Cwm Taf University Health Board held its latest Board meeting on January 30th 2019 at Ynysmeurig House in Abercynon. This bulletin sets out the key messages from the meeting about healthcare provision in Cwm Taf.
Board approves ‘ambitious but deliverable’ three-year Plan for health services in Cwm Taf
The health board’s Integrated Medium Term Plan (2019-2022) was unanimously endorsed by Board members before its submission to Welsh Government on January 31st.
The health board has successfully developed and delivered against its IMTP for a number of years; each year building on the success of the previous. The main challenge for the next three years will be maintaining and further improving quality and performance, whilst incorporating the population health needs of Bridgend residents into commissioning plans.
The updated NHS Planning Framework for 2019/20 requires Health Boards and NHS Trusts to demonstrate a whole systems approach to the provision of Health and Social Care. In reflecting the national strategy ‘A Healthier Wales: Our Plan for Health and Social Care’ the NHS Planning Framework sets out a requirement to break down the barriers that prevent health and social care services and their wider partners from operating across the whole system, delivering seamless care to the people of Wales.
Over the next three years the health board’s priorities will therefore include:
- Integration of services across the new Cwm Taf Health Board boundary
- A further strengthening of the focus on population health and the well-being of future generations;
- Working across the whole of the new Cwm Taf to finalise the UHB’s 10 year Clinical Services Strategy;
- Delivering on the Regional Partnership Board transformation ambition and further aligning Primary Care Clusters;
- Taking a strengthened workforce and OD approach across the whole of the new organisation, including innovation in recruitment, retention, career development and further building delivery capacity within the organisation;
- More sophisticated demand and capacity plans, and robust monitoring of their delivery
Bridgend boundary change
There are just eight weeks to go before the management of healthcare services for the Bridgend county borough area transfer to Cwm Taf University Health Board from Abertawe Bro Morgannwg University Health Board.
Both health boards are working closely via a Joint Transition Board to ensure a smooth transition on April 1st. The boundary change is administrative change involving transfer of responsibilities therefore no patient services are being reduced or lost and the way in which patients access and receive their care will be the same after April 1st.
The Minister for Health and Social Services has agreed to both health boards’ proposed name changes to reflect the change of geographical areas following the transfer. ABMU will become Swansea Bay University Health Board while Cwm Taf will become Cwm Taf Morgannwg University Health Board. You can keep up to date with progress on the boundary change here.
Cwm Taf Board responds to Welsh Government escalation
The Board emphasised its determination and commitment to address the issues raised by Welsh Government after its decision to escalate Cwm Taf from Level 1 ‘routine measures’ to Level 2 ‘enhanced monitoring’.
Cwm Taf has been at the lowest level of escalation, ‘routine’, since the performance framework was introduced in 2014 but has welcomed the short term enhanced support as a result of some of the issues the health board is currently addressing, including maternity services, an inspection by the Human Tissue Authority and its quality governance arrangements.
The levels are regularly reviewed between Welsh Government, Healthcare Inspectorate Wales and the Wales Audit Office. An organisation can be escalated in its entirety, for a particular service or for part of its business.
Chief executive Allison Williams told Board members that she hoped the organisation will build on the significant improvements already made in the areas identified to enable it to return to level 1 as soon as possible. Over the next few months the health board will be working with Welsh Government officials and colleagues from both Health Inspectorate Wales and Wales Audit Office to provide them with the necessary assurance to address the issues raised.
Maternity services update
The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives visited the health board in mid-January to conduct an independent review of Cwm Taf’s maternity services. The formal report will be published in the Spring but the health board responded to some immediate concerns by putting in place a range of actions following the three day visit.
These included improved medical rota arrangements; strengthened escalation processes with regards to staffing and more support for trainees. The health board has also brought forward the changes to the admission criteria for the Neonatal Unit in the Royal Glamorgan Hospital from 28 weeks to 32 weeks which were planned to coincide with the move of services to Prince Charles Hospital later this Spring. This brings the current arrangements in line with the rest of Wales.
Out of 43 previously identified cases that had resulted in an adverse outcome and may not have been properly investigated, eight cases remain to be reviewed, but will be completed as soon as possible. The health board has expressed its sincerest apologies for any distress and is continuing to work with Welsh Government and the Royal Colleges to put in place the required measures to deliver the best possible care.
