Hywel Dda University Health Board Annual Plan 2017/18 Action Plans YR HYWEL DDA A GAREM ...

509 Pages·2017·8.48 MB·English

Hywel Dda University Health Board
Annual Plan 2017/18

Action Plans

SUBMISSION TO WELSH GOVERNMENT
st
31 MARCH 2017

YR HYWEL DDA
A GAREM

THE HYWEL DDA
WE WANT

1
Contents

Action Plan Page
Prevention and Public Health 3
Primary and Community Care 8
• Carmarthenshire 8
• Ceredigion 12
• Pembrokeshire 14
• Primary Care 16
A Regional Collaboration for Health (ARCH) 21
Mid Wales Healthcare Collaborative 22
Strategic Objectives 24
• SO1 Risk Taking Behaviours 24
• SO2 Overweight and Obesity 25
• SO3 Cardiovascular Disease 26
• SO4 Cancer Prevention) 27
• SO5 Diabetes 28
• SO6 Respiratory 30
• SO7 Mental Health 32
• SO8 Frailty and Dementia 34
Nursing Quality and Experience Improvement Plans 36
Service Improvement 51
Workforce and Organisational Development 53
Research and Development 59
Equality and Diversity 61
Governance 68
Communication and Engagement 75
Welsh Language 79
Carers 81

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PREVENTION AND PUBLIC HEALTH

(1) Action delivered on the Wellbeing of Future Generations Act and 2017/18 plans.
Ambition: to ensure comprehensive planning for the Act, and the undertaking of the new assessment.

What we planned to do in 2016/17 What we did What we are going to do in
2017/18
To provide professional support to the The Public Health Directorate were Provide professional support to the
Public Service Board (PSB) and active members of a number of local Public Service Boards (PSBs) and
Regional Partnership Board (RPB) in and regional groups driving forward Regional Partnership Board (RPB) in
the development of local and regional the activity required to develop the the development of the Area Plan
Needs Assessments Population and Wellbeing and Local Wellbeing Plans to ensure
assessments. The voice of the that the impact on health is taken
citizen was central to our engagement into account when considering and
approaches and a regional toolkit was agreeing priorities for local and
developed to ensure a consistent regional action.
approach to gathering views on the
state of wellbeing or the care and
support needs of our current
populations.
Support integration of public health Delivery of awareness raising Continue to promote the ACEs
priorities within county level strategic sessions at county level and regional research and work with partners to
partnership structures and plans strategic partnership meetings on the agree collaborative action, through
impact of Adverse Childhood the development of Area Plans and
Experiences (ACEs). Local Wellbeing Plans that will
proactively tackle ACEs.

(2) Action delivered on Smoking Cessation and Tobacco Control and plans for 2017/18
Ambition: Our ambition as a University Health Board is reduce smoking prevalence in the population through
increasing service capacity to support smoking cessation through expansion of the Hospital Smoking Cessation
Service and ensuring wide ranging uptake and full implementation of Community Pharmacy Level 3 Smoking
Cessation Services

What we said we would do in What we have done. What we will do in 2017/18.
2016/17.
Continue to recruit pharmacists to 34 pharmacists recruited • Ongoing recruitment
provide smoking cessation support • Train pharmacy Technicians
as detailed in the Additional Funding • Undertake audit to review service
for Primary Care Delivery Agreement delivery
• Support development of an
integrated smoking cessation
service (all local providers)
Continue to develop and deliver the Developed a joint approach between • Support development of an
in-hospital smoking cessation service UHB Respiratory Services and Public integrated smoking cessation
as detailed in the Additional Funding Health Directorate. service (all local providers).
for Primary Care Delivery Agreement. • Support pilot of patient
management systems.

Continue to deliver the Early Years Midwives have received training and • Continues to support Midwifes
Smoking Cessation programme as equipment to ensure compliance with through training/.
detailed in the Additional Funding for NICE Guidance 26 • Audit Maternity Record to ensure
Primary Care Delivery Agreement. compliance with CO monitoring
guidance
• Work with Health Visiting service
to identify training needs in
relation to smoking cessation and
smoke free homes and cars.
• Work with School Health Nursing
teams to develop brief advice
training to support their role in
promoting smoking cessation.
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(3) Action delivered for Alcohol and Substance Misuse and plans for 2017/18
Ambition: To reduce alcohol consumption and substance misuse in line with the new Welsh Government strategy
and promote a healthier conversation around these topic areas.

