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Planning for a healthy futurePowys Teaching Health Board’s Integrated
Medium Term Plan 2015
Powys teaching Health Board – Integrated Medium Term Plan
Introduction from the Chair and Chief Executive Health and wellbeing plays such an important part at every stage of our lives. Whilst we all hope to lead healthy lives, we know that there are times when we will need the services of health or social care. This Plan sets out how over the next 3 years Powys teaching Health Board (PTHB) aims to work together with the population of Powys, professionals and others to help achieve better health and better health and care services.
We start from a strong base of having a generally healthy population, strong communities and staff that are truly committed to Powys. However, we know that there are areas where health is poorer than it could be; that some health and care services are fragile; that some services don’t provide the best experience possible for people; a lot of our building are old and out of date and that some staff (whether doctors, nurses, therapists, critical support staff, or managers) are stretched. Importantly, we also know that staff across the county; individuals, communities and the groups that represent them; and leaders of health, social care and other services are highly motivated to work together to continue to improve the lives of people and communities in Powys.
Whilst the period of austerity for public services continues, we are determined that we use such challenging times to help us work more innovatively and creatively. Being ‘prudent’ is going to be essential. Spending money efficiently and effectively is critical, and is something we all have collective responsibility for. Our Plan focuses on 3 key elements:
Enhancing Primary and Community Care – Providing high quality and efficient care in or as close to home makes sense on all fronts, especially in our rural county. Supporting GP teams, pharmacists, optometrists/opticians and dentists is key, as is developing a wide range of services in health and social care settings and community hospitals.
Integrated Working – Finding new and better ways to work jointly with people who use our services, with other health organisations in and outside of Wales who provide services to the people of Powys, and essentially our key partner Powys County Council.
Excellent Commissioning – There are services we will continue to need to ‘buy’ from others. We want these to be high in quality and effectiveness, innovative in approach and sensitive to the needs of the individuals who use them.
We anticipate that over the coming 3 years there will be change. Firstly, we intend to support people to make positive changes in their own health and wellbeing. Secondly, many of the services we ‘’buy’ on behalf of the people of Powys are needing to change and we will be working together with others to help design and implement those changes. Last but certainly not least, the services we provide in Powys will also need to change and we look forward to engaging positively with people to deliver better services for all.
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Our Purpose Powys teaching Health Board is committed to improving the health and wellbeing of the people of Powys and providing the best possible healthcare services that meet the needs of the local population now and in the future.
Our vision is to provide “truly integrated care, centred on the needs of the individual” through 6 aims
• Improving health and wellbeing• Enabling the right access to services• Striving for excellence• Involving the people of Powys• Making every pound count• Always valuing, developing and supporting our staff.
Our new Integrated Medium Term Plan (IMTP) sets out how we will achieve this over the next three years by working together with the people of Powys, staff and others to improve health and healthcare services. Our plan will focus on three key areas;
making sure that wherever you receive care, in Powys or outside Powys, servicesare of the highest standards and wherever possible, close to home;
becoming a leader in Wales for the way in which it provides primary care andcommunity services;
putting people at the heart of our work by working with other local services and thecouncil to integrate our approaches to health and social care.
As a Health Board we aim to make important progress against the requirements set out in Welsh Government’s (WG) ‘Together for Health’ strategy and deliver the WG required outcomes. The success of the Plan will be measured by progress against seven areas. The outcomes include:
1. Staying Healthy: People in Powys are well informed and supported to managetheir own health;
2. Safe Care: People in Powys are protected from harm and protect themselves fromknown harm;
3. Effective Care: People in Powys receive the right care and support as locally aspossible and can contribute to make sure that care is successful;
4. Dignified Care: People in Powys are treated with dignity and respect, and treatothers the same;
5. Timely Care: People in Powys have timely access to services based on clinicalneed and are actively involved in decisions about their care;
6. Individual Care: People in Powys are treated as individuals with their own needsand responsibilities;
7. Our Staff and Resources: People in Powys can access information about howtheir NHS is resourced and make careful use of it.
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About us Powys THB is responsible for improving the health and wellbeing of around 132,000 people living in Powys. We have 9 community Hospitals,1 Health and Social Care centre, community health teams and primary care teams, all providing a variety of services. These services are managed by the THB in partnership with our GPs, optometrists, dentists and pharmacists. More specialist services are provided by neighbouring organisations. We buy or ‘commission’ these services through contracts and we are responsible for managing these contracts and making sure that residents of Powys receive the best possible care from our partner organisations.
