powys.
Our local themes and priorities During 2018-2019 we will deliver a programme of engagement and scrutiny activity in support of the following local priorities:
• Monitoring of waiting times, to include: Cancer services, renal dialysis, ophthalmology, orthopaedics, cardiology, paediatrics. To include monitoring the site of availability as well as waiting times. • Non-emergency Patient Transport Services (NEPTS) The Board of CHCs has recently undertaken and published a review of NEPTS. Powys CHC will undertake a follow-up review and align this priority to the availability of Family Accommodation review. • Enhanced GP services including wound care and phlebotomy Map provision of enhanced services to identify any recent changes or potential gaps. Use the information to target patient engagement at specific clinics and within specific geographical communities. • Children and young people Speak to Powys youth forum and other youth and community groups to help scope activity.
36 Annual Report, 2017 - 2018
• Discharge Review outcome of, and health board response to 2017-2018 activity; monitor health board activity or engaging directly with people as appropriate. • Dementia Seek feedback from patients (and those who care for them) about them on NHS services for people with dementia including those delivered in care homes • Child & Adolescent Mental Health Service (CAMHS) Scrutiny via the Mental Health and Learning Disability committee including seeking information and assurance on timely access to treatment and the number of people receiving out of area care. • Older people in hospital Engage with people in hospital across the health board to identify if and where lessons have been learnt following the national report on boredom and isolation in community hospitals. • Adult Mental Health Scrutiny via the Mental Health and Learning Disability committee including seeking information and assurance on actions taken to reduce waiting times for access to community services. • Maternity Services Visits to baby clinics across Powys to hear from recent parents about their experience of maternity services.
We will continue to routinely scrutinise the performance of PTHB by attending and representing the interests of patients and the public. We will seek regular reports and representation from PTHB and other NHS organisations at our Local Committee and Executive Committee meetings on issues, challenges and developments impacting on NHS services in Powys.
37 Powys CHC
Our Advocacy Service During 2018-2019 we will develop our service further by:
• Increasing our outreach activities • Implementing our Communication and Marketing Strategy • Capturing Patient Experiences
Working with Other CHCs During 2018-2019 we will be working with CHCs across Wales to look at issues impacting on people wherever in Wales they live including: • Out of hours GP services • Sustainability of GP practices • Information and communication • Delayed transfer of care.
Link to Operational Plan Powys CHC Operational Plan 2018-19 CIC Powys Cynllun Gweithredol 2018-19
38 Annual Report, 2017 - 2018
We are listening to you
Your experiences You can help us by telling us about your experiences of the NHS; we want to hear your views on the services in your area. You can share your views and experiences with us in any of the following ways: • By telephoning one of our offices • By writing to us • By e-mail • By visiting our website • Via Twitter • Via Facebook.
We often seek views on particular aspects of health services through on- line surveys accessed through our website.
Keeping you informed We hold our Full Council and Local Committee meetings in public and we offer the opportunity for members of the public to ask questions at these meetings. You can find out when we are next meeting on our website. Our website also contains more information about our activities. If you would like to come and see us to discuss our activities or to share your views and experiences please let us know.
Becoming a CHC member If you are interested in becoming a member of the CHC, please get in touch with us. Our contact details can be found later in this report (Appendix 5).
39 Powys CHC
Appendix 1 Financial Statement
The financial statement recording the budget and expenditure for the period 1st April 2017 to 31st March 2018 is set out below. The information below relates to the core funding provided by Welsh Government, through the Board of Community Health Councils for the performance of the Council’s functions including the provision of the Complaints Advocacy Service. Powys CHC is able to report an underspend of £14 at the end of the financial year 2017-18.
Fixed costs
Budget Expenditure Variance
Staff costs £168,793.00 £162,203.00 £6,590.00
Office expenses £4,882.00 £4,677.00 £205.00
Accommodation £34,560.00 £34,500.00 £60.00
Total (fixed) £208,235.00 £201,380.00 £6,855.00
Variable costs
Budget Expenditure Variance
Travel costs £13,000.00 £17,290.00 £-4,290.00
Office expenses £8,180.00 £11,602.00 £-3,422.00
Total (variable) £21,180.00 £28,892.00 £-7,712.00
Total £229,415.00 £230,272.00 £-857.00 (fixed and variable)
40 Annual Report, 2017 - 2018
Complaints advocacy costs
Budget Expenditure Variance
Staff costs, travel & £98,057.00 £103,886.00 £-5,829.00 subsistence
Office expenses £2,760.00 £2,760.00 £0 Total complaints £100,817.00 £106,646.00 £-5,829.00 advocacy costs
Total costs £330,232.00 £336,918.00 £-6,686.00
Budget adjustment £6,700.00 £6,700.00 from CHC Board
Total £336,932.00 £336,918.00 £14.00
41 Powys CHC
42 Annual Report, 2017 - 2018
Appendix 2 Executive members declarations of interest
Executive Committee members’ directorships of companies or positions in other organisations likely, or possibly, seeking to do business with the NHS are published in the Council’s Annual Report to Welsh Ministers required under Regulation 25 of the CHC Regulations 2015.
