swansea nhs trusts annual report 2… · this annual report provides information on the trust’s...

SSwwaannsseeaa NNHHSS TTrruusstt Annual Report 2007/2008

Swansea NHS Trust Annual Report 2007/08 Page 2


Table of Contents

In Our View

5

Introduction

7

Around the Divisions

10

HealthVision Swansea

21

Clinical Governance

23

The School of Medicine at Swansea University

35

Our Staff

36

Making the Connections

41

Corporate Governance

43

Operating and Financial Review 52

Trust Profile 56

Summary Financial Statements 58


In Our View

2007/2008 was a momentous year for Swansea NHS Trust because, following a consultation exercise involving our staff and partner organisations, it was agreed that we would merge with our neighbours, Bro Morgannwg NHS Trust from 1st April, 2008, to become the largest NHS Trust in Wales.

This, therefore, is the last Annual Report for Swansea NHS Trust, and we are delighted to say that as we welcome in the new era, the Trust ends on a particularly high note with a series of outstanding successes:

• Hitting or exceeding waiting times targets for in-patients and out-patients;

• Swansea NHS Trust hospitals were ranked in the Top 40 in the UK in 2007 by

independent benchmarking experts CHKS;

• Trauma survival rates, made public for the first time in 2007, showed that survival rates at Morriston Hospital were higher than expected;

• Morriston Hospital’s Cardiac Centre produced excellent results and was the only one in the UK to be a awarded a better than expected score for by-pass surgery survival rates under tough new UK standards;

• The Trust’s Infection Control Team won the 2007 Nursing Times Award for infection control;

• The Trust was placed in the top quarter for Wales in the first Healthcare Standards awards;

• Savings of over £10 million in 2007/08 on a budget of £390 million, thus meeting the key statutory requirement to break even financially;

• The Welsh Centre for Burns and Plastic Surgery was backed by the South West UK Burn care Commission as the centre for not just Wales but the South West of England;

• Swansea NHS Trust, along with Cardiff and Swansea Universities, were awarded the UK’s first and only Healing Foundation for Burns Research, worth £10 million;

• Success, too for our midwives, who were runners-up in the UK-wide British Journal of Midwifery Team of the Year Category, and the Trust’s Active Travel Scheme which won a number of Welsh awards, also went on to become runners-up in the National Transport Awards;

• HRH The Duchess of Gloucester officially opened the £1.2 million refurbishment of Ty Olwen, and two stalwart Ty Olwen trustees, Mick Bartlett and his wife, Margaret, won the title of Wales Volunteer of the Year.


All this success could not have been achieved without the dedication of all our colleagues who have continued to work extremely hard to ensure challenging financial and performance targets have been met.

Special thanks go to John Carr, who was the Trust Chairman for the first few months of the financial year before resigning to pursue other health-related challenges. Mr Carr’s enthusiasm, support and hard work played an important part in the Trust’s success. He was succeeded Vice Chairman Michael Williams.

We now look forward to 2008/09 and the establishment of a new NHS Trust. Bro Morgannwg NHS Trust is a highly successful NHS organisation, and the merger of our two Trusts is expected to bring many advantages to patients, staff and the local economy.

Calum Campbell Acting Chief Executive

Michael Williams Acting Chairman


Introduction The Swansea National Health Service Trust provides a comprehensive range of acute, community and mental health services for the 250,000 residents of Swansea, as well as many specialist services for people across South and Mid Wales. A detailed profile of the Trust is set out on page 56.

During the year the Trust treated more that 108,200 inpatients and day cases, nearly 330,000 outpatients and dealt with over 108,000 attendances at Accident & Emergency/Casualty Departments.

The Trust was established on 1st April 1999 as a result of the merger of the former Swansea NHS Trust, Morriston Hospital NHS Trust and part of Glan-y-Mồr NHS Trust. Employing in excess of 9,500 people, it had an income of over £390 million in 2007/08, mostly generated from NHS commissioning bodies such as Local Health Boards and Health Commission Wales (Specialist Services).

The Trust places great value in working in partnership with partner organisations, patient groups, voluntary organisations and the public as well as all the people employed by the Trust, based on the following values:

• Openness and transparency; • Honesty and realism; • Inclusivity; • Challenging the status quo in a constructive way; • Being responsive, flexible and focused – with a reputation for delivery; • Being a learning organisation; • Providing support and development to our employees; • and,

• Pursuing the highest standards of professional practice.

This Annual Report provides information on the Trust’s achievements and activities during 2007/08.

Managing Change

In November, 2002, the Trust Board approved revised organisational and management arrangements to ensure the delivery of the Trust’s aims and objectives and to provide improved and modern services to the people it serves.

The revised arrangements signaled a move away from a traditional method of service delivery, to a more modernised approach which can be supported by the available workforce.

This is based on:


• The active involvement of clinicians throughout the management structure. This refers to clinicians in the broadest sense – doctors, nurses, Allied Health Professions and all clinical professionals;

• Skilled clinical leaders; • Strong professional management support; and • A workforce which is encouraged to find new ways of delivering efficient and effective

services to patients.

In April, 2003 the Trust implemented revised management arrangements based on Trust-wide Divisions. The overriding purpose of this change was to create an organisational culture that concentrates on patients and care processes, not hospital sites.

In April, 2007 this model was further updated, and included the following Divisions:

• Surgery • Mental Health • Cancer and Tertiary • Clinical Support Services • Women and Child Health • Medicine and Elderly Care

Within each Division there is a Divisional General Manager, Clinical Chair and a Divisional Nurse/Allied Health Professional.

These Divisions are supported by the following Corporate Departments:

Operations

Finance

Human Resources

Information Technology

Planning, Estates and Facilities

Clinical Governance Support Unit

Corporate Services

Modernisation and Efficiency

The NHS in Wales: Operating Framework for 2007/08, which sets out the Welsh Assembly Government’s requirements and expectations for the NHS for the year ahead, includes the need to cut waste, reduce costs and improve productivity. All these are essential in delivering good financial health and world class services. This will ensure that the extra resources invested in NHS Wales produce a good return for the taxpayer through more efficient and effective care for patients. For Swansea NHS Trust its delivery was through modernisation processes and adoption of identified good practice, which is a continuation of the work introduced in 2006/07 based on the ‘Modernisation Assessment’.


The National Leadership & Innovation Agency for Healthcare (NLIAH) ‘Modernisation Assessment’ is a key component of Welsh Assembly’s direction of travel and specific requirements for the NHS by 2015.

Swansea NHS Trust set out to achieve the task by establishing a programme of projects to address each issue, which contributed to balancing the books at year-end, improved our performance in utilising our beds and using outpatient clinics appropriately.

In addition and as a result of a further ‘Modernisation Assessment’ in November 2007, NLIAH has reported that:

‘Swansea NHS Trust shows improved processes across the original indicators from the first Modernisation Assessment in early 2006.

The Trust has continued to implement a programme of service improvement over the last 12 months. This has involved the development of improved models of service provision, for example operating theatres, as well as investment in the development of staff to take improvements forward.’ Nevertheless, there is acceptance that our services can improve further and for 2008/09 departments will be working towards ‘Design for Improvement’ action plans to ensure all opportunities for improvement are introduced, sharing also practice and learning with our colleagues in the new Trust.


Around the Divisions SURGERY

All the specialties within this Division were successful in achieving a reduction in the time patients were waiting for their outpatient appointments and appointments for surgery, and all targets of 22 week waiting times were met.

• This achievement has been supported by utilising theatre sessions and beds more efficiently, through extending the working day by reducing theatre delays, and supporting patients to reduce their length of stay in a hospital bed.

• By scheduling patients to have a preoperative assessment either by telephone or in person, before they attend for surgery we are able to plan the use of our resources better and patients can plan their own admission and discharge more effectively in order to reduce their length of stay in hospital.

• The Division has seen an increase in the percentage of patients who now can be discharged after 2 or 3 days stay in hospital, compared to one year before. For majority of specialties this is in excess of 5%.

• We have established two Day of Surgery Admission units (DOSA) to reduce length of stay in order to receive patients directly from home, on their day of their operation, thus avoiding one night stay in hospital before surgery takes place.

To assist patients in a prompt discharge after their surgery the Division has introduced a range of measures including.