Community Hospital
Inpatient /Day
Hospital
Birth Centre
MIU Outpatients Mental Health
Services Other
Ystradgynlais X-Ray
Brecon Theatre, Endoscopy, Children’s Centre, Stroke Rehab, X-Ray
Bronllys
Llandrindod Wells Theatre, Endoscopy, Renal Unit, X-Ray
Knighton
Newtown Stroke Rehab Llanidloes
Welshpool Renal Unit, X-Ray Machynlleth X-Ray Glan Irfon Health & Social Care Centre
Short stay shared care re-ablement beds
Primary Care Facilities
Number
GP Practices 17 Main & 12 Branch Sites
Community Dental Service
5
General Dental Practices 24
Optometry Practices 25
Community Pharmacies 23
= Community Hospital
= Health & Social Care
Centre
Bronllys
Brecon
Ystradgynlais
Builth Wells
Llandrindod
Wells
Knighton
Llanidloes
Newtown
Welshpool
Machynlleth
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Primary care services – through General Practices, dentists,optometrists/opticians, pharmacists.
Community care services - such as district nursing, reablement (therapy athome), specialist nursing services, palliative care services
Minor Injury Units and Services – either through GP practices or throughCommunity Hospitals
Community Hospital – including a wide range of services such as therapy,rehabilitation, palliative care, outpatient appointments, audiology andradiology.
Day Surgery – through Theatres at Brecon War Memorial Hospital andLlandrindod Wells Memorial Hospital
Midwifery and Maternity care – both through Community Midwifery servicesand together with District General Hospitals
Children’s services – in the community through health visiting, school nursingand community paediatrics, and through services at District GeneralHospitals.
Ambulance services – through working closely with Welsh AmbulanceServices Trust
Acute care services – through working closely with main providers such asAneurin Bevan University Health Board (Nevill Hall Hospital, Royal GwentHospital); Wye Valley Trust (Hereford County Hospital); Shrewsbury andTelford NHS Trust (Princess Royal Hospital, Royal Shrewsbury Hospital);Abertawe Bro Morgannwg University Health Board (Morriston Hospital, NeathPort Talbot Hospital, Singleton Hospital); Hywel Dda University Health Board(Bronglais Hospital), Robert Jones and Agnes Hunt NHS Trust (OrthopaedicHospital); and Velindre NHS Trust (cancer services).
Highly Specialist services – providing services such as neonatal intensivecare, renal dialysis, transplants, treatment for rare conditions.
Mental Health services – provided by our own Child and Adolescent MentalHealth Services, and services provided by Aneurin Bevan University HealthBoard, Abertawe Bro Morgannwg University Health Board and BetsiCadwaladr University Health Board.
Health screening services – working closely with Public Health Wales NHSTrust for services such as breast, bowel and neonatal screening programmes.
Voluntary Sector services – working closely with services such as Care andRepair Powys, Powys Carers, Crossroads, St Davids Foundation, Macmillan,and many others, linking closely to the Powys Association of VoluntaryOrganisations.
Independent Care Homes and Hospitals – for a wide range of services.
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Population Health Needs in Powys PTHB works with other organisations in Powys to develop a shared view of the health and wellbeing of people living in Powys. This helps the THB to make sure services and plans are developed according to the needs of the people it serves. This information is vital to developing a robust and effective plan. A summary of the assessment carried out for 2014/15 is as follows:
Population
Our population is:o Older than other areas of Wales – the largest age group in Powys is
people aged 60-64, in Wales it is those aged 45-49o Ageing faster than other areas of Wales - by 2033, the number of
people aged over 65 in Powys will have increased by 80%
Living in Powys
For people living in Powys:o Overall poverty and unemployment is lower than other areas of Waleso Access to services is more difficult than anywhere else in Wales -
many areas are ranked in the bottom 10% in Wales for this indicatoro Around 13% of children live in poverty; the average full time annual
wage is almost £3,000 less than the Welsh averageo Some living costs are relatively high, compared to local wages and to
the rest of Wales Powys is the second most expensive place to buy ahouse in Wales, housing quality is poorer and 32% of households inmid Wales are in fuel poverty
o More positively, there is a stronger sense of belonging to a communitythan in other areas of Wales – 83% vs 76%
Health in Powys
People living in Powys:o Have the best life expectancy in Wales - 79 years for men and 83
years for womeno Tend to live healthier lives than people elsewhere in Wales – yet two
thirds of people in Powys don’t eat enough fruit and vegetables a day,not enough people take regular exercise and more than half Powysadults are overweight or obese. 19% of adults smoke – still too many
o 46% of people over 65 are being treated for an illnesso 31% of adults are limited by health problems or disabilityo 50 % of people over 65 have high blood pressureo 21% of people over 65 have respiratory illness
What’s driving our plan? The THB faces unique challenges in Wales. Powys covers 25% of Wales but we only have 5% of the population. This is part of what makes Powys the beautiful and wonderful place it is, but it also makes delivering healthcare more complicated. Transport links are poor, poverty can be hidden, supporting very small teams and
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services can be challenging. It also means that the way our services are delivered is different from most other organisations because to make sure acute and specialist care is provided in the safest and most efficient way, we contract our larger neighbouring organisations to provide some services.