What we said we would do in 2016/17 What we have done What we will do in 2017/18
Lead on commissioning, partnership • Provided programme and Continue to provide commissioning,
development, financial management, project management to financial and programme and project
strategy programme planning and review the annual delivery management support to the regional
project management support for the plans in line with the new WG partnership for drug and alcohol
regional partnership for drug and alcohol Delivery Plan. misuse, the Area Planning Board and
misuse (the Area Planning Board) and • Governance workshops held implementation of the priorities
the Health Board. • Draft partnership agreement identified via the Commissioning
between APB partners Strategy for Drug and Alcohol Misuse
• Commenced work on the which will include:
development of the third - Tackling Alcohol related Brain
commissioning strategy. damage
• Submitted a business case - Co-occurring substance misuse
and mental health pathways
for the pilot of an alcohol
screening and brief - Developing a more co-ordinated
intervention service within a approach to drug and alcohol
Pharmacy setting. education for young people within
schools, NEETS and home
schooled
Development and implementation of • Estates strategy produced Continue to develop and lead on the
APB Estates Strategy and capital work and submitted to Welsh estates planning for drug and alcohol
programme Government. service delivery, including securing of
• Service base in Abertyswyth, long term bases in Llanelli and
Ceredigion secured for a Pembrokeshire.
further five year period.
• Options for Pembrokeshire
and Llanelli still being
explored.
Establish, develop, implement and • Multi agency action plan in Continue to take action to ensure a
manage a robust processes for the place to tackle drug related reduction in drug related deaths
review of both fatal and non fatal drug deaths through a robust process for the
overdoses and lead on multi agency • Multi agency case reviews review of fatal and non fatal
case review process on behalf of the undertaken with lessons overdoses.
APB learned reports produced.
• Development discussions
held over role out of
‘Prenoxad’ across hospital
sites .
Provide support for the further Business case submitted for Continue to provide support for the
development and roll out of the Alcohol funding for an Alcohol Liaison further roll out of the Alcohol Liaison
Liaison Nurse scheme in secondary care Nurse in Withybush in order to Service.
settings in the UHB. ensure equitable service delivery

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(4) Action delivered on the overweight and obesity agenda and plans for 2017/18
Ambition: Our ambition as a University Health Board is to work with our partners to ”turn the curve‟ in the upward
trend in individuals being overweight and to support families to give the next generation a greater chance of health.

What we said we would do in 2016/17 What we have done What we will do in 2017/18
Work in collaboration with other partners Concept of ‘10 Steps to a healthy Continue to develop and embed ‘10
of the public health system to develop, weight’ launched, promoted and Steps to a healthy weight’ across
deliver and support existing programmes embedded within all three county children’s and parents’ setting in
which aim to promote a healthy weight, 3 Healthy and Sustainable Pre- conjunction with all public health
especially in the first 1000 days (from School schemes. Directorate work plans with
conception to 2 years old – pregnancy Additional resources secured. additional focus on the promotion of
and early years). physical activity.
Continue to deliver the Early Years Joint approach between Public • Continue to develop and extend
Obesity Prevention programme, as Health, Midwifery services and the service and extend reach
detailed in the Additional Funding for local authority Exercise Referral across the 3 counties.
Primary Care Delivery Agreement. developed. Training and referral • Ensure all ‘Baby Let’s Move’ staff
systems established. are trained in the new ‘Foodwise
Publicity materials developed. in Pregnancy’ training package.
Services launched with referral • Monitor and evaluate.
now being received through
Midwives.
Qualitative research into Work with School Health Nursing
professional perceptions of teams to develop brief advice training
overweight and obesity in to support their role
maternal and early years Work with Health Visiting service to
conducted. Report finalised in identify training needs in relation to
November 2016. promoting healthy weight.
Development of a short film and • Develop communications
poster promoting healthy eating in plan
pregnancy, particularly to those • Monitor reach and evaluate
with lower literacy levels. feedback from pregnant
women and Midwives.
Continue to further develop the Lifestyle First year programme complete Second year programme agreed with
Advocates programme within primary and evaluated positively. Primary Care Clusters .
care clusters.
Develop and implement services for Business cases for adult services Continue to provide evidence and
Obesity Pathway Level 2 and 3 for at Level 2 and Level 3 developed information for the need to develop
children and adults. and submitted for consideration appropriate services across the levels
and prioritisation. of the All Wales Obesity Pathway
framework.
Continue to work in partnership to Walking initiatives promoted and Continue to work with partners,
support initiatives that increase physical bilingual resources developed. particularly in Primary Care and Local
activity and reduce sedentary behaviour. Playful walks promoted for Authority Leisure Services to promote
children and families in physical activity opportunities,
conjunction with partners. including targeted interventions for
Physical activity for older adults young people and frail elderly.
promoted.
Physical activity promoted as
positive for mental health and
wellbeing.
Local authority partners
supported to deliver physical
activity programme for young
people disengaged from team or
group activities.