Position held Other Positions Name Directorships in CHC held
Administrator Agnes Evans Trust Member of RCGP Wales Patient Group Member of Llanfyllin Patient Mrs Frances Participation Chair, Powys CHC None declared Hunt Group First Responder (WAST) Secretary of St Dogfan’s Church Tanat Valley Mission Area Secretary Mr Geoffrey Vice Chair, Powys CHC None declared None declared Greaves Chair of Montgomeryshire Cllr David Jones None declared None declared Local Committee Until October 2017
43 Powys CHC
Chair of Montgomeryshire Local Committee Elected October 2017 Mr. Carl Strack None declared None declared Vice Chair of Montgomeryshire Local Committee Until October 2017
Member of Caersws Community Vice Chair of Council Dr David Montgomeryshire Secretary of None declared Collington Local Committee Montgomery Elected October 2017 County Music Festival Treasurer of Mid Wales Arts Centre Chair of Radnorshire & Brecknock Local Committee Until November 2017 Mr Geoffrey Vice Chair of None declared None declared Davies Radnorshire & Brecknock Local Committee Elected November 2017 Chair of Board Chair of Radnorshire Bronllys Well & Brecknock Local Being Park (CLT) Mrs Jacqueline Committee None declared Ltd Wilding Elected November Town Councillor, 2017 Talgarth Town Council Vice Chair of Radnorshire & Mrs Barbara Brecknock Local None declared None declared Whitticase Committee Until November 2017
Katie Blackburn Chief Officer None declared None declared
44 Annual Report, 2017 - 2018
Appendix 3 Members of Powys CHC 2017/2018
(*Membership ended during the year)
Name Position held in CHC Locality
Radnorshire & Geoffrey Davies Public Appointment Brecknock
Frances Hunt Public Appointment Montgomeryshire
Carl Strack Public Appointment Montgomeryshire
Radnorshire & Barbara Whitticase Public Appointment Brecknock
Radnorshire & Jacqueline Wilding Public Appointment Brecknock
Radnorshire & Cllr Jackie Charlton Local Authority Brecknock
Cllr James Radnorshire & Local Authority Gibson-Watt* Brecknock
Cllr Peter Harris* Local Authority Montgomeryshire
Cllr Heulwen Hulme Local Authority Montgomeryshire
Cllr David Jones Local Authority Montgomeryshire
Radnorshire & Cllr Peter Roberts Local Authority Brecknock
Radnorshire & Cllr Huw Williams Local Authority Brecknock
Graham Bath Third Sector Montgomeryshire
45 Powys CHC
Dr David Collington Third Sector Montgomeryshire
Radnorshire & Geoffrey Greaves Third Sector Brecknock
Nicola Ruck Third Sector Montgomeryshire
Rex Shayler Third Sector Montgomeryshire
Peter Dagger* Co-opted Montgomeryshire
Radnorshire & Patricia Dryden Co-opted Brecknock
Radnorshire & Penny Everett* Co-opted Brecknock
Radnorshire & David Filsell* Co-opted Brecknock
Radnorshire & Auriol Graham Co-opted Brecknock
Radnorshire & Gareth Hayton Co-opted Brecknock
Radnorshire & Gillian Thomas Co-opted Brecknock
Radnorshire & Alan Watson Co-opted Brecknock
Richard White* Co-opted Montgomeryshire
Anthea Wilson Co-opted Montgomeryshire
46 Annual Report, 2017 - 2018
Appendix 4 External Representation 2017/2018
Commitee/group CHC Representatives
Aneurin Bevan University Health Board (ABUHB) Geoffrey Davies - Board Meeting Mid Wales Joint Committee for Health & Social Care (formerly Mid Wales Healthcare Frances Hunt Collaborative) Powys teaching Health Board (PtHB) Frances Hunt - Board Meeting Katie Blackburn
PtHB Out of Hours Project Board Katie Blackburn
PtHB Crickhowell Health Focus Group Geoffrey Davies