The population of Powys is also getting older and this is rising faster than anywhere else in Wales. This means we need to make sure we support our older population and prepare for the future pressures this could add to services. Finally, there are still significant financial pressures on public services across the country. We have to make every pound count so that we can meet rising costs and increasing demand, continue to improve services and facilities and make sure people get the highest quality care.
Population: Powys has the fastest rising number of elderly population inWales. Our services will be unsustainable if we do nothing to meet theincreasing demand.
Changes to health: Health issues are becoming more complex as thepopulation ages and we live longer with multiple chronic conditions.
Austerity: We are in a continued period of financial austerity and we need tomake sure that we use our resources in the most efficient way.
Workforce: We need to attract and retain more staff in Powys to support ourvision.
Technology: Improving technology means we can do more outside hospitalsand we need to use technology to help us manage health needs andtreatments.
Estate: 50% of our buildings predate the NHS.
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Priorities
Commissioning
The health board spends more than half its money on emergency and planned care services from other health boards in Wales and NHS Trusts in England. We will work with our partner NHS organisations to re-shape services so that they are sustainable and meet the changing needs of the local population. We will also secure high quality and efficient services through strong contract arrangements.
We aim to: Make sure our partner organisations give quality, timely care and do more
to prevent people becoming ill and treating them earlier. Make sure our partner organisations focus on the outcomes for patients
and are innovative and prudent in how they work. Get assurance that services we buy are high quality and effective.
Primary Care and Community Services
Developing and improving primary care and community services is central to the health board’s plans. The health board has worked closely with GPs and other Primary and Community Care Clinicians throughout Powys to develop priorities. Supporting and building GP leadership will be key to developing a more robust and sustainable rural healthcare system.
We aim to: Increase the amount we can do in Powys; Make sure primary and community services are stable and resilient; Give GPs, primary and community staff a stronger role in leading how we
plan, buy and deliver services.
Integrated Working and Partnerships
We work closely with a wide range of stakeholders including service users and carers, Local Authorities, neighbouring health services in Wales and across the border, the third sector, the independent sector, other public bodies, academic partners, the Community Health Council (CHC) and our volunteers. Our approach to improving health and well-being and reducing inequity within Powys is to work with our partners through the Local Service Board (LSB). We are also working closely with other Health Board as part of the Mid Wales Collaborative improving services in rural areas.
The One Powys Plan outlines how we will work with Powys County Council to integrate health and social care services. Mental health, services for people with learning disabilities, older people and carers are really important areas to do this. We are also considering how we can integrate other services more. The two organisations are already working together on things like Information Technology and how we use property and assets. The plan will influence the work of the health
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board until at least 2017 and will make sure that by working together with our key partners, the wellbeing of Powys people will be improved.
We aim to:
Make people the centre of everything we do Join up our support services and systems where possible Have a joint strategy and approach to how we improve
Transforming Services For improvements to be made, there has to be change. Work has taken place to establish our priorities through engagement with staff, clinicians, GPs, and primary care staff. In order to manage this work the THB has set up the Transformation Programme.
The Transformation Programme will manage the really big changes over the next 3-5 years. It will work to make sure we keep delivering our everyday services and that any improvements and changes are co-produced with service users and delivered with strong management so that patients benefit directly. This work will need a lot of input and conversation with all our stakeholders.
The Transformation Programme has four key programmes that will help us deliver our vision:
Commissioning Programme
This programme will strengthen our commissioning arrangements with other health boards in Wales and Trusts in England to make sure we deliver more efficient, better quality services in an economical way.
Adult Mental Health Project
After engagement with all stakeholders the THB will bring adult mental health services under the direct management of the THB from December of 2015. This project is managing this process carefully so that services are unaffected or improved and staff are looked after.
Service Reform Programme
This programme will manage the immediate changes and improvements to services over the next three years, making sure projects are planned and delivered to the highest standards.
Strategic Delivery Model Programme
This work is looking at the next 5 – 10 years and working out how we can deliver services in the future that meet the needs of the people of Powys, what services we can deliver, where, and in what sort of buildings.
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There is some other work that will be needed to help make the changes happen, including:
Stakeholder engagement- making sure that we involve the right people at the right time and that we listen to the views of the people of Powys
Estates Investment Plan – supporting our future vision for services with technical work so that our buildings are fit for purpose.
Organisational Development –helping to shape and strengthen our workforce for the future and making sure all our staff are engaged.
Information Technology – making sure we use technology wherever possible to support staff and deliver patient care.
More details on the work that we will be carrying out over the next thee years can be
found in Appendix A.
