Serving the population of South Wales, West Wales and South Powys Programme Business Case 26 November 2019 For reporting to Health Boards 1 Acknowledgements The authors would like to thank all those who have contributed to the programme over the last five years and to the development of this Programme Business Case. Authors Rosemary Fletcher Director, NHS Wales Health Collaborative Dr Dinendra Gill Clinical Lead, South Wales Trauma Network Rhys Blake Head of Planning, NHS Wales Health Collaborative Jeremy Surcombe Programme Manager, NHS Wales Health Collaborative Vickie Harding Project Support Officer, NHS Wales Health Collaborative 2 Contents 1 Executive Summary .................................................................................................. 8 1.1 Introduction ............................................................................................................................. 8 1.2 Vision ....................................................................................................................................... 8 1.3 Background .............................................................................................................................. 8 1.4 Strategic Case .......................................................................................................................... 8 1.5 Case for Change ....................................................................................................................... 9 1.6 Clinical and Operational Model ............................................................................................. 10 1.7 Operational Delivery Network ............................................................................................... 12 1.8 Pre-hospital Care and Transfers ............................................................................................ 12 1.9 Major Trauma Centre ............................................................................................................ 13 1.10 Health Board Configuration ................................................................................................... 14 1.11 Financial Case ........................................................................................................................ 15 1.12 Economic Case ....................................................................................................................... 17 1.13 Commercial Case ................................................................................................................... 17 1.14 Management Case ................................................................................................................. 17 1.15 Summary and Recommendation ........................................................................................... 18 2 Strategic Case .......................................................................................................... 20 2.1 Introduction ........................................................................................................................... 20 2.2 Strategic Context ................................................................................................................... 20 2.3 National Drivers for Change .................................................................................................. 21 2.4 Key Interdependent Policies .................................................................................................. 23 2.5 Population and Existing Activity Profiles ............................................................................... 24 2.6 Overview of the Current Position – The Trauma Pathway .................................................... 26 3 Case for Change ...................................................................................................... 33 3.1 Introduction ........................................................................................................................... 33 3.2 Investment Objectives ........................................................................................................... 33 3.4 Health Gain ............................................................................................................................ 36 3.5 Equity ..................................................................................................................................... 41 3.6 Clinical and Skills Sustainability ............................................................................................. 43 3.7 Value for Money .................................................................................................................... 45 3.8 Local Health Board and WAST/EMRTS Specific Benefits ....................................................... 47 4 Clinical and Operational Model .............................................................................. 52 4.1 Introduction ........................................................................................................................... 52 4.2 Chronology of Developing the Model ................................................................................... 53 3 4.3 Initial Service Modelling ........................................................................................................ 53 4.4 Non-financial Options Appraisal for MTC Location 2015 ...................................................... 58 4.5 Independent Panel Review .................................................................................................... 60 4.6 Public Consultation Process and Recommendations ............................................................ 62 4.7 Designation of Trauma Units ................................................................................................. 64 4.8 Predicted Change in Patient Flow ......................................................................................... 66 5 Operational Delivery Network ............................................................................. 70 5.1 Introduction ........................................................................................................................... 70 5.2 What is a Trauma Operational Delivery Network (ODN)?..................................................... 70 5.3 Purpose of the Operational Delivery Network ...................................................................... 70 5.4 Phased Implementation ........................................................................................................ 71 5.5 Clinical Informatics Model ..................................................................................................... 78 5.6 Training and Education Model .............................................................................................. 81 5.7 Resource Requirements ........................................................................................................ 85 5.8 Key Challenges ....................................................................................................................... 89 5.9 Issues Arising for Resolution.................................................................................................. 89 5.10 Options to the give the ODN Meaningful Operational Authority ......................................... 89 6 Pre-Hospital Care and Transfers ........................................................................... 91 6.1 Introduction ........................................................................................................................... 91 6.2 Service Specification and Quality Indicators ......................................................................... 91 6.3 Welsh Ambulance Service ..................................................................................................... 95 6.4 Emergency Medical Retrieval and Transfer Service (EMRTS) ............................................. 103 7 Major Trauma Centre......................................................................................... 107 7.1 Overview .............................................................................................................................. 107 7.2 National Major Trauma Quality Indicators .......................................................................... 107 7.3 Case for Change ................................................................................................................... 108 7.4 Workforce Summary ........................................................................................................... 109 7.5 Predicted Activity Uplift....................................................................................................... 111 7.6 Workforce Summary ........................................................................................................... 116 7.7 Benefits and Risks ................................................................................................................ 117 7.8 Planning and Assurance Process ......................................................................................... 117 7.9 Financial Summary .............................................................................................................. 118 7.10 The Major Trauma Centre Role within the wider Network and Opportunities for Collaboration ......................................................................................................................