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(5) Action delivered on increasing survival rates for cancer through prevention, screening, earlier diagnosis,
faster access to treatment and improved survivorship programmes and plans for 2017/18
Ambition: Our ambition as a University Health Board is to work with our partners to decrease mortality rates from
cancer in the general population, and to increase survival rates of those who have been diagnosed with cancer.

What we said we would What we have done What we will do in 2017/18
do in 2016/17
Prevention of cancer Work underway on obesity, alcohol, sexual See separate sections on smoking,
health and smoking – see other sections. obesity, alcohol and sexual health.
Early detection • Screening: The Screening for Life campaign • Bowel Screening Uptake project
in 2016 aimed to raise awareness of cancer will be carried out across four of
and improve uptake of bowel, breast and seven GP Cluster areas
cervical cancer screening programmes. • Promote uptake of screening
Action is targeted on improving bowel through Screening for Life 2017
screening rates through joint working with campaign
primary care clusters and the third sector. • Explore business case
• Bowel Cancer Screening uptake – patient opportunities for additional
participation project. Working with the Third investment in campaigns to raise
Sector and community groups we undertook awareness of symptoms among
638 conversations with individuals within the general population
the target age group to explore views on
uptake of the screening programme192
structured questionnaires were completed,
13 case studies were gathered, and focus
group discussions were held. The results
will inform the Screening for Life 2017
campaign.
• Commitment secured from 4/7 Primary
Care Clusters to work to increase the
uptake of Bowel Screening invitations.
• Appointment of Hywel Dda Macmillan
funded GP Cancer lead.
Survivorship • We conducted a scoping review of the • During 2017/18 we will establish a
literature on survivorship which will inform Task and Finish Group on
the work of the survivorship Task and Finish survivorship, to review services in
group in 2017/18 place once patients are
discharged from cancer treatment
services, and identify
opportunities for the third sector to
get involved, to improve patients’
experiences and quality of life
post-treatment.

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(6) Action delivered on the early years agenda and plans for 2017/18.
Ambition: To provide comprehensive coverage of the universal health services as per the Healthy Child Wales
Programme, and work with partners to deliver innovate services for our families and children.

What we said we would What we have done What we will do in 2017/18.
do in 2016/17
Promoting the principles of Commenced Implementation of the Welsh Deliver the HCWP within allocated
effective partnership Government (WG) Healthy Child Wales Health Visiting and School Nursing
working to improve health Programme (HCWP) 0-7 years from October 1st resource.
outcomes Health Visiting Workforce trained in Maternal Undertake MIMHS assessment for
Infant Mental Health (MIMHS) all new born parent and baby as Part
of the HCWP
Continued partnership working with the 3 Local Continue partnership working
Authorities delivering the Health Visiting element alignment Flying Start Health Visiting
on the Flying Start Agenda 0-4 years Programme with the HCWP.
Representation from the School Nursing Implementation of the revised
Management Team on WG Task and Finish framework including identification of
review of the School Nursing Framework. workforce resource.
Provide a comprehensive accessible to school
aged children and young people within the
community

Work with Local Authority Contributed to the development of Families First Continue to deliver the Flying Start
partners to deliver Welsh plans and Flying Start programme plans in Health Visiting programme and
Government tackling conjunction with the Local Authorities to ensure partnership projects focused on
poverty programme that there are a range of projects which will responding to the needs of the most
activities across the deliver on the WG population indicators, vulnerable young people e.g. HDUHB
Health Board including health outcomes. Youth Health Team.