Service Delivery Plans
There are a number of national Service Delivery Plans that have been developed to
improve services for specific conditions. We will continue to develop local service plans
for the following conditions:
Unscheduled/emergency care Planned/elective care Integrated care for Older People Mental Health Learning Disabilities Services Cancer Services Heart Disease Services Diabetes Services End of Life care Services for the Critically Ill Stroke services Respiratory Services Neurological conditions Liver Disease services Organ Donation Substance Misuse Maternity Services Children’s Services Sexual Health services.
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Quality & Safety The Board’s Quality Delivery Plan is based simply around the following four themes:
Putting quality and safety above all else: Embed a culture of continuous improvement in safety, quality and patient experience in all settings. Ensure absolute compliance with fundamental standards, professional conduct and competence across disciplines;
Patient-centred care: Create a culture that places the patient first in everything that is done. Patients and their carers to be treated with dignity, respect and compassion;
Integrating improvement into everyday working: Eliminating harm, variation and waste by looking to improve everyday working
Investing in our staff: Through training and development, help staff to care well for patients/carers and to work safely and effectively.
We will make sure that we listen and learn from our patients and ensure care is person centred as set out in our vision to deliver ‘truly integrated care centred on the needs of the individual’.
IMTP on a Page Below is a visual map which highlights they key work of detailed in the health Board’s IMTP.
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Develop rational outcome based system forplanning and commissioning
Introduce framework to ensure quality and safety across providers and services
A L W A Y S W I T H O U R S T A F F
Make sure our partner
organisations givequality, timely care
and do more to prevent people
becoming ill and treating them
earlier.
TRULY INTEGRATED CARE CENTRED ON THE NEEDS OF THE INDIVIDUAL
Outcomes
Strategic Priorities COMMISSIONING PRIMARY CARE & COMMUNITY SERVICES INTEGRATION
Make sure our partner
organisations focus on the outcomes for patients and
are innovative and prudent in how
they work.
Increase theamount we can do
in Powys
Make sure primary and community
services are stableand resilient
Give GPs, primary and community staff a stronger
role in leading how we plan, buy and deliver services.
Make people thecentre of
everything we do,
Join up our support services and
systems where possible;
Have a joint strategy and
approach to how we manage and
scrutinise our performance.
Get assurance that services we buy are
high quality and effective.
Staying Healthy
People in Powys are well informed and supported to manage their
own physical health
Safe Care
People in Powys are protected from harm and protect
themselves from known harm
Effective Care
People in Powys receive the right care and support as locally as possible and are enabled to
contribute to making that care successful
Dignified Care
People in Powys are treated with dignity and respect and treat
others the same
Timely Care
People in Powys have timely access to services based on clinical need and are actively involved in
decisions about their care
Individual Care
People in Powys are treated as individuals with their own needs
and responsiblities
Our Staff and Resources
People in Powys can find information about how their NHS is resourced and make careful use
of them
Strategic Objectives
Transformation Programme
Agree best future model of care andconfiguration of future services for the long term
Ensure public, patient and staff engagement Ensure processes are robust and rigorous
Deliver priorities for service development over 5 years
Manage implementation of efficiency, and quality improvement projects
Manage delivery and performance of service change
Prevention and Health Improvement : Make Every Contact Count• Reduction in Smoking prevalence • Reduction in Childhood obesity • Increased resilience of children and young people • Increased flu vaccination
Improve early diagnosis Complete review of cancer
chemotherapy Introduce cancer pathway
management
Develop specialist nursingservices
Ensure action plans for at riskpatients in community
Ensure self-management plans in place
Develop knowledge and skillsframework
Develop evidence based standards for care
Develop local symptom management services
Birth 30% of women in Powys by 2016 Maximise usltrasound scanning and day
assessment in Powys Promote use of remote technology
Awareness campaign and identification of those with Atrial Fibrillation
Improve access to community rehabilitation
Support development of hyper acute services
Ensure equitable access to care at home
Ensure availability ofappropriate carers
Ensure governance arrangements for hospice care
Strengthening diagnosis and management in primary andcommunity services
Strengthen education and selfmanagement
Ensure waiting times targetsare met
Develop consistent model for delivery of risk assessment
Improve participation inNational Clinical Audit
Deliver NHS Adult Management arrangementsproject
Delivery of integrated Adult Service Model Strengthen partnership working
Finalise approach to integrated services for CAMHs
Develop management of elective and emergency paediatric pathways
Further develop community, School Health Nursing and Health Visiting
Develop co-ordinated processes for health and social care needs
Develop county-wide reablement service Review and deliver older people’s
commissioning strategy
Improve demand management through alternative pathway and virtual ward
Improve capacity management Improved escalation management
EnablingProgrammes
Ensure optimum level of planned care provided in Powys within agreed target times
Repatriate appropriate planned care services Evaluate local MRI, deliver sustainable
audiology, sonography and opthalmologyservices
Delivery Plans
Implement estates compliance programme Deliver ‘first impressions’ programme Take forward proposals for Bronllys and Llandrindod
Wells
Build on chat to change programme Ensure 90% compliance with appraisals Recruitment and retention strategy across Powys
Implement Community Care Information Service Roll out primary care based systems Deliver further benefit of IT integration with PCC
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Finance Over the past 2 years the Health Board has successfully demonstrated that the historic resourcing provided to the Health Board is insufficient to meet the demand for healthcare across the breadth of our activities.