• Enhanced recovery program in colorectal surgery, which through a structured preparation program and post operation exercise, pain relief and drug regime supports the discharge of patients home in 4 – 6 days rather than 10 -14 days after bowel surgery.

• Breast surgery patients can return home several days earlier with their post op drains in place, these are then removed at home with the support of the Trust’s district nurse team.

• A new urology lithotripter based in Morriston Hospital means equipment is readily available to treat emergency and elective patients who attend the hospital with urinary stones. Previously, patients were admitted and were treated with a loan lithotripter twice weekly.

The Division has worked with the Swansea Local Health Board to support the management of patients by their GPs or alternative practitioners. Referral pathways have been developed with GPs:

• A pilot was introduced as a GP led service to direct patients with muscular\joint pain to the appropriate clinician – either a GP with special Orthopaedic interest, or a physiotherapist, or consultant orthopaedic surgeon.


• Physiotherapists with extended practitioner roles in management of children’s orthopaedics shoulder and knee orthopaedic conditions are now in place to offer an alternative to the consultant led services in orthopaedics.

Emergency surgery referrals attending Morriston Hospital are fast tracked to the Surgical Decision Making Unit (SDMU) based on Ward D, where their condition is assessed and a treatment plan determined. This has increased the number of cases who can be treated without the need for an admission to hospital. On average 340 patients per month are seen in the SDMU and fewer require an admission

• 24% of patients can now managed by their GP or as an outpatient compared to only 14% prior to this unit being opened.

• Of those admitted 30% will be discharged home within 1 day.

• Trauma cases are managed by Trauma nurse coordinator via identified pathways and have reduced the length of the acute stay in hospital of the patients with fractured femurs.

• Further development of nurse led services have assisted in patient care.

• The Division is supporting prompt safe discharge with nurse led discharge being rolled out to a range of specialties across the wards.

• The nurse\therapy team in orthopaedics improve the management at home of patients after joint replacements allowing an earlier return home.

• Links with the district nurse and the ward staff also allow patients to receive intravenous drug therapy at home rather than in a hospital bed. This is in place for select urology, surgery and trauma and orthopaedic cases.


MENTAL HEALTH

Repatriation Programme

• Following agreement with Swansea LHB the Trust is implementing the repatriation of a number of individuals previously placed in services remote from Swansea.

• The agreed programme enables the Trust to establish the specialist services needed

by these patients, which has significant benefit for the individuals concerned and also helps develop local mental health services. The Trust has been able to establish additional nursing, senior clinical psychologists and occupational therapy posts.

Crisis Resolution and Home Treatment Services

• The Crisis Resolution and Home Treatment (CRHT) team has been in place for approximately 18 months and in that period occupancy of Cefn Coed Hospital's admission wards has reduced by around 15%.

• Evaluation of the service reveals that patients prefer home treatment where this is

practical and in addition, the service has also benefited from the Team's ability to assist in earlier discharge from hospital.

• There has also been a significant reduction in the use of compulsory admissions

under the Mental Health Act as there are viable community based alternatives available.

• The Trust has been able to strengthen the initial team by recruiting Occupational

Therapy staff, and the City and County of Swansea has established 2 Approved Social Worker posts in the Team. The CRHT will work in conjunction with the Assertive Outreach service which the Trust is currently creating.

Assertive Outreach Service

• Work was underway in 2007/08 to establish an Assertive Outreach Service which is expected to be operational in July 2008. The service will operate in a range of settings offering a flexible and responsive alternative to in-patient care. It aims to provide a service for adults with severe and enduring mental illness who have a history of disengagement or non engagement with mental health services. It will provide a service promoting a multi disciplinary approach whilst focusing on the psychosocial needs of service users and their carers.

• It will also promote continuity and consistency of care, and intervention for service

users and carers, offering a range of approaches and skills for defined and extended periods of time. The service will be multi-agency, i.e. health and social care services and others where appropriate, including non statutory sector providers. It will be available to respond between 9.00 am to 9.00 pm 7 days per week including statutory bank holidays and is intended to achieve the following beneficial outcomes:

o Improve engagement; o Reduce hospital admissions; o Reduce length of stay (when hospitalisation is required); o Increase stability in the lives of service users and their carers/family; o Improve social functioning; o Be cost effective.


Mental Health Act 2007 – Implementation Together with our partners, Swansea, Bridgend and Neath Port Talbot Local Health Boards and Local Authorities, the Trust is working towards the implementation of the new mental health legislation which has to be in place by November 2008. Funding has been obtained from the Welsh Assembly to assist in staff awareness and training in preparation for the changes. In addition the implications upon current service arrangements are being addressed.


CANCER AND TERTIARY SERVICES During the year the Division succeeded in meeting all waiting list access times targets, and the Division also demonstrated greater efficiency by meeting its Cost Improvement Programme and achieved financial balance. Some of the main highlights of the year include: Neurosciences

• Telemedicine for Neurology clinics - introduced into Bronglais Hospital from Morriston Hospital to help reduce the distance and journeys patients need to travel to be seen.

• Pre-assessment - 7 out of 10 elective patients are now seen before their operations to ensure they are generally fit to come in for surgery.

• The Parkinson’s Centre at Gorseinon Hospital has developed a recognised Care Pathway which will be replicated across Wales.

• Additional funding for Neuro rehabilitation with Speech and Language Therapy (SALT), clinical psychology appointment pending.

Cardiac

• The Department achieved excellent by-pass surgery survival rates. Healthcare Commission cardiac surgery figures published in 2007 showed that Morriston Hospital’s cardiac centre was the only one in the UK to be awarded a “better than expected” score for by-pass surgery survival rates when judged against tough new UK standards introduced in 2007.

• Cardiac ITU/HDU achieved practice development re-accreditation with the Centre for development of healthcare policy and practice Leeds University.

• Acupuncture has been introduced for patients on cardiac ITU/HDU. Initially for treating nausea and vomiting, it will also be used for pain management to complement more conventional pharmacological treatments.

• The Cardiac Short Stay Unit has evolved within the past year and now supports consultants in undertaking an increasing variety of procedures.

• The Cardiac Catheter Lab has introduced radial pressure bands which help to stop patient bleeding more quickly.

• A new specialised Atherectomy (rotablation) service which clears hard blockages in arteries, but is gentler than other procedures.

• The Trust's Echo Department became the first in UK to be accredited for transthoric echo, dobutamine stress echo and for teaching/training to British Society of Echocardiography under new, strict, procedures.

Plastic Surgery

• Pressure Ulcer Prevention Pilot – Development and implementation of a care

process to reduce hospital acquired Pressure Ulcers. • Senior staff involved in a training Reconstructive Surgery Module, which is

recognised by Swansea University School of Health Science. • Day Of Admission Unit – this safely and effectively manages patients who attend for

surgery on the day of admission, instead of the day before. This reduces the length of time patients are in hospital unnecessarily.

• A new Medical Tattooing Service. At present the service tattoos simulated nipples following breast cancer surgery. The service could widen could widen to cover other


conditions, including burns or scarring, where medical tattoos could help with reconstruction.

• Links with Cancer Care Cymru were strengthened with close liaison with Skin Cancer Specialist Nurse.

• Links with the Armed Forces were developed over Plastic and Reconstructive Surgery training.

Burns

• A major coup for the Welsh Centre for Burns and Plastic Surgery was Swansea NHS Trust’s had been in a joint bid with Cardiff and Swansea Universities for the UK’s first Chair in Burns Injury Study. The Healing Foundation award, worth £10 million, was won against stiff competition from other UK Burns centres.The new centre will focus on all aspects of research aimed at improving the treatment and long-term support for burns survivors. Brendan Eley, Chief Executive of the Healing Foundation said: “This award represents a major step forward in our goal to improve the treatment, care and long term understanding of burns research, education and prevention. The centre will become a global leader.”

• The South West UK Burns Network chose the Morriston Centre as the centre for the South West of the UK, covering a population of approx 10m people in the delivery of a service for complex burns. Work also continued on the £10 million extension to the Burns Centre, and is expected to be finished in the autumn of 2008.

• Swansea successfully hosted the annual British Burn Association Scientific Meeting. Renal

• A Live Donor Co-ordinator was appointed. Funded by UK Transplant, the aim is to help increase transplantation rates by increasing the number of live donors.

