Consultation Summary In October 2009, Hywel Dda Local Health Board (known as Hywel Dda Health Board) became fully operational. As an integrated health body, it is responsible for the health and wellbeing of people across Carmarthenshire, Ceredigion and Pembrokeshire. The health board also provides a range of services for people who live in south Gwynedd and Powys. As the Minister for Health and Social Services made it clear in Together for Health (2011), establishing integrated health boards was only the first step in creating a world class NHS in Wales. Hywel Dda Health Board has a population Our vision for the future of 375,000 and covers over a quarter of the As well as supporting the vision the Welsh landmass in Wales. We have 9,500 staff. Government has for NHS Wales, we want to: Primary care and community services are • improve health and wellbeing for all delivered through: • move from a sickness service to a wellness service 55 GP practices 51 Dental practices • deliver quality healthcare in the best setting 100 Community pharmacies 52 Optometry premises • have high quality, safe and sustainable hospital 8 Community hospitals services 11 Health centres • be recognised as Wales’ leading integrated Our in-hospital services are currently rural health and social care system delivered through: We want to provide integrated healthcare with 4 Hospitals (Bronglais, Glangwili, 80% of NHS services being delivered locally, Prince Philip, Withybush) through primary, community and social care teams. Integrated care means all agencies and people In response to the challenge identified in working together to deliver services where the Together for Health, the health board has journey through the system of care is made as published a consultation document setting out simple as possible. These will be provided locally, what it wants to achieve in the next 3-5 years. It by doctors, dentists, pharmacists, opticians is consulting on the proposals highlighted in that (the primary care team), nurses and therapists document from 6 August 2012 to 29 October (the community team) and social care teams all 2012. This summary document tells you about working together. the plans we want you to consider for the future We will provide this care either at home, close of healthcare services in Hywel Dda Health Board. to home or in the community. Delivering this The full version of the consultation document, vision will support care for the frail and elderly, questionnaire and detailed technical documents whilst allowing our hospitals to concentrate on can be found at www.hywelddahb.wales.nhs. what they do best – providing both planned and uk/Consultation or requested by calling 01437 emergency care when it is needed. 771232. 1 Consultation Summary What integrated care will mean for Health inequality – people live longer in different people parts of our area and we need to make sure that everyone gets the same high quality and Working across boundaries – by teams working consistent standard of care. closer together it will be easier for patients to move between services - which will result in care Rural location – quite a lot of the population live being given in the right place at the right time. in the country or small towns and face problems getting the right services at the right time. Supporting patients in the community – by providing faster diagnostic tests in the community Waiting times – people are sometimes waiting too and by proactively managing patients we believe long for treatment. we will have less people needing to go into Recruitment – we need to make sure we have hospital. a constant flow of well-trained doctors and Chronic disease management – we will continue specialists, especially as almost half of our senior to support patients to manage their conditions doctors are able to retire within the next few with the help of community and practice nurses, years. preventing them having to go to hospital unless New technologies and medicines – our patients absolutely necessary. should be receiving the benefit of new Self care – patients and their carers will be offered technologies and drugs as soon as possible to advice, encouragement and support to do more achieve the best outcomes possible. for themselves in their home. Value for money – we need to make sure we use our resources in the best way. What this will mean for our workforce Best configuration of hospital services for Wales: For this to work we need to have everyone A Review of the Evidence published in May 2012, working together delivering services. There will be www.glam.ac.uk, concluded that patients in Wales new and exciting opportunities for parts of our are not getting the best possible outcomes from workforce, such as nurses and therapists, with their hospital care and there is a strong case for clinicians taking on major roles. All the hospitals changing the way hospital services are organised. in Hywel Dda Health Board will operate as one because we want the best for the community By not dealing with these challenges, we could be from our resources - both staff and money. We putting the future sustainability of services at risk. will carry on finding best practice from around the We also risk not having the right services available UK and around the world so we keep on getting for our population when they need them. better. We believe that by implementing the changes Why things have to change identified in the consultation document, we expect to see a number of benefits: Although people living in this area in the main have healthier lifestyles than other places across • Improved services Wales, there are still many different issues and challenges to address, including: • Improved health outcomes for patients Safety and quality – whilst we perform well • Providing more care closer to home in many areas standards can vary across our • Efficiencies across the organisation hospitals . • Improved experiences and career A changing population – by 2026, the number opportunities for staff of people aged over 75 is going to double from 2008 levels. 2 What we have done so far We want: Between December 2011 and April 2012, the • to reduce hospital visits and stays health board undertook a wide ranging listening • more day case surgery in hospitals meaning and engagement exercise outlining what services less travel for patients and their families were provided at that time and what needed to be in place in the future. More detail on the • better public and community transport to activities undertaken and analysis of the feedback services on all our sites received during the process is contained in a • shorter journeys for patients because of report by Opinion Research Services (ORS) and mobile facilities in communities can be found at: www.hywelddahb.wales.nhs.uk/ Yourhealth-yourfuture • to involve families and carers when planning out-patient appointments and when and how We are now in the formal consultation period someone leaves hospital and are outlining our plans for the future of healthcare within Hywel Dda Health Board. • to have one telephone number to book The health board has reflected on the concerns transport raised during the engagement period and has considered carefully alternative proposals for We have discussed our plans with Welsh change. As a result, we have refined and shaped Ambulance Services NHS Trust and they are our proposals in light of what we heard. Any working with us to help deliver our new service proposed new or changed services will need to be plans alongside their plans. fit for purpose and fit for the future – they must be person-centered, high quality, modern, safe, Care closer to home sustainable and affordable. Our plan is to deliver services as close to home The health board proposals would be as possible. This includes moving some services implemented over a five year period - so you will previously only available in a hospital to GP only see changes to services when the health surgeries or the community. This will reduce the board is satisfied that we have the appropriate number of people who need to go to hospital. alternative services available in our communities. Better efficiency and improvements in primary and community services will reduce the overuse Transport of hospital beds; our evidence shows that up The listening and engagement exercise to 40% of patients in our hospital beds don’t highlighted that transport needs to be improved need to be there. By developing our primary so people can get to the care they need. Moving and community services and facilities further care closer to home is a major step forward in we can prevent this. The boundaries between in this. Themes highlighted during this exercise hospital and out of hospital services are still too included concerns over the long distances great. We need to ensure that all of our services families and carers sometimes have to travel – emergency, planned, primary, community and to visit patients in hospitals, the fact that over social care – are working together to meet local 90% of people find their own way to hospital needs. Meeting the chronic disease challenge will appointments, the difficulties with public and require us to bring together traditional hospital community transport over the weekend, returning services with community services and primary care home from an A&E department and difficulties services – to create integrated services. with parking at some hospitals. Our vision for care closer to home will enable us, in time, to reduce, by as much as 20%, the number of acute hospital beds. This will allow us to undertake an ambitious and comprehensive ward refurbishment programme to increase the 3 Consultation Summary number of single occupancy side rooms and core hours, extended appointment times and single sex accommodation in our hospitals.