hywel dda health board forward planning process 2011/2012 ... · forward planning process 2011/2012...

Hywel DdaHealth Board

Hywel Dda Health Board

Forward Planning Process

2011/2012

Stakeholder Reference Group

Meeting 3rd May 2011


CARMARTHENSHIRE

FORWARD PLAN 2011/12


OVERVIEW - Vision

• Integrated Com,1#, 2#, Social & MH Care�Multi-agency and multi-disciplinary� Integrated Community Strategy

• 1#, Com & Social care service ‘infrastructure’�3 Primary / Community ‘Localities’�Community Resource Teams�ART�Continuing Care

• High quality / efficient acute care but reduced reliance on beds:�Focus on safety�LOS / efficiency


OVERVIEW - Profile

• Population (170k)� Ageing (22% 65 yrs+)

� Deprivation / inequalities

� Post industrial legacy (chronic conditions)

• Staff (3.5k WTE / 5k total):

� 120 GPs / 100+ Consultants / 1065 WTE NMR

� 78% female (35% 25-40yrs)

� 16% 55yrs+

• Estate

� 2 Acute Hospitals / 3 Community Hospitals

� 50 Care Homes (1145 beds)

� 24 GP practices / 27 Dental Practices

� 47 Pharmacies

� 32 Adult MH beds / 15 MHSOP beds


OVERVIEW - Profile

• Budget

� £207m

• Activity

� 184k OPs (61k new /123k f/ups)

� 31k IPs (6k elective / 25k emergency)

� 26k DCs

� 75k A&E attendances

� 1700 deliveries (2100 total cases)

� 240k District Nursing interventions

� 10k ART interventions


OVERVIEW

▪ Hywel Dda Context

– 42% HD landmass

– 48% HD population

– 54% HD population with physical / sensory disability

– 58% HD hospital activity (35% Ceredigion)

– 50% HD staff

• Strategic Location

– Net importer of acute work (west, north & east)

– Cross-border challenges (3 LAs)

• HD IP Centre – (ENT/Eyes/Urology/Vascular/Complex/Revisions)

• Host HD Services

– (Child & Adolescent / Sexual Health / Adult Psychology)


• Creation of Integrated Cohesive County Management Team Structure

– PERFORMANCE� Consistent Achievement of 95% RTT Target� AV Monthly Performance of 99% against 31 day Cancer Target of 98%� Improved Ophthalmic referral demand management leading to shorter waits at all stages of

the pathway� Consistent Long Stay Bed Reductions June → Oct� Consistent Qtr by Qtr Improvement in Combined Medical LOS� Continuous month on month reduction in volume and numbers in accumulated days delayed

(DTOC)

– SERVICE� Opening of 22 Convalescent Beds & Closure of 38 Acute Beds� Establishment of 3 Community Resource Teams� Introduction of MAST� Enhanced Stroke Service @ GGH� Transfer of Mental Health resources to community

– PRIMARY CARE� Delivery of QOF� Delivery of Access Targets� Delivery of Medicines Management Initiatives

ACHIEVEMENTS IN 2010/11


CHALLENGES IN 2010/2011

• Managing increase in emergency admissions - 9% in 2010/11 YTD compared with 2009/10

• An increasingly complex case mix being undertaken in Carmarthenshire

• Difficult to disinvest in acute & reinvest in community given service & financial pressures

• Agreeing changes to clinical practice in some specialties re:

�OPD FUP’s

� Improved Short Stay Procedures

�Focus on Case Mix AVLOS Emergency

• Delivery of further efficiency improvements in Theatre utilization

• Ensuring greater involvement in primary care strategy i.e.

�DES

�NES

�LES


• Shortage of Medical Staffing in Certain Specialties�A&E�General Surgery

• Critical Care Demand Pressures due to Rising Acuity

• Demographic change driven demand outpacing our ability to transfer services from Acute to Community leading to increases in EMA’s

• Poor OPD infrastructure which restricts the introduction of new ways of multi-disciplinary working – we will develop a primary care strategy for OP services

1 time09th Bed Open

7 times1 time8th Bed Open

29 times5 times7th Bed Open

20102009Additional Beds

CHALLENGES - cont/d


• Need to better quantify, recognise & resource activity transfers into

Carmarthenshire

� 27% reductions in EMA’s from Carmarthenshire treated in ABMU

� 15% reduction in elective and emergency orthopaedics from

Carmarthenshire treated in AMBU

CHALLENGES - cont/d


SWOT RISK ANALYSIS

County Risk Register

• The County Risk Register is managed by County Nurse with support from the Quality Improvement Manager