• Along with the infection control department, the renal unit won a Nursing Times Award for decreasing certain infection rates within the renal unit.

Cancer

• Haematology - Clinical Nurse Specialists in anti-coagulation and haemophilia have been appointed, and the haemophilia home service introduced. A clinical lead and a clinical manager for the haematology Day Unit have been appointed.

• Launch of Chemocare; an IT application aimed at producing greater accuracy for prescribing chemotherapy for cancer patients.

• A review of the radiotherapy pathway was undertaken to improve the process for patients.

• A system was developed on how Herceptin can safely be given to breast cancer patients in their homes.

• An End of Llife working Group set up to redesign Specialist Palliative care. • Teleconferencing equipment purchased for specialist palliative care. • A Specialist Palliative Care Conference was held with delegates from all over Wales. • A workshop was held to look at the palliative care needs of patients with respiratory

disease.


Ty Olwen

• In the 2007 Lord Mayor’s Design Awards, a commendation was given to Ty Olwen following its £1.2 million refurbishment. Supported by the Big Lottery Fund, it was formally opened by HRH the Duchess of Gloucester.

• Two Ty Olwen trustees, Mick Bartlett and his wife, Margaret, won the adult category

of Wales Volunteer of the Year from the Wales Council for Voluntary Action.


CLINICAL SUPPORT SERVICES

2007/08 saw the introduction of a new static 3T MRI scanning unit on the Singleton site. This unit replaces the limited mobile MRI scanning service which previously visited Singleton on a once weekly basis. The new unit is one of the very few 3T scanners operational within the NHS and offers new scanning techniques. Over the same period a second CT scanner with 64 slice technology was commissioned on the Morriston site. This new scanner greatly improves the resilience of the CT scanning service on the Morriston site and again offers opportunities to introduce new CT scanning techniques with its newer technology. Radiology across the Trust saw the roll out of a Trust wide Picture Archive Communication System (PACS) which digitally stores and distributes all radiological images to users across the Trust. Benefits of the system will include multi-user immediate access to a patients previous radiology and allow greater levels of radiological reporting of images. In addition to additional hardware the directorate have continued to review internal processes which have seen all Welsh Assembly Government Access Targets met. The number of patients on Radiology held waiting lists dropped from 3772 to 2218. Medical Physics & Clinical Engineering

• Nigel Shapcott, Head of Rehabilitation Engineering, has been elected Chair of the Posture and Mobility Group (a UK-national body).

• Dr Richard Hugtenburg, joined the Directorate as Senior Lecturer in Medical Physics. This is a new, joint venture between the Trust and the Swansea School of Medicine.

• One of the Linear Accelerator machines, which treats cancer patients, was upgraded and connected to the radiotherapy computer network, increasing the number of machines in clinical use to four This has provided an improved, faster service for patients from Swansea and all over South West Wales requiring radiotherapy.

• A CT scanner specially designed for oncology was commissioned. An old bunker for high energy radiation treatment was redeveloped to accommodate the new scanner, which is more accurate, and will help clinicians plan treatment more speedily.

• After extensive review, a five work station virtual simulation system was commissioned for clinical use in the preparation of breast radiotherapy treatment plans. Further clinical sites will be added in the coming year.

• There was an increase of 25% in the number of patients requiring Radiotherapy Physics treatment planning during 2007.

• Image Guided Radiotherapy - a business case was prepared to seek approval and funding for the introduction of new state-of-the-art linear accelerator with facilities for volume imaging during radiotherapy treatment. If approved, the clinical service is anticipated to start during 2009/10.

The Audiology Department was the only Welsh service to take part in a pilot evaluation of the British Association of Audiologists (BAA) Quality Assurance scheme. This involved an extensive questionnaire, site visit and interviews with Audiology staff.

The report was highly complementary regarding the quality and efficiency of the department. A suggestion to increase patient involvement has resulted in plans to establish a new user group.


WOMEN AND CHILD HEALTH

Birth Centre

• During 2007 631 women had their babies in the new Birth Centre, which is midwife-led and designed to be homely as possible with minimal clinical equipment on view. For many mothers-to-be it offers a third choice as well as a traditional maternity unit or a home birth.

• This equates to 1 in 5 women giving birth in this environment. Nearly one in five -

18% of births - within the centre took place in the water pool in 2007. The commitment of the midwives and the excellent team working within this area was recognised by the British Journal of Midwifery and the team were runners-up prestigious UK Team of the Year Award 2007.

• Also in 2007, midwife Christina Davies, just missed out on winning the Mamas and

Papas UK Midwife of the Year title,

• Swansea has 10 Supervisors of Midwives. In 2007 the Supervisors won an award for excellence in midwifery supervision, from the Heads Of Midwifery Advisory Group.

• The Baby Friendly Initiative (BFI) is a global programme by UNICEF and The World

Health Organisation that aims to improve breastfeeding rates throughout the world, helping to improve the health of all. In July 2007 the unit was successful in passing the 1st stage of the BFI award. The 2nd stage of this award has been organised for the 16th and 17th of November 2008. This programme and all the hard work that the mothers have put in has been acknowledge by the Welsh Assembly Government Minister for Health Edwina Hart who presented the certificates to a number of peer supporters in August 2007.

Service Developments

• Development of the nurse-led coloscopy service has allowed medical staff to be released for other duties. It also helped all cervical screening targets to be met.

• A nurse now leads in Emergency Gynaecology. This role has been pivotal in

decreasing the length of time patients are seen prior to review and has decreased the number of emergency inpatient stays.

• Post Menopausal Bleed Clinic: this innovative clinic has helped to reduce the number

of laparoscopic procedures in theatre and gynaecological outpatient appointments. It is hoped that it will develop into a one stop clinic in 2008 – 2009.

• A new fertility unit with a designated laboratory opened. These are nurse led

services which are constantly evolving to help decrease waiting times for patients.

• There has been the development of nurse led scanning within the Termination of Pregnancy service thus improving the availability of this service, releasing medical staff to carry out other duties and to reduce the waiting times. A nurse-led open access service commenced 15th October 2007.

• We developed Nurse led HIV specialist clinics – this has allowed for continuous

professional development for the nurse and has proved successful in ensuring that more patients are quickly.


Sexual health

• Our Lead Nurse for integrated Sexual Health Jean Beard was nominated as the first nurse to be appointed to the British Association of Sexual Health and HIV (BASHH) Clinical Governance Committee.

• The Info-Nation internet café commenced – this is a highly innovative programme

which delivers sexual health service to under 25 year olds run by the Nurse Practitioner within Integrated Sexual Health service.

• There were two very successful symposia run by the Integrated Sexual Health Team.

The symposia covered topics which included people trafficking, men’s sexual health issues and workers in the sex industry. There will be two follow up symposia in 2008 due to the positive evaluation received.

Continuing Care for Children

• Continuing Care for Children has been the responsibility of the Women & Child Health Division for some years. This service has both developed and expanded during the past year or so and caters for a number of children and young people (and supports their families) with complex health needs. The training and competencies are carried out by Registered Sick Children’s Nurses whilst much of the care is delivered by Health Care Support Workers who are suitably trained and experienced. This service is not only of great support to the families by giving them a well earned rest but also prevents hospital admission.

• The service also supports the other siblings in the family by helping them to

understand the disability and making time for them as they often experience the impact of having a sister/brother with complex health needs.

Other achievements

• The Health Visiting Swansea West Team were Runners up for the Twf Award which is given for promoting the Welsh language with families with new babies. They received their award at a presentation ceremony in Cardiff.

• Our Practice Development Health Visitor, Sharon Llewelyn, has been appointed as

the Suicide Strategy Prevention Co-ordinator. This is an extremely high profile post and Sharon will co-ordinate a multi-agency approach to reviewing the needs of young people in the Bridgend community.

• ‘Flying Start’ is a four themed initiative by the Welsh Assembly Government to

specifically target poverty. It includes intensive Health Visiting, Free Child Care, Parenting courses and literacy skills for parents in some of the most deprived areas of Swansea. Chris Koukos has been seconded to be the ‘Flying Start’ Co-ordinator.

• The Health Visiting service is planning to develop a number of important initiatives

including an Access Health Team and a Health Visiting Team who will specifically look at the needs of vulnerable young people leaving the care system.