As a result Welsh Government have provided additional resources in 2014-15 and have confirmed future years funding to the same level.
However we are still in a time of austerity and our work shows us that the pressures on the health board will continue to rise and if we are to meet this demand we will need to change the way in which demand is met.
In response, this IMTP sets out the priorities the Health Board has agreed to develop and improve services with the intention of ensuring services are sustainable, efficient and provide a platform for limiting the financial impact of growing demand for services.
The financial modelling undertaken based on the proposed service models identify that the health board will
Break even for 2015/16 and deliver a modest surplus in future years Transfer the balance of resource from the expensive acute care delivered
services to more efficient local community and primary care services, usingWelsh Government targeted primary care funding wherever possible
Deliver savings of £5.8M across primary and community care though efficiencyand re-design.
Deliver growth avoidance measures of £9.5M from our commissioning spendthrough redesigning services, bringing care back into Powys, implementing thevirtual ward across Powys and through our unscheduled care and planned careprogrammes.
This plan depends on the assumptions that: There will be no repayment of the debt incurred with Welsh Government in
2013/14 The £25M funding allocated by Welsh Government in 2014/15 will be
repeated in each of the three years of this plan Our assumptions for years 2 and 3 are a 2% cash uplift from Welsh
Government across all income streams which will be passed onto Welshproviders and Primary Care contractors
Cost reduction opportunities identified within the external reviews have beentaken into account in the three years savings programme where they havebeen assessed as being possible
The recently announced invest to save funding has been factored into theplan.
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Additional funding for the tHB of £3.120M (out of the £80M across NHSWales) has been assumed and is a risk if not approved.
Risks A risk assessment has been completed which gives us an idea of the scale of risk of the financial plan. The risks include delivery issues, partner compliance issues and risks from the relative robustness of the assumptions made. Significant to our plan is the confirmation required that the additional funding received in 2014/15 and 2015/16 (£25M) will be received again in the last 2 years of this plan.
The span of risks across all areas of risk suggest at best the Health Board could be underspent by £0.5M in 2015/06 and at worst overspent by £6M.For future years, the risks move up to £22M if the additional funding received in 2015/16 is not forthcoming.
Financial Plan Summary - by category of Spend
2015/16
£M
2016/17
£M
2017/18
£M
Pay & Employee Benefit Expenses 50.026 50.576 51.183
Non Pay 23.145 24.119 23.990
Primary Care Contractor 34.504 35.627 36.323
Medicine Management 26.877 27.371 27.866
Continuing Care and Funded Nursing Care 13.764 14.095 14.429
Commissioned Services 123.264 124.170 126.069
Depreciation 2.540 2.540 2.540
Other Income (6.499) (6.525) (6.542)
Resource Limit (267.621) (272.973) (278.433)
Net Position 0.000 1.000 2.575
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Workforce and Leadership We expect that as we do more in Powys, including bringing back adult mental health services, our workforce will increase. Our aim is that we build a workforce that is fit for the future. We will do this by working to make sure our workforce is:
Engaged: highly engaged, committed and contributing to the success of the Health Board through our Chat to Change programme.
Sustainable and Skilled: recruited, developed and skilled to meet the needs of the people in Powys and continue to have learning opportunities and development.
Healthy: healthy and have high levels of wellbeing through a positive work environment and culture that produces happy, motivated and high performing staff.
Efficient: able to use e-Systems, processes and structures that are designed, joined up and delivered in ways which make sense to staff and allow them to do their jobs to the best of their ability.
Integrated: able to take advantage of shared learning, organisational improvement and the delivery of services through joined up working across organisations.
Conclusion This is an ambitious plan, which reflects our ambition as an organisation with partners to improve the health of the people of Powys and to provide excellent healthcare services. We will improve the way in which we lead and manage the organisation to make sure that we can effectively stand up to scrutiny. We will develop and put in place an improved way of managing performance both for individuals, teams, services and for the organisation as a whole. The Board, made up on Executive and Independent members will continue to work together to improve their effectiveness in leading the organisation. We will carefully monitor progress in putting this Plan into practice and report openly and honestly to the public.
