Cwm Taf University Health Board held its latest Board meeting on January 31st 2018 at Ynysmeurig House in Abercynon. This bulletin sets out the key messages from the meeting about healthcare provision in Cwm Taf.

You can read the full Board papers here but if you have any queries or questions about the issues discussed please do not hesitate to contact the communications team at [email protected]

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Cwm Taf staff continue to manage increased winter pressures

Board members expressed their thanks and gratitude to staff across the health board for their ‘tremendous’ efforts and commitment in dealing with increased service pressures.

Cwm Taf, like other health boards in Wales and across the UK continues to manage significant demand within the emergency care system but is making every effort to respond quickly and provide the best possible care to all its patients.

The health board has implemented the actions set out in its Winter Resilience Plan and whilst significantly challenging, the position across three key performance measures has improved on last year.

The health board is maximsing all available resources within its primary, secondary and community care teams including new initiatives such as the ‘Stay Well @Home Service’ which identifies patients who can be cared for at home with targeted support from partner agencies. Close working is also taking place with the Welsh Ambulance Service to manage chronic conditions such as diabetes and respiratory care; as well as signposting of patients to alternative professionals such as dentists, optometrists and pharmacists.

The virtual ward concept at St Johns Surgery in Aberdare continues to be developed with support from community paramedics, occupational therapists, physiotherapists and other key professionals and discussions are underway to develop the next phase of this initiative for roll out across the Cwm Taf area. Out of a group of 150 patients there has been a 60% decrease in GP appointments, 80% decrease in hospital admissions and a 90% reduction in Out of Hours service demand.

The health board continues to adopt a zero tolerance approach to ambulance delays at both emergency departments and patients are brought into the hospitals as quickly and as safely as possible. Whilst this approach can bring challenges to the departments, we believe that patient safety risks are more appropriately managed and the early release of the ambulance crews helps to maintain ambulance response time performance for immediately life threatening calls.

The Board also discussed the recent letter submitted by a number of Accident & Emergency Consultants across NHS Wales to the First Minister and considered whether there were any further actions that the health board needed to be taking, in addition to those outlined within its winter plan. A further review will also feature within the work of the Quality, Safety and Risk Committee.

Cwm Taf trainees celebrate graduation!

Cwm Taf’s first Board meeting of 2018 congratulated the first ever cohort of its local graduate management trainees for completing their 2 year programme!

Cwm Taf’s Graduate-Growth programme introduces participants to the skills required for effective management and supports them to develop leadership skills in a variety of patient facing and corporate support services. Working alongside clinicians and other professional staff, the ‘on the job’ training programme is the first to be introduced in NHS Wales, and following its success Cwm Taf’s chief executive Allison Williams is now leading the programme on behalf of other health boards to increase the numbers of home-grown management talent.

Cwm Taf’s graduate management trainees from left to right Naomi Davies; Hannah Brunskill; Abigail Powell; Toni Davies and Caitlin Jacob. Matthew Swarfield was unfortunately unable to attend the Board meeting but was also congratulated for completing the programme.

New vice Chair appointment

Maria Thomas (former Independent Board Member) has been appointed the Vice Chair of Cwm Taf University Health Board by the Cabinet Secretary for Health and Social Care Vaughan Gething, from 1 January 2018 until September 2021.

Maria has worked in the NHS for more than 40 years both as a nurse as well as the Executive Director of Nursing for the former Merthyr Tydfil Local Health Board. An active member of the local community, Maria is a Trustee of Voluntary Action Merthyr Tydfil, Safer Merthyr Tydfil, St David Community Hall, and Cancer Aid Merthyr Tydfil. She has also served as an Independent member of Cwm Taf UHB for the past four years, chairing the Quality and Patient Safety Committee.

Last month she was awarded the British Empire Medal (BEM) in the Queen’s New Year’s Honours list.

Paediatric, Neonatal and Obstetric Services

Later this summer the multi-million pound expansion of maternity and neonatal facilities at Prince Charles Hospital in Merthyr Tydfil will be completed and the health board will be ready to implement some of the key changes set out in the South Wales Programme.

Board members were updated on the progress being made in implementing the plans which includes staff briefings and the development of a major public communications exercise in the coming months to inform expectant mothers, members of the public, the Community Health Council, local authorities and other stakeholders of the changes.

The South Wales Programme (SWP), a major public consultation exercise spanning four health board areas, was set up in 2013 to address the challenges faced by many hospitals in recruiting and retaining highly skilled staff in certain speciality areas. It concluded that consultant-led maternity and inpatient children’s services would in future need to be provided at fewer hospitals across South Wales to ensure they could continue for the future, and provide the best possible care for patients. Prince Charles Hospital was identified as one of five hospitals that would continue to provide these specialist services. The other sites would be the Princess of Wales Hospital in Bridgend; the University Hospital of Wales in Cardiff, Morriston Hospital in Swansea and the Grange University Hospital (previously referred to as the SCCC) which is the new hospital that is being built in the Aneurin Bevan Health Board area covering Newport.