MEDICINE AND ELDERLY CARE

A&E

• Trauma survival figures showed higher than expected survival rates. 2007 was the first year Trauma Audit and Research Network (TARN) figures were made public. They showed that Morriston Hospital not only admitted the highest number of trauma patients in Wales, but also had survival rates which were 2.1 per cent higher than expected.

• According to TARN, between 2003/04 and 2005/06 Morriston Hospital admitted 943 trauma patients – the highest number in Wales. Of these patients, 847 were expected to survive. In fact, the survival figure was 869. Morriston’s performance put the hospital in the top 15 UK hospitals which took part in the research.

• A&E staff, along with colleagues from a range of Trust trauma services, including orthopaedics and neurosurgery, were involved in attaining these excellent results. This multi-disciplinary approach is considered key to the high survival rate.

• Since 2003, Swansea staff have dealt with nearly 2,000 trauma patients, including around three people a month with serious multiple injuries.

In General

• A new Consultant Dermatologist, Dr Debbie Shipley, was appointed at Singleton Hospital. This was a welcome appointment to the progressive dermatology team and ensured the team was able to deliver on patient access and cancer targets.

• The Division achieved a 99% score in the Welsh Risk Pool Standards for A&E, which was a significant achievement. Significant progress was made towards improving performance against the Welsh Assembly Government emergency access target of 95% of patients attending A&E, being assessed, admitted or transferred within 4 hours, with the year end position being 98%.

• A key focus for the Division centred upon the development and refinement of integrated care pathways and developing innovative approaches to delivering patient care in a timely manner, in the most appropriate environment by the right health care professional.

• The transfer of the District Nursing Team into the Division of Medicine and Elderly care, from April 2007, enabled closer integration between community and hospital based services. The team developed formal links with ward managers in Medicine and Elderly care to improve communication, patient pathways and to support earlier discharge, and built upon already well established links and services provided by the District nursing team in A&E.

• In October 2007, Ward 3 at Hill House Hospital underwent an extensive refurbishment programme, to improve the environmental standards of the patient care facilities. The refurbishment cost a total of £140,000, and the ward re-opened in early April 2008.

• The Division of Medicine and Elderly Care also hosted the appointment of the new post of Mental Capacity Co-ordinator , which was funded by the local authority to support the implementation of the new Mental Capacity Act, by ensuring staff are appropriately trained on the comprehensive new legislation and it’s applicability to patient care.


HealthVision Swansea (formerly Reshaping Health Services in Swansea, RHSS)

Swansea NHS Trust had been working on the Reshaping Health Services in Swansea programme to plan a new single hospital for Swansea. However due to the high capital cost of this new hospital and the long timeframe which would be needed to plan and build it, the Trust was asked to develop a programme which distributed clinical services in a complementary way across the existing two acute sites of Morriston and Singleton Hospitals, so reducing duplication of services.

The HealthVision Swansea programme aims to achieve this and ensure people’s needs are met by supporting them to maintain their independence and maximise their wellbeing through the most effective configuration of acute, community, social and primary care services in Swansea.

The HealthVision Swansea programme, when complete, will deliver the best quality health care for the population of Swansea and people from the wider Region and beyond. It comprises a number of phases which will change the pattern of services currently provided at the existing Morriston and Singleton Hospitals making the best use of staff and ensuring services are more accessible:

Phase 1A – Infrastructure Improvements at Morriston Hospital

Essential internal and external road improvements to relieve congestion, and the development of further car parking to improve access to services plus re-provision of accommodation displaced by the new internal road. This phase will likely involve the purchase of parcels of land to provide expansion capacity for the site, and the repositioning of the helipad. It is anticipated that a start on site can be achieved by October 2008 subject to appropriate planning approvals. A Strategic Outline Business Case (SOC) for Phase 1a has been submitted to the Assembly for approval.

Phase 1B – Re-provision of key Morriston Hospital poor accommodation

The intention is that the Phase 1B build will house a range of services, providing the ambulatory care requirements for the Morriston site including a new main outpatients facility, endoscopy suites and a state of the art multi-disciplinary, multi-use Education Centre and a main entrance which are commensurate with Morriston Hospital’s status as one of the largest hospitals in Wales. This Phase will not involve services moving from Singleton to Morriston Hospital or vice versa but rather will replace the old World War II accommodation on the Morriston site and as such will not be subject to public consultation.

Phase 2 – Clinical Reconfiguration across Swansea

This phase will be informed by the Clinical Strategy for the new Trust and will focus on Singleton and Morriston Hospitals operating in a complementary way in future.

The development of Phase 2 will be informed by a concordat the Trust has signed with Swansea University, which outlines a broad direction of travel for future health care services in Swansea and by Swansea Local Health Board’s Model of Care work for the delivery of services across communities in Swansea in future.


Mental Health

Work has also been underway over the modernisation of mental health services in the city. During 2007/08 the Reshaping Mental Health Services Swansea Project moved on from talking with stakeholders about the mental health service models for Adults, Older People & Substance Misuse Services should be developed, to starting to identify location options.

Service users have visited possible sites and looked at recently completed mental health facilities elsewhere. It has also been recognised that the development of the new Trust will offer opportunities for developing specialist services which need a greater population, and work has began to assess these. Improving the Health of Wales In line with the Welsh Assembly document Improving the Health of Wales which outlines plans for a more collaborative culture between hospitals and primary care, HealthVision Swansea is an important vehicle driving forward more effective working relationships and a “seamless” NHS. Working in partnership with Swansea Local Health Board and Swansea University, a key aim of the HealthVision Swansea scheme is integrating primary and secondary care, with a particular focus on the future role of Singleton Hospital, and plans for an Ambulatory Care Centre on the Singleton site, which will closely involve primary care practitioners.


Clinical Governance The Trust is fully committed to providing high quality, safe and effective patient care delivered through a culture where the patient is the focus, and where continual learning and organisational growth occurs. This is called Clinical Governance.

Significant work has gone on over the last year to further develop the Trust’s Clinical Governance structures and processes, including further developing clinical pathways and GP referral pathways. The Trust continues to participate in a number of national clinical audits and has had exemplar results in a number of areas including intensive care, trauma care, and cardiac.

The Trust has made significant developments within Infection Control and won the first prize in a National Infection Control Conference for the Infection Reduction Programme. A back to basics programme has been implemented and the Trust is undertaking an innovative hand hygiene training and education programme.

The Trust increased its compliance when undertaking self assessment in the Healthcare Standards for Wales and made good progress in meeting the Clinical Governance Priorities outlined in the 2007/08 Healthcare Standards Quality Improvement plan.

PATIENT EXPERIENCE / PUBLIC & PATIENT INVOLVEMENT (PPI)

Providing patients and the public with the opportunity to work alongside NHS staff is a critical element of service improvement, service delivery and service redesign and the Trust Board is committed to ensuring that PPI is given a high priority.

Patient involvement groups, in many cases, have gone from strength to strength producing key quality improvements to patient care and services. These include the Patient Experience Forum, Patient Representatives’ Network, Research User’s Group, the Patient’s Council; Editorial Board and the Cleanliness and Infection Control Patient Group. A number of other groups continue to provide valuable feedback that influences change across all strands of the organisation. They are the Carers Strategy Group; Parent & Child Group; the Welsh Kidney Patient Association; Patient’s Council; Stroke Association; the GUM Group; Alzheimer Society; The Maternity Forum; Welsh Dragon Burns Club; Cancer Network Patient Group; WRVS; Red Cross and the Cardiac Rehabilitation Support Group. During the last year a number of new initiatives were introduced to the Trust including:

• Volunteers who help support new mothers who want to breast feed their infants;

• The ant-natal screening users group;

• Volunteer “helping patients at mealtime” project, and

• A library of consent specific patient information has been introduced to support staff and patients in delivering care.

Gauging the Patient Experience The Trust is committed to putting patients at the centre of everything we do and we recognise the value of listening to patients and taking on board feedback. A summary of activity undertaken is outlined below:

• A programme of satisfaction surveys and privacy and dignity audits have been undertaken in wards and departments throughout the Trust in order to establish


patient opinion about the quality of care and range of service provided. The surveys tell us how satisfied patients were with various aspects of their care and if they were dissatisfied, why.