PtHB Ex-Armed Forces Forum Jacqueline Wilding
PtHB Finance, Planning & Performance David Collington
Frances Hunt PtHB Joint Chair / CEO Meetings Katie Blackburn
PtHB Llanfyllin Patient Participation Group Frances Hunt
PtHB Llanidloes Patients Forum David Collington
Carl Strack PtHB Machynlleth Patients Forum Nicola Ruck
PtHB Mental Health & Learning Disabilities Geoffrey Greaves
PtHB Mental Health Planning & Development Geoffrey Greaves Group Nicola Ruck
47 Powys CHC
Carl Strack PtHB Patient Experience, Quality & Safety Geoffrey Davies
PtHB North Powys Quality, Risk & Patient Andrea Blayney Experience Group
PtHB South Powys Quality, Risk & Patient Andrea Blayney Experience Group
PtHB Red Kite Healthcare Solutions Geoffrey Davies
PtHB Rhayader Health Focus Group Geoffrey Greaves
PtHB Stroke & Neurological Conditions Huw Williams Steering Group Geoffrey Greaves
Huw Williams PtHB Unscheduled Care Partnership Board Carl Strack
Jacqueline Wilding PtHB Workforce & Organisational Development Nicola Ruck
Huw Williams PtHB Ystradgynlais Health Focus Group Auriol Graham
Katie Blackburn NHS Future Fit Programme Board Jayne Thornhill
Robert Jones & Agnes Hunt Orthopaedic Hospital Anthea Wilson NHS Trust (RJAH) Board Meeting Rex Shayler
RJAH Patient Experience & Involvement Panel Rex Shayler
Shrewsbury & Telford Hospital NHS Trust(SaTH) David Jones Trust Board Meeting David Collington
SaTH Patient Experience & Involvement Panel Frances Hunt
SaTH/Healthwatch Shropshire/ Healthwatch Jayne Thornhill Telford & Wrekin/ CHC
Frances Hunt Wye Valley NHS Trust Board Meeting Geoffrey Davies
Wye Valley NHS Trust Stakeholder Group Geoffrey Greaves
48 Annual Report, 2017 - 2018
Appendix 5 Powys CHC staff and contact details
CHC members are supported in their work by a team of loyal CHC staff. Our staff are located across our 3 offices in Carmarthenshire, Ceredigion & Pembrokeshire.
Hours worked Job title Name per week
Chief Officer Ms Katie Blackburn 37.5
Deputy Chief Officer Ms Jayne Thornhill 37.5
Business Manager Mrs Gill Coles 22.5
Complaints Advocate Ms Ruth Eaton 18.5
Complaints Advocate Ms Shanaz Dorkenoo 18
Complaints Advocate (Temporary) Mrs Sonia Thomas 37.5
Advocacy Support Officer Mrs Nadine Johnson 32
Advocacy Support Officer* Mrs Gina Clarke 15
Monitoring & Scrutiny Officer Mrs Andrea Blayney 32 Administration Assistant Ms Lisa Foster 30 (Temporary to June 2017)* Administration Assistant Ms Flora Buckle 37.5 (Temporary July to August 2017)* Administration Assistant Mrs Sheila (Temporary September to December 37.5 Macpherson 2017)*
Administration Officer Mrs Ann Newman 37.5
Administration Assistant (Temporary) Mr Naren Keeble 30
49 Powys CHC
Office contact details Post: Powys Community Health Council 1st Floor, Neuadd Brycheiniog Cambrian Way Brecon Powys LD3 7HR
T: 01874 624206
Or: Powys Community Health Council Ladywell House Newtown Powys SY16 1JB
T: 01686 627632
E-mail: [email protected]
Website: www.communityhealthcouncils.org.uk/powys
Accessible formats If you would like this publication in an alternative format and/or language, please contact us. You can download it from our website or order a copy by contacting our office (contact details above).
50 Post: Powys Community Health Council 1st Floor, Neuadd Brycheiniog Cambrian Way Brecon Powys LD3 7HR T: 01874 624206
Or: Powys Community Health Council Ladywell House Newtown Powys SY16 1JB T: 01686 627632
E-mail: [email protected]
Website: www.communityhealthcouncils.org.uk/powys