It means that consultant-led maternity and inpatient children’s services will no longer be delivered from the Royal Glamorgan Hospital from late Summer 2018. However, the hospital will still provide a Midwife-led birthing centre, open 24 hours, and a Paediatric Assessment Unit which will be open from 8am until 10pm.  To accommodate the changes, a major expansion is underway at Prince Charles Hospital and is due for completion later in 2018. More than £6m has been invested to increase the size of the neonatal unit to 19 cots, redevelop the obstetric labour ward, refurbish the birthing rooms, and provide two birthing pools.

In the meantime however it is business as usual at the Royal Glamorgan Hospital and regular updates and progress reports will continue to be provided in the coming months via all our communication channels.

Bridgend Local Government boundary change proposal

The Welsh government consultation on proposals to re-align the Bridgend local authority boundary within the footprint of the Cwm Taf University Health board area is ongoing, with members of the public encouraged to have their say until March 7th 2018.

This follows the publication of the White Paper in January 2017 Reforming Local

Government: Resilient and Renewed which looked at ways of strengthening

local government’s ability to work together to meet the challenges it and other

public services face across Wales.

The consultation can be found via the following links:

https://consultations.gov.wales/consultations/proposed-health-board-boundary-changebridgend

https://ymgyngoriadau.llyw.cymru/ymgyngoriadau/newid-arfaethedig-i-ffin-y-byrddauiechyd-ym-mhen-y-bont-ar-ogwr

District Nursing Service to pilot Dutch model of care for the elderly

The District Nursing Service in Cwm Taf University Health Board has been chosen as a pilot site by Welsh Government to implement a Dutch model of community nursing for the elderly.

Jos De Blok developed the Buurtzog (which means “neighbourhood care” in Dutch) approach to support and care for older people in their communities. In De Blok’s experience of nursing, unnecessary bureaucracy was having an impact on service delivery, and that the influence of nurses was diminishing.

The model will support our teams to respond to the increasing demand and complexity of many of our patients and will support patient flow, provide better access to palliative care and avoid hospital admissions.

A project group will be established to determine how the initiative will be implemented and look at the opportunities for joint working with Powys and

Aneurin Bevan health boards who have also received funding. The potential additional funding from other institutions to progress this model will also be explored.

Health Board performance

For December, performance against the 4 hour A&E waiting times target was 82.9% (down from 90% in November), due to ongoing winter pressures.

The positive performance across unscheduled care has resulted in only 21 elective patients being cancelled due to lack of beds during the period April to December 2017.

December performance for emergency ambulance services against the 15 minute handover target was a provisional 89.4%, a modest reduction from the confirmed November position of 89.6%. Performance against the Red Ambulance target was 74.2% for November, with the All Wales average being 73.3%.

The number of beds lost to Delayed Transfers of Care in December reduced by 44% from November. This is a similar level to December 2016 and the challenge will be to maintain a similarly low level for the remainder of the year.

You can find more data on health board performance here in Agenda item 4 – Integrated Performance Dashboard

Cwm Taf’s three-year Plan

The Board approved its ‘draft’ Integrated Medium Term Plan for 2018-21, ahead of its submission to Welsh Government. Cwm Taf is the only Health Board in Wales to have had an approved plan for four successive years.

Following consideration and approval by the Board, work will now continue to further develop the Plan including, considering the feedback from Welsh Government and development of individual Directorate plans. The final IMTP will be submitted to Welsh Government, following consideration by the Board, on March 29th for approval.

Future of Thoracics services in South Wales

In recent months the Welsh Health Specialised Services Committee (WHSSC) has worked with a range of individuals and organisations, including Health Boards, to review the provision of thoracic surgery in South Wales.

As part of this process, an independent panel also reviewed the evidence and made a recommendation on how best to ensure these specialist services would be sustainable for the future and provide patients with the best possible care.

In January, the Joint Committee of the Welsh Health Specialised Services Committee (WHSSC) – which is made up of the chief executives of all Health Boards – accepted the recommendations of the Independent Panel that services should be provided from a single site rather the current two sites in Cardiff and Swansea, and that the new single unit should be based in Morriston Hospital, Swansea.

Further work and engagement will now be carried out on the implementation of such a change with all key partners and stakeholders including Health Boards and local Community Health Councils.

Gardening on prescription will boost well-being in Rhondda

Patients in Rhondda may be offered gardening on prescription to help to improve their wellbeing. Rachel Bennett, a GP at Forest View practice in Treorchy, came up with the idea of Grow Rhondda, a therapeutic gardening group designed for people presenting with mild anxiety, low mood, low self-esteem or social isolation.

Patients can now be referred directly to the eight week gardening programme which is based at Ysbyty George Thomas. The project is a joint venture by Rhondda primary care, Ysbyty George Thomas and the community group Men’s Sheds who will deliver the sessions to cultivate courtyard gardens at the hospital.

Men’s Sheds was first developed in Australia to help to combat male isolation but has spread to the UK and Ireland. There are now 32 ‘sheds’ in Wales. The project combines the growing interest of primary care in well-being, brings the local hospital into the community and links with community groups.

Grow Rhondda was officially launched by the chair of Cwm Taf University Health Board Marcus Longley. He said: “The health board is committed to improving the health and well-being of the people we serve. This is exactly the sort of thing we need to support this in practice. It is a tremendous initiative and I hope to see similar projects grow across the health board area.”

You can watch a short video of the gardening project here