• Actions taken since the audits include improving patient information; replacement furniture and fittings; a review of menus, cleanliness and staff training on customer care and new to this year, training on dignity in care.

• The Patient Suggestion scheme continues to provide valuable feedback on Trust services and care. Improvements have been made as a direct consequence of public interest and concern. These include: • Posters in A&E advising of equality issues have been amended to include

disability issues. • Toilets in the Morriston hospital main corridor were refurbished as a result of

suggestions and complaints received • Additional disabled car parking places near hospital entrances have been

introduced. • Additional seating has been provided in corridor areas e.g. outside Phlebotomy

Department in Morrison Hospital and Cefn Coed hospital corridors. • Menus are reviewed every three months and patient suggestions are included in

the discussion for consideration • A Dignity in Care Charter has been drafted in response to a patient suggestion

Cleanliness & Infection Control Patient Group

This has been an extremely active and acts as a public voice in shaping services related to cleanliness, hygiene and infection management. It aims to increase public involvement, communication and access to information for patients. Key activities of the group over the last year include:

• Undertaking environmental audits in Morriston & Singleton Hospitals. • Making recommendations for best practice in hygiene and infection control. • Developing and introducing a Visitor’s Charter. • Requesting that infection rates and other information is produced in a user friendly

format. • Requesting that public information be posted on the Trust Website, to include issues

raised on hand hygiene, staff training, standards of cleanliness, screening policies and lack of isolation rooms

Consultation Events

A number of public consultation events have been held during this year: • World Mental Health Day was held in the Brangwyn Hall, Swansea in October, 2007

which was well attended by the public. The Minister for Health, Edwina Hart AM, opened the event. Staff from a number of organisations including the Trust, Local Authority, MIND, Hafal, Swansea Council for Voluntary Services, Job Centre Plus provided a poster exhibition and demonstration of products/services. A number of presentations on topics about mental health were delivered by Trust staff.

• Health Visiting Services Awareness Day was held in Singleton Hospital in

December. Staff from the different health visiting/public health teams spoke on issues like school nurses, asylum seekers team, child disability team, sexual health team, family planning, the work of the looked after children team and other schemes.


• Division of Clinical Support Services consultation event was held in March. There

were over 70 people in attendance which included members of voluntary organisations and groups, staff and members of the public. The aim of the event was to inform the public about service improvement and modernisation, discuss proposed changes to therapy services with the public, and demonstrate achievements in practice.

• HealthVision Swansea- A number of consultation events have taken place in local

venues to discuss the future of health services in Swansea. This included consultation on future plans for new accommodation where the debate focused on single room accommodation; consultation with parents of children with special needs on the proposal to develop a Children’s Centre; consultation with carers about carers assessment and pubic consultation on travel arrangements.

INFECTION CONTROL

In the first year of the Healthcare Standards for Wales, the Trust was assessed as Practicing at the Corporate and Operational/Clinical Outcomes levels, and Developing at the User Experience level for Standard 5: Healthcare services are provided in environments, which are well maintained; kept at acceptable national levels of cleanliness; minimise the risk of healthcare associated infections to patients, staff and visitors, achieving year on year reductions in incidence; and emphasise high standards of hygiene and reflect best practice initiatives.

The Trust continues to advance its Action Plan for Hospital Acquired Infection. 90 per cent of the actions identified were achieved up to March 2008, and 10% are partially completed.

Swansea’s hospitals also launched an innovative hand hygiene training scheme, involving special Glo-Germ™ boxes which make visible, with startling clarity, patches on people’s hands which have not been washed clean.

From the programme’s commencement , 107 Hand Hygiene Trainers had been trained to the end of March 2008. These trainers go to clinical areas, using the ultra violet boxes, and have trained more than 400 staff on good hand hygiene practices.

Welsh Assembly Government surveillance schemes

The Trust participates in a number of surveillance schemes. Since the commencement of the Infection Reduction Target Programme in April 2004, the incidence of MRSA and MSSA bacteraemia has fluctuated. However, there has been a general downward trend in incidence, by more than 2 standard deviations.

In November 2007, the Infection Control Team won the Infection Control category of the Nursing Times Awards, in recognition of the Infection Reduction 3-year renal bacteraemia programme.

The Trust’s participation in the mandatory quarterly surveillance of Staphylococcus aureus bacteraemia (established on 1 April 2001) continued during 2007/8. Due to the multi-specialist nature of Swansea NHS Trust, comparison with most other Welsh Trusts does not provide a true comparison for the Trust to benchmark its performance in relation to incidence of infection. For this, the Trust needed to benchmark with similar sized, multi-specialty


Trusts in England. Swansea continued to compare favourably with these similar English Trusts. Additionally, the Trust’s performance in comparison to other Welsh Trusts has continued its steady improvement; to where the incidence of MRSA bacteraemia within Swansea NHS Trust is generally below the Welsh average.

Mandatory surveillance of Clostridium difficile infection in patients over the age of 65 years was established on 1 January 2005. The NPHS published the results for this surveillance in April 2008, for the period January 2005 to December 2007. The results for Swansea NHS Trust indicate that, generally, the rate of Clostridium difficile associated diarrhoea has remained below the All Wales rate. The Trust has established a multi-disciplinary group, to review the management of Clostridium difficile and to look at ways to achieve continued and sustained reduction in the incidence of this infection.

Infection Prevention and Control Education

The Trust provides a comprehensive Core Education Programme, which is mandatory for all staff. This is a three-year programme, delivered in separate modules or as a complete study day. During 2007/08, 199 staff attended, bringing the total to more than 600 since the programme started. Several hundred additional staff have received individual modules of the programme.

Hygiene issues (Clean Hospitals)

The National Standards of Cleanliness for NHS Trusts in Wales were published in 2004. The results of the National Standards of Cleanliness Audits undertaken within the Trust, for the last quarter January – March 2008, indicate a steady, continued improvement in standards, with a compliance of 87% against the standards.

Developing and improving partnership with other health care providers

The Infection Control Team (ICT) continued to work collaboratively with the National Public Health Service Microbiology Laboratory, Swansea. The ICT continues to have an excellent working relationship with the local Consultant in Communicable Disease Control and the Public Health Nurses; relationships with members of the Welsh Healthcare Associated Infection Programme Team have strengthened also.

Members of the Infection Control Team attend the quarterly Infection Control Forum, coordinated by the Welsh Healthcare Associated Infection Programme and hosted by the Welsh Assembly Government.

Episodes of infection

There were a total of 36 episodes infection between April 2007 to March 2008, involving 358 patients and 117 staff; 48% fewer outbreaks than in 2006/07. The majority of outbreaks (21) involved the Division of Medicine and Elderly Care, 8 involved the Division of Cancer and Tertiary Services, 4 the Division of Mental Health, and 3 involved the Division of Surgery.

CLINICAL PATHWAYS

Over 100 Clinical Pathways are currently in varying stages of development across the Trust, 30 of which have been fully implemented. In addition a considerable amount of work has


been undertaken in conjunction with Swansea Local Health Board in developing GP referral pathways. Each pathway has an identified Clinical Lead, who is a Consultant / GP and is being developed through a Multidisciplinary Team approach. Pathways have been identified for development based upon risk analysis, areas of high activity with variation in practice and areas were clinicians have identified opportunities for innovation or service modernisation.

INFORMATION TECHNOLOGY

The Trust believes that the judicious use of I.T can support and promote the modernisation of patient services within the Trust. 2007/08 saw continued improvements in the services provided by I.T. Main achievements during the year included:

• The Trust became the first in Wales to begin migration to the all-wales email and active directory (NADEX) service.

• The implementation of a Secure Wireless Network was started in clinical areas of Morriston Hospital e.g. Theatres, Clinical Wards, Radiology, Pharmacy in order to improve bedside management. Included within this implementation was the roll out of a large number of wireless Mobile carts to improve access to clinical systems at points of care.

• Implementation of the Netbotz security system to monitor and protect IT environments across the trust.

• IPM PAS system went live across the Trust allowing 700 concurrent users, 50% increase on the existing systems.

Informing Healthcare

Informing Healthcare (IHC) funds a dedicated Trust IHC Project Office, which works closely with the National IHC Programme to take forward initiatives.

