Cwm Taf University Health Board held its latest Board meeting on January 27th at Ynysmeurig House in Abercynon. This bulletin sets out the key messages from the meeting about healthcare provision in Cwm Taf.
Board welcomes implementation of the ‘front door’ Acute Medicine service at Royal Glamorgan Hospital
Deputy Health Minister Vaughan Gething officially opened a new acute medicine service at Royal Glamorgan Hospital (RGH) last week which will treat the increasing number of patients attending the A&E department with complex medical conditions (January 21st).
RGH is only one of a few hospitals in the UK to recalibrate the way in which it delivers emergency hospital care, offering faster diagnosis and tailor made care that will bring specialists to the bedside.
Access to the service, which is located near the front door of A&E will be via GP referral, paramedic or the A&E department. It will be staffed 24/7 by acute medical doctors and advanced nurse practitioners, supported by a wider team of therapists and pharmacists.
Robust plans help to manage winter pressures
The winter months have provided the usual challenges in Cwm Taf and across NHS Wales with higher levels of escalation over recent weeks, particularly in our A&E departments.
However robust winter plans, in partnership with the local authorities, are working effectively to reduce some of the pressures along with a nationwide campaign by NHS Wales encouraging people to ‘Choose Well’ when they need health services. The pressures have been exacerbated by the need to temporarily reduce beds in Royal Glamorgan Hospital due to nurse staffing levels which is being addressed.
As always staff have been supportive and flexible in responding to the increased pressures across the healthcare system and the Board recognised and thanked staff.
Surgical Assessment Unit opens at Prince Charles Hospital
A new Surgical Assessment Unit (SAU) opened at Prince Charles Hospital on January 18th providing a central point of access for surgical emergencies and taking referrals from bed managers, A&E staff and other consultant teams.
The aim of the SAU is to provide a central point of access to assess, stabilise, investigate and initiate treatment. Diagnostic support will be provided to identify those patients who require admission to a ward or those that could be safely discharged with a follow-up appointment at a ‘Hot Clinic’. The Consultant on-call will run a ‘Hot Clinic’ each morning (Monday to Friday 10am – 12 noon) from outpatients.
The Board approved a decision to proceed with enabling capital works to develop the shell and related infrastructure at the Royal Glamorgan Hospital for the implementation of a second CT Scanner. This facility will provide much needed additional diagnostic capacity and the enabling work will run in parallel with the Health Board’s submission of the related diagnostic hub business case to Welsh Government.
GP Out of Hours re-design leads to a more stable and sustainable service
Following the re-design of the out of hours’ service in September 40 sessional GPs have been recruited to support the new model. Face to face out of hours GP appointments are now held at Prince Charles Hospital in Merthyr Tydfil and Royal Glamorgan in Llantrisant. The service operates close to, but clinically separate from the A&E departments of both hospitals. The re-design was supported by a £500,000 investment by the Health Board to strengthen the service and expand workforce to include nurse practitioners.
The Board recognised the progress made and the challenges that remain and will review the outcome of the 6 month evaluation later in the year.
Cwm Taf Community Health Council chair Mary Williams complimented health board staff on the engagement around the new service and the way in which the re-design had been developed and confirmed that the CHC will continue to work with the Health Board in monitoring the new arrangements.
Health Board’s ‘Draft’ Three-Year Plan built on ‘ambition’ and ‘innovation’
Key planks of the health board’s ‘Draft’ refreshed Integrated Medium Term Plan (IMTP) from 2016-2019, include a focus on embedding the principles of prudent healthcare, further strengthening primary and community care services and an increased focus on performance, particularly for unscheduled and planned care.
• Implementing the UHB’s new Primary and Community Care Delivery Plan;
• Embedding the new Acute Medicine model at Royal Glamorgan Hospital;
• Development of Dewi Sant Health Park;
• Development of a new model of critical care;
• Completion of capital works at Prince Charles Hospital to support the implementation of the Paediatric, Obstetric and Neonatal model;
• Development of the Diagnostic Hub and Paediatric Assessment Unit at Royal Glamorgan Hospital.
The ‘draft’ plan will be developed further and finalised by the end of March for Board approval and submission to Welsh Government for Ministerial approval.
Appointment Reminder Service expanded to cut missed appointments
Following the successful roll out of the text reminder service in 2015, Cwm Taf UHB recently expanded the service to include free voice reminders, with the aim of further reducing missed hospital appointments.
More than 72,000 appointments were missed in Cwm Taf Hospitals last year taking up valuable slots that could have been used for other patients. The aim of the new service is to reduce the number of patients who do not attend by 30%, freeing up more than 21,000 appointments for those who need them.
Clinical Service Delivery Plan and Annual Reports show progress
The Health Board considered four Annual Reports relating to Together for Mental Health; Cancer; Diabetes and Neurological conditions and a refreshed End of Life Care Delivery Plan. All Annual Reports identified areas of improvement in service development and delivery and identified some improved outcomes for patients. The End of Life Care Delivery Plan focused on the improvements progressed over the last year with GP Facilitators and the work of the Advance Care Planning Team and outlined priority areas to progress in the coming year.
Social Services and Wellbeing Act to be embedded into healthcare provision
Cwm Taf UHB continues to work in partnership with local authority colleagues to develop our collective approach to implementing the requirements of the Social Services and Well-being Act. A Regional Implementation Plan has been developed and will be monitored closely by Board members in the coming months.
Health Board performance
Performance delivery is also linked to operational pressures and this report was considered against a number of updates received at the Board meeting. The Board noted the actions being taken to improve performance in a number of areas; not least;
• Unscheduled Care
• Referral to Treatment (RTT);
• Stroke; and
• Cancer targets (31 and 62 day targets).
The Board also noted and welcomed the publication, through the Emergency Ambulance Services Committee (EASC), of the new Ambulance Quality Indicators.
The Board received a detailed update of the month 9 financial position, its impact on the remainder of this financial year and the challenging underlying financial position of the Health Board going forward into 2016-19, linked to the IMTP.
During December 2015, a number of financial issues positively impacted on the Month 9 financial position, albeit primarily on a non recurrent basis, resulting in projected in year slippage of £7.1m. This included anticipated continuing healthcare expenditure of £2.4m and legal claims expenditure of £1m being deferred into next year, along with confirmed funding settlements linked to our current plan and additional monies to reduce patient waiting times.
The Board endorsed decisions to assist its overall financial challenges this year and going forward, including some increased resource directed to its discretionary capital programme, but also recognised the significant underlying recurring financial issues outlined within the ‘draft’ 2016-2019 Plan.