The above is simply an illustration of the range of activities underway. We also have significant ambitions and
achieved significant progress in the following areas:
Mental wellbeing - Ambition: To promote healthier mental wellbeing amongst our communities, and promote the
Five Ways to Wellbeing approach within the organisation and with partners.
Immunisation and Vaccinations - Ambition: Our ambition as a University Health Board is to support our partners
in primary care to increase the uptake of immunisations and vaccinations in eligible populations. This ambition
extends to both childhood and adult schedules of vaccinations with a particular focus on actions to reach Tier 1 Welsh
Government targets.
Community Resilience – Ambition: We want to see our communities growing in resilience and to develop greater
self care approaches.
Sexual Health – Ambition: To develop an up-to-date strategy on sexual health and wellbeing for our population and
to transfer the service hub to a more modern environment.

7
PRIMARY AND COMMUNITY CARE
Carmarthenshire
Carmarthenshire
Objective 1: Community, Universal and Prevention (the Currently well person)
Service
Task Action Q1 Q2 Q3 Q4
area
To consider WG response to Population Needs Assessment
√
submitted
Locality Leadership Teams to co produce Locality Plans with
Population Areas Plans / √ √ √
all stakeholders
Needs Cluster and
Measurables: Monthly Locality Leadership Group Meetings in
Assessment Locality Plans √
place
Draft Locality Plan produced and shared for consultation and
√
signed off
‘Proof of Concept’ service evaluated and substantive service
√
established
Single Point of
Performance Framework developed and reporting
Access √
mechanisms established
Performance reviewed monthly and assurance provided √ √ √
IAA
Independent
ILC ‘goes live’ √
Living Centre
‘Dewis’ established and information quality assured and
Directory of √ √ √ √
updated
Service
Performance monitored as per governance outlined √ √ √ √
Evaluate CUSP pilot from Q4 16 / 17 in Llanelli and extend to
Social √
Community 3Ts and Amman Gwendraeth
Prescription /
resilience Evaluate position against agreed performance measures and
PIVOT / CUSP √ √ √
its wider impact
Lifestyle Primary Care

advocates
Public
Obesity
Health & Public Health
pathways
Engagement
Smoking
Public Health
cessation
Evaluate current provision ‘Strength and Balance’ programmes
√
in the community
Develop plan for improving and extending to other specialist
√
National populations
Exercise
Leisure Implement plan for specialist populations √
Referral
Scheme Review performance across provision √
Evaluate current position and consider proposals for future
√
development
Submit proposals for future development for 2018/19 √
Submission of proposals to ICF to enhance ‘Care and Repair’
resource based on ‘proof of concept’ Information, Advice and √
Assistance and its impact on increased referrals to the service
Housing / Care and
Implement proposed ICF plans if approved by Integrated
Equipment Repair √
Services Board
Review performance across provision √
Submit proposals for future development for 2018/19 √
Social Worker appointed to support ‘Carers Information
√
Service’
Assessment Establish baseline position and develop the role to meet
√
and Support agreed targets
Review performance and improvement √ √
Carers
Submit proposals for future development for 2018/19 √
To progress GP practices from bronze level to silver level √ √ √ √
Investors in across all practices in Carmarthenshire.
Carers Develop / Identify ‘carer’ training opportunities √ √ √ √
To appoint carer champions. √ √ √ √

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Objective 2: Intermediate Care (Living with an ongoing condition)
Service area Task Action Q1 Q2 Q3 Q4
Implement new ‘short term assessment & acute response’ √
pathway based on intelligence gathered during Q4 ‘proof of
concept’ outlined in narrative above
Implement ‘long term care pathway’ based on intelligence √
gathered during Q4 ‘proof of concept’ outlined in the
narrative above
Recruitment to support the implementation of the pathways √

is ongoing in Q3 / Q4 16 / 17
Introduce ‘Care 2 Move’ into community hospitals. √
Recruitment of X4 HCSW ongoing in Q3 / Q4 16 / 17
Implement new ‘short term assessment & acute response’ √
Community pathway based on intelligence gathered during Q4 ‘proof of
Resource concept’ outlined in narrative above
Teams Implement ‘long term care pathway’ based on intelligence √
gathered during Q4 ‘proof of concept’ outlined in the
narrative above
Implement ‘long term care pathway’ based on intelligence √
gathered during Q4 ‘proof of concept’ outlined in the
narrative above
Recruitment to support the implementation of the pathways √

is ongoing in Q3 / Q4 16 / 17
Introduce ‘Care 2 Move’ into community hospitals. √
Recruitment of X4 HCSW ongoing in Q3 / Q4 16 / 17
(Multi
professional /
Review pathways against agreed measures and impact on √ √ √
multi skilled)
regional unscheduled care position
Workforce
Go Live’ at end of March 2016 for Carmarthenshire √