Informing Healthcare has also assisted with funding for:

• A Trust project to reduce the number of duplicate patient records in key systems such PAS, Pathology and Radiology. This improves data quality and reduces risks to patients

• The purchase of upgraded PCs to improve access to IT in clinical areas within the Trust. • E-referrals pilot projects located to improve transfer of care communication from primary

care, focussing on suspected Cancer referrals. • An E-discharge system to allow GPs to view discharge summaries and information about

take home medication electronically • Delivering free ECDL training to staff members • A project to allow GPs to produce barcoded pathology labels, increasing the use of NHS

numbers and thus improving data quality. • A pilot project to address the issue of patient safety, by the use of wristbands to provide

better patient identification • Migration to a new email system


INFORMATION GOVERNANCE

The Information Governance department is responsible for ensuring that Swansea NHS Trust operates within the legislative framework of Information Governance and Security, together with appropriate confidentiality standards as defined within the Caldicott Guidelines. We have been working towards this throughout 2007/08 through the production of Policies and Procedures, audit, a variety of training initiatives and individual support/advice on specific issues.

The range of training programmes to facilitate education and awareness surrounding key Information Governance issues, continues to be a major priority for the Trust. The NHS e-Learning Academy was introduced to the Trust in January 2008 with many staff enjoying the flexibility of an e-learning training package.

Another priority for the Trust is good records management and information security which will be assessed through a continuous programme of audit, risk assessment and best practice throughout 2008/09.

PATIENT SAFETY

The Trust has patient safety as a key priority. Within the Trust risk management is used to proactively identify risks and manage them to ensure the likelihood of an occurrence is minimised. The emphasis is on analysing why and how events occur, learning and supporting staff to ensure, where possible, risks are avoided.

Risk Management continues to develop, and over the last year, the following developments and actions have been undertaken:

• A considerable number of senior staff trained at Divisional level in Root Cause Analysis have been supported by the Risk Management Team to investigate all serious incidents and concerns where trends are identified.

• Presentations on risk management and incident reporting have been undertaken to all the specialty audit meetings. This has included a benchmarking section setting out how the specialty is reporting in comparison with like size Trusts/specialty in England. This has resulted in a 14% increase in the patient safety incidents being reported in comparison to 06/07. In addition, the no harm incidents being reported for 07/08 has increased from 70% (in 06/07) to 77%.

• A new risk management staff website which sets out how to report incidents, provides guidance on the codes and identifies the lessons which have been learned.

• Following the Maidestone & Kent Clostrdium difficile outbreak, we set up a Task & Finish Working Group to learn from their lessons. As a result of the work undertaken by the Group a Clostridium difficile care pathway was developed involving multi disciplinary staff which is currently being trialled on a medical ward. Also, a template action plan was developed for the management of a Clostridium difficile outbreak which will be incorporated into guidance following a trial in 2 areas within the Trust.

• Joint Risk & Health & Safety Ward and Departmental visits have been undertaken. • Work recently began to inform national standards on the effective management of beds

and associated equipment.

Learning from patient Incidents


Approximately 8,000 incidents were reported during 2007/8; these reports included those relating to staff, patient and other safety events.

4%

0%

22%

0%

1%

0%

0%

0%

73%

Other incl Security, Fireetc.Relative

Employee

Contractor

Visitor

Volunteer

Locum/Agency

Confidentiality/IT

Patient

All incidents reported are recorded on the Trust Incident database. This information is shared within the Trust and is used to inform corporate Committees such as the Clinical Governance Committee, Health and Safety Committee etc of key trends and issues and to ensure that appropriate action is taken to prevent a re-occurrence. This information is also used to inform national databases such as the National Patient Safety Agency (NPSA) and Medicines and Healthcare Regulatory Authority that advise and develop common safety systems for the United Kingdom.

Approximately 25% of patient safety events relate to patient mobility including slipping or falling from chairs toilets and beds. In order to reduce the incident rate and learn for these the Trust has reviewed and revised its patient falls policy and practices and is auditing compliance.

All patient safety incidents are reported to the NPSA. For the period 2007/2008 4845 patient safety incidents have been reported the majority of which are no harm or low harm incidents.

Incidents directly affecting staff safety accounted for 22% of the reports. For staff events key areas included manual handling (16%), slip, trips and falls (15%) and contact with sharp objects (15%). The figure for manual handling again probably reflects increased levels of reporting. Slips trips and falls continues to be an area of concern and Health and Safety staff work with Clinical Governance staff to conduct routine environmental audits. To reduce the number of accidents with sharp objects (syringes, scalpels etc) the Trust has introduced a number of needle-free devices and continues to try to identify opportunities to replace equipment with safer alternatives

COMPLAINTS

The Trust received a total of 660 formal complaints during 2007/08 compared with 645 during 2006/7 (an increase of 2%, but is the same number received for the year 05/06). The


overall number of complaints received remains very low in comparison to the number of patients treated within the Trust (0.001%).

Assembly Member and Member of Parliament enquiries (90) continue to be logged as formal complaints which have had an impact on the total number

11 complaints were received from children (or on behalf of) or young people, which are included in the total number of complaints for the year.

The Trust logged 394 informal complaints during 2007/8, compared with 478 during 2006/7 (a decrease of 5%).

The Trust recorded over 5,600 letters of appreciation during this period.

The Trust Suggestion Scheme has continued throughout the year and has allowed patients, relatives and members of the public to make complaints through completing a suggestion form. These are treated either formally or informally depending on the nature of the complaint.

The complaint management rolling training sessions were revised during 2007 and two levels of training have been provided throughout the year, which have been well attended.

Complaints performance against Nationally set performance targets

2-day acknowledgement target- Trust met this target on 96% of occasions

20 Working day response target- Trust met this target on 58% of occasions

Service Improvements arising as a result of Complaint Investigations

A number of service improvements have been made as a result of complaint investigations. These include:

• Consultants to be part of the clinical planning process when additional outpatient clinics are being arranged. This will avoid additional clinics having to be cancelled after patients have been informed of their appointment date.

• Intravenous Cannulation training provided to staff on an identified ward. • Training on hand washing and infection control has been undertaken across all

wards / departments • Drive to ensure that Domestic staff change empty or nearly empty alcohol gel and

soap dispensers on every shift. • Trust wide priority identified as increasing the compliance with undertaking Nutritional

Risk Assessments • Age Concern volunteer pilot project on feeding patients introduced. • Charter developed for vulnerable adults • Trust Complaints Procedure revised following feedback from complainants and the

analysis of the complainant satisfaction survey

Improvements to the complaint management process

The complaint management process was reviewed during the year and changes made so that those complaints deemed to be less complex are provided with a rapid response. Improvements were also made to the feedback mechanism to staff to enhance the analysis of complaints and to ensure lessons are learned. The complaints management process is again under review in light of the development of the newly merged Trust.


Independent review referrals

Summary of Independent Review requests:

Independent Reviews

Number of IRP requests

Apr-Jun

7*

Jul-Sep

3*

Oct-Dec

3*

Jan-Mar

3

Refused 1 1

Referred to further local resolution 5 2 1 1

IRP granted 1 1

* 5 of these cases relate to complaints raised in 2006

Of the 16 requests for Independent Review during this year; no further action was required on 2 cases, 9 were referred back to the Trust for further local resolution and a Panel granted on 3 cases.

Public Services Ombudsman referrals

10 cases were referred to the Health Service Ombudsman for Wales for consideration during the year; 3 of which were not pursued by the Ombudsman, 2 were investigated and the complaints were not upheld and the outcome is awaited on 4 cases. The remaining case was partially upheld by the Ombudsman and recommended that the Trust provide a further apology for the failings that his investigation had identified. The Ombudsman noted that the Trust had already developed an action plan in response to the problems identified by its own investigation of the complaint and the Trust was asked to ensure that implementation of these actions continued.

There were two outstanding cases from 2006/07, where the Ombudsman investigation reports were concluded in 2007/08. The Ombudsman upheld the first complaint and recommended that staff be reminded of the importance of considering extraction of milk teeth and of maintaining comprehensive records. The second case was partially upheld and recommended that action be taken in relation to ensuring adequate monitoring following prescribing of steroids.