Appendix A Key documents that explain how we are performing what we are doing and what we plan to do in the future in more detail include:
PTHB Integrated Medium Term Plan 2015/16-17/18 (Full Version) Annual Quality Statement 2014/15 Annual Report 2014/15 One Powys Plan 2014/15 Joint Strategic Needs Assessment 2014
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Appendix B Glossary and some key phrases that you will probably hear a lot over the next three years.
Annual Quality Statement (AQS)
A report that sets our how we have performed on quality and safety and how we plan to improve over the coming year.
Business Intelligence
The information and evidence we gather to support service improvements.
Commissioning
The way we ‘buy’ services from other health organisations e.g. we pay Aneurin Bevan UHB when Powys residents have surgery in Nevill Hall Hospital.
Delivery Plan
The Welsh Government has National Delivery Plans for key illnesses which set out how we need to improve care in these areas. The HB develops its own local delivery plans explaining how we plan to meet Welsh Government guidance.
Demand and Capacity Modelling
The way we look at the capacity to deliver services we currently have, what the evidence tells us will happen to demand in the near future i.e. population growth, and what capacity e.g. beds, we would need to meet this demand.
e-rostering
An electronic staff management tool and a resource used to plan staffing requirements.
Emergency Medical Retrieval and Transfer Service (EMRTS)
National service established to enhance emergency services providing critical care and transfer e.g. Air Ambulance
Equality Impact Assessment (EIA)
An assessment that has to be carried out by law which looks at how changes to services will impact on equality, particularly on people with protected characteristics e.g. disabilities
Future Fit
A programme of work in Shrewsbury and Telford Hospital NHS Trust to oversee and improve acute and community hospital services in Shropshire.
GP Cluster
A group with representation from each GP practice in an area which works together to develop plans to improve services for their population
Integrated Medium Term Plan (MTP)
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The Health Board’s Plan for the next three years. It is submitted to Welsh Government for approval every January
Integration
The way we work with the council to organise and manage services that provide more seamless care and better value for money
Joint Strategic Needs Assessment (JSNA)
An assessment carried out by various partners in Powys, including the HB and the Council) which looks at all the evidence on the local population and what their needs are based on things like poverty and levels of ill health.
Mid Wales Healthcare Collaborative
A group set up in response to the Welsh Government’s review of healthcare services in Mid Wales. The group will lead on the cross organisation work to improve healthcare delivery in rural mid Wales.
One Powys Plan
The plan developed by partners working in Powys including the HB, the Council and the third sector, which sets out how we will work together to improve services in Powys.
Operating principles
The agreed principles we work with to deliver our aims.
Outcomes Framework
The measures against which we measure our performance as a Health Board.
Programme Management Office (PMO)
The team of programme and project managers who work in the Health Board to deliver key work within the Transformation Programme.
Prudent Healthcare
An approach set out by Welsh Government that challenges us to plan, manage and deliver care in a wise way with careful thought to planning, vigilance, budgeting and that achieves tangible quality outcomes fro patients.
Quality Impact Assessment (QIA)
An assessment carried out when we make changes to services or introduce services to assess how quality of care will be effected.
Service Reform Programme
A programme of work that is look at the service changes we need to make over the next 3 to 5 years and managing the implementation of these changes.
Shift left
The process of shifting resources and care from secondary case (district general hospitals) to community to peoples homes.
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South Wales Programme
Programme made up of health boards across south wales including Powys which is looking at how specialist hospital services are delivered across the region
Stakeholders
All individuals and groups who are interested in or have influence on the work of the Health Board.
Strategic Delivery Model
Long term programme of work look at how we can build service resilience and ensure future viability of services for our local population
Strategic priorities
The key priorities for the Health Board that will strengthen and develop Primary and Community Care, Commissioning and out integrated working.
Transformation Programme
The structure which oversees the Health Board’s key large scale change programmes.
Transformation Programme Board
The Board, made up of Executive Directors and chaired by the CEO, who oversee the management and delivery of the Transformation programme.
Values and behaviours framework
How we apply our agreed values and behaviours in the workplace
Virtual Ward
Patients care managed at home by a multidisciplinary community team which meets regularly to review patients who are ‘on’ the ward.
Vision
What we as a HB aim to achieve: “Integrated care centred on the needs of the individual’
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Appendix C: Service Changes: Below are more details on key actions the Health Board will take.
Improving Health and Wellbeing
What do we want to do?
What will success look like?
How will we do this? How will we measure success?