• Risk Leads have been identified for each ward/departmental area. These leads will be responsible for regularly monitoring & updating their risks using the Health Board pro-formas

• Quality Improvement Manager meeting with identified leads to advise/help as needed

• Action plans for risks scored 15. These will be monitored via the County Quality & Safety Committee

• The Top County Risks will be discussed at the County Quality & Safety Committee


Top 5 County Risks

Falls �

Violence & Aggression �

Medication Errors �

Pressure Sores �

Financial pressures �

Risk Current Trend


Service, Capital & Estate

DevelopmentsPrimary / Community / Social Care

• New QOF Targets• Development of Communications Hub• Primary Care Resource Centres

– Whitland– Upper Gwendraeth– Carmarthen

• Llandovery ‘Total Place’ Proposal• Community Resource Team Centres• Andrew Street / Boots Development• Joint County / LA Estates Review• Out Patients Service Strategy



DevelopmentsPPH (Emergency Medicine / Routine Surgery / Rehab)

• Clinical Service Strategy to follow Engagement Event May• Review Patient Flows for Minor Injuries/Illness and Medical

Emergency Patients• Reconfigured Medical Wards (sub-specialty)• Medical Day Facilities• Review spread of Rehabilitation Bed Capacity

• Short Stay Surgical Unit• 2 Room Endoscopy Unit• Pre-Assessment Unit• Hydrotherapy Pool



DevelopmentsGGH (Emergency Medicine / ‘Complex’ Surgery/Rehab)

• Clinical Service Strategy to follow Engagement Event May

• Critical Care Development

– Autumn 2011

– Revenue consequences

• Adult Clinical Decision Unit

– Medicine / Surgery

– Spring 2012

– Business case under development

• Angiography Suite

• Asceptic Suite

• Ty Cymorth Day Care Service

• Children’s Centre


Quality Improvement Strategy

County Aims

1. Reduce the Risk Adjusted Mortality Index (RAMI) across the county to a level of <100.

2. Reduce the adverse event rate by 25% of the baseline within the county

3. Monitor compliance with the improvement initiatives contained within the Hywel Dda Health Board Quality Improvement Strategy with particular emphasis on medication errors, pressure sores, falls, healthcareassociated infections (HCAI), hospital acquired thrombosis (HAT).

The above will be measured and monitored through the County Quality & Safety Committee


Overview: County Approach to Workforce

Planning, Sustainability and Modernisation

• The county is developing an integrated workforce plan which reflects the

agreed service delivery plan;

• Key sections of a draft plan have been prepared by the Head of

Workforce Modernisation with additional narrative completed by County

Head of Workforce to reflect local issues

• Draft content reviewed by key members of County Management Team

WORKFORCE


Overview: Processes already in place to

support development of integrated plan

• Workforce Expenditure Review Panel – meets weekly

• County Workforce Planning, Sustainability and Modernisation Group –

meets monthly

• Local County Partnership Forum established – meets bi-monthly

• Robust workforce expenditure controls in place to control variable pay

expenditure supported by weekly reporting system

• County Head of Workforce is an integrated member of the County

Management Team – W&OD report is a standing agenda item

WORKFORCE


Overview: Risks associated with

implementation of the integrated and

affordable workforce plan

• Staff and Trade Union resistance to change

• Timescales associated with the implementation of organisation change

• Capacity within the County Workforce Team to support organisational change/modernisation initiatives

• Management of press/political enquiries

• Conflict in terms of HR policy/practice in other partner organisations

WORKFORCE


Overview: Key Workforce Considerations

• 78% female (30% 25-40yrs)• 16% 55yrs+• Recruitment Challenges

– A&E– Radiology

• Medical Training– F2s / CTs (Deanery strategy)

• Succession Planning– GPs / Consultants

• Strategic Vacuum – risks to retention

WORKFORCE


Current Problems:

• Lack of a speedy and robust IT infrastructure

• Emphasis on provision of data not information

• Lack of investment in community based IT

• Over reliance on paper

IM&T

What we Need:

• An integrated and timely information system to enable us to properly

manage our business

• Seamless data exchange across Primary/Acute/Community and Local

Authority boundaries

• Ability to access all systems from all locations

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