Service specification for ‘111’ in Carmarthenshire is being √
developed alongside the ‘proof of concept’ programme for
IAA and Community services outlined in the narrative
above. The service specification contains robust care
bundles which allow rapid access to support the following:
• Blocked catheters, √

• Frail adults ‘off their legs’ due to acute episode, √

• Palliative Care, √
111
• Mental Health, √

Consolidate implementation of pathways to ensure √
avoidance of conveyance. Monthly ‘highlight’ meetings with

WAST and ‘111’ to monitor position and response
Monthly ‘highlight’ meetings with WAST and ‘111’ to √ √ √

monitor position and response
Review pathways against agreed measures and impact on √ √ √

regional unscheduled care position
Consider proposals for service improvement in 17 / 18 √
Recommissioned provider services to commence and √
Reablement and
deliver against agreed standards.
Rapid Response
Joint
Domiciliary Care
Commissioning
Carmarthenshire
/ Pooled Introduce ‘Care 2 Move’ into community hospitals. √
Integrated
Budgets Recruitment of X4 HCSW ongoing in Q3 / Q4 16 / 17
Community
Consider recommendations of regional review and develop √
Equipment Store
action plan as appropriate
9
(CICES) ‘pooled budget’ in shadow format √

‘Pooled
Budgets’ for Review pathways against agreed measures and impact on √ √ √

Older adult regional unscheduled care position
Review pathways against agreed measures and impact on √ √ √
services
regional unscheduled care position
To ensure recruitment completed against agreed proposals
√
for 16 / 17
ICF Initiatives
To review existing programme against national and √ √ √ √
regional priorities and consider planning for 18 / 19
To review existing service and report against agreed √ √ √
measures. Monitor impact locally and regionally against
TOCALS; AAA;
unscheduled care targets.
MAST
To consider service enhancements and potential proposals
√
for ICF 18 / 19
To implement service in Glangwili General Hospital √
To review service through monthly ‘highlight’ meetings and
√
Rapid Access report against agreed measures.
Frailty Service To review impact of service on unscheduled care targets √
To evaluate service and consider enhancements for 18 /
√
Responsive 19
and To review existing service and report against agreed √ √ √
Proportionate measures. Monitor impact locally and regionally against
CCCT unscheduled care targets.
To consider service enhancements and potential proposals
√
for ICF 18 / 19
Project Implementation Document completed √

Regional Project Manager Appointed and Regional Project √
WCCIS; WCCG;
Board established and meetings progressing to implement
e-referrals
WCCIS across region by April 2018
Progress and exception reporting against timescales to √ √ √

Project Board

Objective 3: Long Term Care (The frail and vulnerable to losing life skills)
Service
Task Action Q1 Q2 Q3 Q4
area
Progress the ‘Releasing Time 2 Care’ initiative – this ensures √
that we reduce double handed care and high frequency calls
Long term where appropriate.
Prudent
conditions Review impact of initiative against unscheduled care targets √ √ √
commissioning
(including and national DTOC position
of long term
frailty; Evaluate outcomes at year end √
care
dementia)
Consider improvement proposals to submit √

Pilot of the Implement Pilot - To strengthen service in relation to hospice √
Palliative Amber care at home model throughout the 24 hour period
care and bundles in √ √
Review impact of the pilot
End of Life PPH and
Care WGH for one Consider substantive implementation of the bundles and
√
ward each site submission of proposals to support resourcing for 18 / 19
Core curriculum training to continue 4 times a year in Carms. √

Advance Specialist Wider community nursing to access specific training – to √

care palliative care achieve 25% by end Q1
planning team CDM nurses to be actively involved √

50% wider community nursing and CDM nurses attended √
10