Improve health now and lay the foundations for
maintaining good health for the future
Fewer people in Powys smoke
Strengthen referral pathways to smoking cessation services, focusing on referrals fromGPs, out-patients and partner organisations particularly for pregnant women
Implementation of a communication action plan to raise awareness of smoking cessationservices including championing “Smoke Free Powys”
Identify evidence based interventions to prevent uptake of smoking in children and youngpeople e.g. in school settings
Develop smoking cessation pathways for staff and launch the refreshed PtHB Smoke FreePolicy
Percentage of smokers making anattempt to quit via smoking cessationservices
Decrease smoking prevalence to 18%
More people are immunised against flu
Further consider the role of midwives in vaccination of pregnant women Work with 3rd sector staff to promote flu vaccination
• Attainment of the national influenzavaccination targets
More children receive childhood vaccinations
Pilot pathways for health visitors and GP practices to follow up children who have missedscheduled vaccinations
Work with schools to increase pupil knowledge of vaccination Scope the feasibility and potential impact of an Active Follow Up approach in Powys
• Attainment of the national childhoodvaccination targets
Children are healthier and fewer are obese
Identify and implement priority interventions that will have an impact on childhood obesitylevels
Weight management services (Level 2 & 3) for overweight and obese children Implement the National Healthy Child Wales programme
• Percentage of children aged 4/5classified as overweight or obese
Involving the People of Powys
What do we want to do?
What will success look like?
How will we do this? How will we measure success?
Develop and deliver strategic change proposals
through effective partnership working and continuous engagement
with the Powys population and stakeholders
Stakeholders are engaged in the HBs plans and activities
Development of Stakeholder and Communication Strategies and website development Deliver the Board’s Strategic Delivery Model Programme, including a process of
engagement
Strategies approved Completion of milestones for each
programme
The Powys voice has influence in our partner
strategic change programmes
Fully participate in the following strategic change programmes: Mid-Wales Health Collaborative Future Fit South Wales Programme Hereford Transformation Programme
Completion of milestones for eachprogramme
Maximise opportunities for integrated working with Powys County Council
Integrated working in place providing
excellent, seamless care.
Develop joint strategy, work programme, governance and scrutiny arrangements including ajoint Information Management Technology strategy and implement the OrganisationPartnership Development Programme
Deliver tHB approved actions within the One Powys Plan and prepare stakeholderengagement strategy in partnership with LSB
Delivery of outcomes in LSBAnnual Report
Shared approach to Workforce andOD and employee engagementagreed
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Ensuring the Right Access
What do we want to do?
What will success look like?
How will we do this? How will we measure success?
Increase the capacity and resilience of primary care
and community services to deliver a greater proportion
of care in Powys
Fewer Emergency Admissions
Virtual Ward and Community Resource Team Model in place in Mid and North Powys Enhance the coordination of care and improve patient flow through community hospitals Develop Pharmaceutical Needs Assessment and integrated pharmaceutical care models Introduce lifestyle and psychological support to help the management of chronic conditions Look at further development of health and wellbeing centres across Powys and integrated
re-ablement beds and delivering integrated health and social care services for olderpeople
Redesign respiratory specialist nursing team and therapy support
• Rate of emergency admissions and re-admissions
More services delivered in Powys
Increase the local delivery of diagnostic services and local ultrasound scanning Maximise the potential of optometrists working in Powys and the role of local and visiting
dental staff and improving access to oral surgery Identify appropriate paediatric services to be repatriated and develop robust children’s
community service and CHC nursing services Develop midwife led USS and day assessment service Maximise day case theatre and endoscopy performance
• Increased capacity and volume ofdiagnostics, eye care, Paediatric, dental, sonography, oral surgery, day case, endoscopy and Children’s community services, ,
Primary and community care
services are robust and sustainable
Developing the resources to support development of GP Clusters, implement supportmechanisms where required and support the creation of a new social enterprise
Implement consistent approach to demand and capacity planning across Powys provider
• Social Enterprise governancearrangements described for one GP cluster • Primary care cluster demonstratingimprovement against plans
Time patients wait for services is reduced
Improve coordination between primary and secondary care Improve access to local diagnostics Develop orthopaedics services: fracture clinics and CMATs Reduce missed GP appointments by texting appointment reminders Review and enhance the current Powys Referral Management System
• Waiting time targets met
Develop commissioning system that is innovative,
focused on patient outcomes ensuring timely,
high quality services
Commissioning is effective and robust
Establish a Commissioning Development Programme to design and implement a newcommissioning model using value based care pathways
Develop a primary care quality dashboard in Powys Strengthen joint commissioning arrangements with Powys County Council
• Commissioning Board established• Asst. Dir of Commissioning appointed• Commissioning Strategy andFramework approved • Commissioning Plans in place
Improve the mental health and emotional wellbeing of
the people of Powys
Mental Health Care is delivered locally,
supporting people in their communities
Implement NHS Adult mental Health management arrangements Implement Powys Community Intensive Teams for CAMHS Extend use of psychological therapies and Implement on-line Cognitive Behaviour
Therapy scheme Maximise flexibility of bed use in Powys for Powys residents Put in place pharmacy support for mental health services
Adult Mental Health servicesdelivered directly by the HB
Level of care delivered in thecommunity
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Striving for excellence
What do we want to do?