CLINICAL AUDIT AND EFFECTIVENESS

Further significant progress has been made in the structure, planning and delivery of Clinical Audit over the last year, through the delivery of the Trust’s third Annual Clinical Audit plan and the development of the 2008/9 Clinical Audit Plan. This enables the Trust to prioritise audit activity to ensure it focuses on key areas of concern and acts as an assurance that locally and nationally agreed standards in the quality of service and care delivery are being maintained.

A total of 159 audit projects were registered and completed across the Trust (an increase of 50% from 06/07). However, these projects are not the sum of all audit activity throughout the Trust, with many clinical areas self sufficient in undertaking their audits. Of these:

• 12% were undertaken to assess compliance with NICE guidance


• 7.5% were surveys • 20% were multidisciplinary audits • 96% recommended change in practice • 48% resulted in the development of an action plan

Clinical Audit & Effectiveness Intranet Site

The new Clinical Audit & Effectiveness Intranet Site is updated following each bi-monthly Committee meeting as a matter of course and as necessary should the need arise. The information available includes; guidance, registration and outcome forms, teaching packages, committee meeting minutes and future dates, activity levels and the current audit plan, in addition to any news and events and external links thought to be of interest.

National Projects

National Clinical Audit Projects continue to be contributed to by clinicians throughout the Trust.

Trauma Audit Research Network (TARN)

Significant progress continues to be made in advancing the audit of Trauma through participation in the Trauma Audit and Research Network (TARN). Multidisciplinary Audit meetings continue to be held at regular intervals. Recently data collected for TARN has proven invaluable in the Trust’s continued fight to maintain Neurosurgical services at the Morriston site and contributed heavily to the recent publication Swansea NHS Trust Combined Trauma Committee Directory of Trauma Services 2007.

RESEARCH & DEVELOPMENT

The success of the past year in R&D can be seen through the achievement of all key objectives set for the R&D department. A total of 438 studies were listed as active across the R&D Consortium region of Swansea and Bro Morgannwg NHS Trusts, with approximately 183 new studies coming on board during this period. A total of 131 non-commercial publications were released during 2007 by Swansea NHS Trusts staff in collaboration with research and academic partners. Key governance policies introduced during the past year have included a Policy on the Reported of Research Related Adverse Events, which clarifies the policy and process for reported adverse events arising from Trust Sponsored clinical trials. The policy brings Trust Sponsored clinical research in line with Pharmaceutical management of trials and ensures compliance with the Clinical Trial Regulations by which interventional clinical research is governed. In addition, a comprehensive governance framework for Research was drawn together and the harmonisation of Research Standard Operating Procedures across the Trust commenced. A Research & Development Intranet site has been established as a point of reference for all Trust staff, which includes information on the approval process for research and directs staff to key R&D Management documents.


Research Outcomes During 2007/08 one example was the result of a study assessing the comparison of clotting times when using venous or capillary blood INR (a test to check if patients are on the right dose of Warfarin, a drug which thins the blood.) This study proposed using the hand held Roche Coaguchek XS INR meter a point of care testing device, to measure INR on a finger prick capillary sample of blood. The INR would be available within approximately 10 minutes from the start to finish of the procedure. This enabled earlier Warfarin dosing resulting in patients being discharged earlier, thus freeing up beds for new admissions. From a sample of 29 patients the following results were seen –

• The capillary INR results were higher than the venous INR results • The linearity of the method was less reliable with an INR >3.0 • Coaguchek XS results were available on average in < 5 minutes. Potentially Warfarin

could have been dosed once this result was obtained. • The interim findings from the Coaguchek XS proved its usefulness in obtaining a fast

INR result. • The amount of wasted strips as a result of the ‘error’ message on the Coaguchek XS

was a concern and would prove costly and inconvenient for the patient, resulting in repeated capillary collections.

• It was felt more results would be required for effective statistical analysis; the data was insufficient for a good comparison. This is obvious from the scatter graph of results.

• The best line of fit with the current data show poor comparison with INR results >3.0 Clinical Research Unit (CRU)

The Department has again had a busy and successful year with patient recruitment meeting targets, success in attracting new studies and new investigators to the CRU ensuring that the department remains financial viable.

Some Peer funded Research & Development account studies are generating publications (A randomised controlled trail comparing autologous fascial sling techniques for the treatment of stress urinary incontinence in women: short, medium and long –term follow-up Int Urolgynecol Jrn March 09/2007, and a small pilot study – Non-erythropoietic effects of erythropoietin beta in critical illness was accepted as a poster presentation at the XLV ERA-EDTA Congress in Stockholm, Sweden in May 08.). The results from this pilot is leading to further pilot studies which have R&D funding and support from an external pharmaceutical company.

Following collaboration with colleagues in the Medical School at Swansea University we have secured funding for a large study looking at patients who have antibiotic associated diarrhoea and or Clostridium Difficile. The study will be managed by the CRU and includes three hospitals in Durham. The study will be run over 30 months and will generate additional research nurse and clerical posts within the CRU. We are also leading a study at West Wales General Hospital with patients at the renal dialysis unit.

With the formation of the new University Trust further exciting opportunities can be seen with a potential increase in clinical research and already we are collaborating with a new colleague a consultant in rheumatology. Plans to help co-ordinate studies with his team and undertake some studies within CRU are being finalised It is hoped that this type of collaboration will expand to ensure that there is uniform support for research across the Trust.

The CRU current portfolio includes studies in diabetes, cardiology, cardiac surgery, urology, neurology and renal disease.


Oncology Trials Unit & Wales Cancer Trials Network (WCTN) Clinical trials within the oncology trials unit and the South West Wales Cancer Trials Network are continuing to develop. We have reached the Welsh Assembly / WCTN 10% target for the year 2007/08. 11% has been achieved in comparison to 6.7 % the previous year, just 5% of which are into randomised controlled trials. The aim is for WCTN to increase the % of patients into randomised controlled trials to 6%. This will be one of the main network and local objectives together with maintaining the 10% target for the coming year.

The trials unit in the cancer centre is working towards widening its portfolio to include more cancer sites and have been successful in working with Pharmaceutical trials in renal cancer. Currently, trials into head and neck cancers are being explored.


The School of Medicine at Swansea University A Concordat was agreed between Swansea NHS Trust and Swansea University, paving the way for the Trust’s ambitions to gain University Trust status. The Concordat underlined the important and exciting partnership between the Trust and the University, particularly the School of Medicine, and future developments in hospital services.

2007-8 has been a highly successful one for School - as it steadily grows to a total staff complement of some 500, including 27 full professors.

The complete Graduate Entry MB Wales was awarded to School and Swansea University by Welsh Assembly Government in 2007. The highly innovative curriculum in action for Years 1 & 2 of the MB is now being extended to the final two years, 3 & 4. The General Medical Council is engaged and the whole is proceeding through the leadership of Professor Rhys Williams, Dr Aidan Byrne and Dr Clive Weston. The first GE MB Wales cohort graduate was expected to achieve outstanding examination results in the summer of 2008.

Student feed-back on teaching has also been outstanding and a testimony to the abilities and dedication of Senior Clinical Tutors and Clinical Teachers drawn from hospital and general practice staff in Swansea. All deserve congratulations and great thanks.

Mr Ian Pallister’s MSc in Trauma is also proceeding very successfully, with excellent recruitment, and is attracting great interest from HM Forces as an educational opportunity. Schools of Medicine and Health Science plan innovative, multidisciplinary postgraduate clinical skills programmes.

In research, the Institute of Life Science (ILS) is in full action. The super-computing, led by Professor Mike Gravenor and in collaboration with IBM, is making a major contribution to modelling from the molecular to epidemiological levels, and is the foundation for School’s outstanding Health Informatics work under Professor Ronan Lyons and David Ford.

Within ILS, the Boots Centre for Innovation is creating new medical and health products - and ILS’ Business Centre, led by the Institute of Innovation and Professor Marc Clement, has promoted spin-out companies from School’s exciting research programme, including Calon Cardio Technologies (implant devices for cardiac failure), Allerna Therapeutics (new medicines for asthma and allergy), and Vikel Ltd (monitoring devices for epilepsy). ILS is attracting some £10-12 million of fresh research grant monies per annum and producing outstanding research publications – the enterprise being splendidly integrated by Professors Keith Lloyd, Mark Rees, John White, and Stephen Bain from Research & Development at the Trust.