Dutch ‘Neighbourhood Nursing’ pilot launches in Cwm Taf
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 Buurtzorg model is a neighbourhood based system with a focus on continuity of care delivered by a small team of nurses. The team will understand and know the community well, and have good relationships and informal networks within the local community, with GP’s, local authority partners, 3rd sector, allied health professionals and the local pharmacy.
The pilot will be undertaken in the North Cynon cluster with two district nursing teams based in Hirwaun. This will build on already strong working relationships within the cluster, further promoting partnership working.
Funding approved for Nurse Staffing Act
The Board approved the allocation of £4.5m to ensure compliance with the Nurse Staffing Act. The Act places a legal duty on all Health Boards to calculate the nurse staffing level using a specific formula and to take all reasonable steps to maintain that calculated nurse staffing level on the wards. The health board will now take steps to increase staffing through more intensive workforce planning; and further recruitment and retention campaigns but the Board noted that the shortage of nursing staff UK-wide would mean that practical implementation of the Act would be an ongoing and difficult challenge.
Launch of the Cwm Taf Creative Arts, Health and Wellbeing Strategy
Music on the wards, art therapy, reading sessions, and even concerts and drama productions will become a regular part of improving patients’ wellbeing across Cwm Taf thanks to a new strategy launched by the health board.
The arts can make a significant difference to the healing process, particularly those with mental or physical health challenges, memory loss or pain, and in improving patient and staff wellbeing.
The new Creative Arts, Health and Wellbeing Strategy sets out the health board’s vision of continuing to engage with patients, carers, staff, family, communities, and all our partners through the arts in its many forms.
The strategy was launched at Ysbyty Cwm Cynon in Mountain Ash by health board chair Professor Marcus Longley, with a special performance by the Tenovus choir and recognition for this year’s winners of the staff photography competition. YCC, along with the health board’s other hospitals, already regularly host a wide variety of concerts by schoolchildren and local choirs in the main foyers.
Staff, patients and members of the community are being asked for their ideas to help implement the strategy across Cwm Taf and are encouraged to contact the health board to make a pledge. For more information or to make a pledge please contact [email protected]
Closure of Brookside branch surgery in Aberfan
Cwm Taf University Health Board has consulted with the local community over the proposed closure of the Brookside branch surgery in Aberfan Community Centre to ensure the future sustainability of services in the area.
A decision has been made to close the branch surgery after lengthy consideration and the decision of the Health Board to award the contract for primary care services in the area to Morlais Medical Practice.
The team from Morlais will be able to offer all registered patients an improved service, with additional appointments and greater continuity of care at Brookside, as a result of this change.
The facilities at the branch in Aberfan made it difficult to provide a high standard of care, and the majority of services are already provided from the Brookside Surgery.
By having the team working across fewer sites Morlais Medical Practice will be able to offer improved communication and continuity of care with better access to both GPs and nurses. Services will be provided more efficiently by no longer having to spread reception, administration and clinical staff across both sites.
Head of primary care services Sarah Bradley said: “We are not asking any patients to leave the practice. All registered patients, including patients who are usually seen at the Aberfan branch, will be offered appointments at our Brookside surgery if they need to see a GP or a nurse.
“We will continue to offer home visits for all our frail and housebound patients. Any patients who choose not to remain registered with the practice will be supported and offered advice on how to re-register where needed.”
The health board is working with Merthyr Tydfil County Borough Council to explore the options to build a new all-purpose facility to accommodate the two remaining surgeries within the Aberfan/Troedyrhiw area.
Hospital performance including Referral to Treatment Times (RTT)
The number of patients waiting over 36 weeks has decreased from 317 in November to a provisional 297 in December, which is above the trajectory of 124 for year-end delivery. RTT performance continues to be scrutinised weekly as the health board strives to deliver the 36 week target on a sustainable basis.
The provisional position for December shows a slight reduction to 88.5% waiting less than 26 weeks from referral to treatment, which is well above the corresponding figure for December 2017.
Performance at a Health Board level for the 4 hour waiting time target in A&E for December reduced further to 82.98%. Individual hospital performance was 82.3% at Prince Charles Hospital (PCH) and 81.2% at Royal Glamorgan Hospital (RGH).
December performance for emergency ambulance services against the 15 minute handover target was 89.1%, compared to 89.5% in November. The December performance for emergency ambulance services over one hour was 99.9% (November 99.9%).