What will success look like?
How will we do this? How will we measure success?
Create a culture that places the patient first in everything that is done, embedding continuous improvement in safety,
quality and patient experience in all settings
Patient experience in all settings is of high
quality, safe care
Implement key milestones of the Quality Delivery Plan, including:- Develop Patient Experience Strategy; Develop Framework for Learning and Improving from concerns, patient and staff
feedback; Develop the Commissioning for Quality Performance Framework Implementing the Health and Safety Strategy.
Develop a data quality strategy and management function to manage all reference dataused
Appoint a external consultant to advise on a health and safety model that benefits theneeds of the health board
Finalise the arrangements with public health to secure and implement microbiologysupport to provide medical advice on infection prevention and control issues
Development of organisational capacity to support the delivery of quality and safetymonitoring to allow improvement in services and meet current and future needs
Targets for patient safety andexperience are met
Serious incidents and never eventrates
Timely and responsive handling ofconcerns
Patient records are managed efficiently
Appoint project manager to take forward the records appraisals and develop businesscase proposing solutions for managing patient medical records Business case approval
Develop an Estate that is fit for purpose and
progressing to meet service needs
Our buildings are safe, secure and suitable for
service delivery
Develop and implement a medium term Estates Strategy to achieve statutory complianceof the estate
Risk level for estates compliance Estates Strategy agreed
Develop a well governed organisation through
delivery of a Governance Improvement Programme
Improved patient safety and quality of
care
Implement effective system of internal control, risk management, performancemanagement and delivery
Policies up to date Number of internal audit
recommendations Risk Assurance framework in place
Create and implement a framework for systematically engaging in Quality Improvementincluding implementing the Health and Care Standards which came into effect 01/04/2015
Compliant with Welsh Language Act
Deliver improvements across the organisation, including primary and community care, inrespect of the Welsh Language Scheme
Welsh Quality Standardsassessment
Equality is routinely considered when
introducing changes
Strengthen the organisation’s approach to equalities, including the use of Equality ImpactAssessments (EIA)
EIAs undertaken for all strategicdecisions
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Making Every Pound Count
What do we want to do?
What will success look like?
How will we do this? How will we measure success?
Implement effective financial management to
ensure statutory breakeven
Effective financial management that supports strategic
direction
Develop approach to evaluating effectiveness of investments in primary care Implement the national approach to investment/disinvestment for commissioned services Develop and implement the organisational Financial Management improvement
programme
Primary care spending Implementation with Welsh
providers Financial Balance
Robust evidence available to support
service improvement
Further develop costing techniques and Business Intelligence Explore feasibility of delegating budgets to GP cluster or practice level Delivery against action pan
Always with Our Staff
What do we want to do?
What will success look like?
How will we do this? How will we measure
success?
Develop a sustainable, skilled and engaged
workforce fit to deliver the planned service
transformation to meet the needs of the population of
Powys
Develop an engaged workforce
Develop and use Values and behaviour framework to inform recruitment, appraisals, staffdevelopment and ways of working
Implement communications strategy
Staff survey Personal Development review and
performance appraisal rates
Workforce is skilled and sustainable
Support GP practices to recruit to hard to fill vacancies in GPs and Practice Nurses. Launch leadership and management core competence framework, identifying skills gaps Develop Advanced Practitioners in the following fields Explore possible alternatives of Physician Associates Co-ordinate the Primary Care Workforce Development Group.
Recruitment and retentionframework in place
Advanced practitioners in place Improved compliance with
statutory and mandatory training
Workforce is supported to stay healthy
Align a refreshed Team Based Working programme with values and behaviours,Improving Quality Together, Managing Change, Leadership and Managementdevelopment
Ensure consistent application of Sickness Policy and associated policies to ensureemployees are supported to maximise their attendance at work
Refocus work of Well Being at Work group aligning to the Health and Wellbeing and ODstrategy.
Staff sickness and absence rates
Workforce is efficient
Implement recruitment and retention strategy Develop succession planning and talent management Fully realise the benefits from full deployment of electronic systems, in particular Electronic
Staff Record (ESR) and ESR 2 including Self Service and Manager Self Service andensure integration with other systems and OD work
Develop a business case and implementation plan for e-Rostering
E-rostering in place Benefits delivered from electronic
systems
Workforce is integrated
Develop our Health Care Support worker Strategy based on our known priorities for thenext 3 years
Implementation of the Organisation Partnership Development Programme to support theOne Powys Plan
Delivery of programme milestones
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