The School’s bid for a second building within Institute of Life Science for 2010 is progressing - to include a major clinical research facility – and creating the opportunity for development of a MediScience Tower hosting pharma, medical devices and IT companies. It is the ethos at ILS that medical researchers and industry work closely together, so that research is translated into practical medical and health advances.

Of special note is the Welsh Assembly Government’s decision in late 2007 to create the Abertawe Bro Morgannwg (ABM) University NHS Trust – drawing together the forces of Swansea, Neath, Port Talbot, Bridgend and the Western Vale of Glamorgan into Wales’ biggest NHS Trust. This is a strong signal for the Welsh Assembly Government’s support for medical academic progress – and is a platform to build innovative, first-class clinical service intimately linked to research, teaching and training. The School of Medicine and the University, including the Schools of Health Science and Human Sciences, look forward to increasingly strong collaboration with ABM University NHS Trust.


Our Staff Modernisation

Over the past 12 months, the Trust has continued to make significant progress in implementing the Modernisation agenda which still represents one of the most significant challenges facing the Trust and the NHS in Wales.

Working in partnership with Staff Side representatives, significant progress has been made in the following areas:-

• The implementation and bedding in of a new NHS pay and grading system which is based on the principle of equal pay for equal value (Agenda for Change).

• Implementation of the Amendment to the National Consultant Contract in Wales plus additional work to ensure that consultant’ work is aligned with the top priorities of the Trust.

• Improved compliance with the European Working Time Directive for medical and non-medical staff, putting Swansea in the upper quartile of performance in Wales.

• Implementation of a new payroll and personnel system (Electronic Staff Record). • Improving the Trust’s ability to recruit and retain staff and the development of an

action plan based on an All Wales Staff Attitude Survey.

Embracing Equality and Diversity

The Trust is committed to ensuring that equality, diversity and human rights principles are embedded within all the services we deliver, our employment practice and policy making.

Our partnership working with Swansea Bay Racial Equality Council and the Minority Ethnic Women’s Network (MEWN) offers their expertise to assist with implementing our Race Equality Scheme. Our support enabled the local Racial Equality Council to introduce surgeries for people from ethnic minority communities where health topics are discussed.

The involvement of disabled people is crucial to the successful implementation of our Disability Equality Scheme. The membership of our Equality and Diversity Group was extended to include disabled people and carers. Their expertise in disability equality issues has been invaluable.

The Trust hosts an Apprentice Interpreter for Deaf People who is training to become a professional qualified interpreter. The Apprentice is developing her British Sign Language (BSL) skills and assisting in communication between deaf and hearing parties. The Apprentice is raising awareness of BSL by visiting our wards and departments to speak to staff about her role. The Trust holds the Two Tick Disability Symbol, which it uses on all advertisements to make it clear that job applications are welcomed from disabled people.

A statutory duty was placed on all public authorities to promote equality of opportunity between men and women from 6 April 2007. The Trust identified priority issues for gender equality to assist meet our new legal obligations.

The new Trust will provide significant opportunities to strengthen our focus on equality and diversity and build on existing experience, knowledge and expertise.


Recruitment and Retention

The Trust has continued its progress in developing effective approaches to Recruitment and Retention. We have successfully introduced and developed the NHS Jobs Recruitment Website into the Trust which is accessed through the Trust`s dedicated recruitment website. This has ensured that we can continue to develop e-recruitment through on line applications and shortlisting. We are continuing to work closely with other Welsh Trusts to further develop and exploit the current systems and look at ways in which the profile of NHS Wales can be raised.

The Trust has once again successfully participated in the NHS Open Week, holding and interactive Careers fair in a local Further Education College to show the range of exciting and interesting career opportunities in the NHS to young people.

Staff Numbers 2007/08

Full time equivalent 2007/08

Headcount 2007/08

Additional Prof. Scientific and Technical

342.23 385

Additional Clinical Services. 1,027.91 1,715Admin and Clerical 1,214.75 1,465Allied Health Professionals 424.19 502Estates and Ancillary 929.34 1,101Healthcare Scientists 175.86 206Medical and Dental 793.23 943Nursing and Midwifery Registered

2,388.03 3,259

Students 7.00 15TOTAL 7,302.54 9,591

Staff Numbers 2006/07* (please see following note)

Full time equivalent 2006/07

Headcount 2006/07

Additional Prof. Scientific and Technic

331.53 375

Additional Clinical Services 1,054.05 1,717Admin and Clerical 1,318.75 1,517Allied Health Professionals 396.14 470Estates and Ancillary 964.83 1,149Healthcare Scientists 181 209Medicine and Dental 798.64 940Nursing and Midwifery Registered

2,511.10 3,428

Students 9.31 21TOTAL 7,565.37 9,880*Figures for staff numbers in the Trust’s Annual Accounts and the figures in the Annual Report are counted on a different basis. The Annual Report counts contracted hours for our staff only. The Annual Accounts figures includes agency staff and accounts for all additional hours worked.


Staff Involvement

The Trust continues to recognise the importance of working in partnership with Staff Side representatives. The three full time convenor posts representing Amicus, RCN and Unison have been further extended and nominated staff representatives continue to attend Trust Board meetings. The Trust Staff Consultative Committee and Local Negotiating Committee for medical staff continue to meet on a quarterly basis and a new Partnership Framework document has been agreed.

Training

The Trust’s corporate training focus has been on the development of appraisal skills and the roll-out of a Trust wide framework for the conduct of appraisal review and personal development plans. This work has been underpinned by the continuing significant effort in the implementation and development of the Knowledge and Skills Framework (KSF) and training of managers.

This work forms the foundation of the Trust’s longer term plans around the development of detailed training plans based on the KSF and the imbedding of KSF into the local delivery of training across the Trust, both corporate and technical. We are also working towards the integration of personal learning and development records with the e-KSF tool and its interfacing with the electronic staff record.

Occupational Health Service

The Trust has continued to place great emphasis on the development of a modern and supportive Occupational Health service. The main priorities have been supporting effective management of sickness absence, and providing effective and constructive measures for Health Promotion within the organisation.

Additional measures have been provided to shorten referral times to Occupational Health and thereby shortening the periods of absence from work.

The Health Promotion Advisor has implemented initiatives that will assist Trust employees to develop awareness of ill health prevention and thus improve workplace health. The Department also continues to play an important role in the Trust’s commitment to achieve the Gold Corporate Health Standard.

Health, Safety and Fire Department

The role of the department is to support the Trust in managing a wide range of safety risks that may affect staff, patients, visitors and others.

The Health & Safety Department provides advice and support to staff throughout the organisation. Specialist advice and training is provided on manual handling, violence & aggression and fire and there has been considerable development in these areas over the last year.

Manual Handling

The department was reorganised and now comprises a Corporate Manual Handling Adviser supported by Manual Handling Adviser/Trainers. The focus has been on policy development, procedures, risk assessment and performance monitoring and be spoke training courses for


Paediatrics, Anaesthetics and Maternity areas. This approach builds on the success achieved with the Theatre training model.

The change in training has resulted in changes in practice and an increased enthusiasm for the process. Recent examples are an Anaesthetics Consultant who conducted an audit of manual handling risks in his team and the development of new techniques for cleaning limbs prior to surgery where ergonomic risks had been identified.

The work of the department in developing training systems was recognised by the presentation of papers at the Association of Perioperative Practice Conference in Harrogate and Ergo-Coach conference in Utrecht in Holland. In addition a paper has been written that has been submitted to the Health and Safety Executive for publication. Other NHS organisations continue to approach the Trust to get advice regarding the training model that has been developed and adopted.

The policy for the inspection and management of equipment at ward level was developed and introduced supported by appropriate training. Approximately £100, 000 was invested this year in manual handling equipment.

Fire Safety

Work undertaken this year has been to further develop compliance with the Regulatory Reform Order.

Fire Risk Assessments have been completed for all patient care areas and a large number of assessments are completed for other areas of the Trust. Principal findings of the risk assessments are considered at Trust level and used to inform policy, strategy and investment.

The Trust now operates a system of training based upon risk factors such as patient mobility and the use of flammable materials. Training i

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