nliah annual review 2011/12 the national … annual...covers the 2010/11 academic year....

NLIAH Annual Review 2011/12

NLIAH Annual Review 2011/12 1

The National Leadership and Innovation Agency for Healthcare (NLIAH)

The National Leadership and

Innovation Agency for

Healthcare (NLIAH) was set up as

part of NHS Wales and works

with health boards and trusts to

deliver better quality and safer

patient services.

NLIAH’s staff are currently based in Llanharan, Cardiff and Wrexham and have specialist

knowledge, skills and experience in the following areas:

Workforce Development

Leadership and Organisational Development

1000 Lives Plus, Research and Development

Service Improvement

Partnership Development

Equality and Human Rights

Specialist Services such as events management, programme/project management and

web applications

We have taken this opportunity to present our fifth annual review in a condensed format,

highlighting the wide range of programmes and initiatives provided to NHS Wales, as well as

demonstrating the considerable benefits and improvements that NLIAH, working with its

partners, has brought to patient services.

NLIAH’s results have been achieved through the commitment and enthusiasm of our staff

and the excellent working relationships we have with individuals, teams and organisations in

the health service in Wales, with the Welsh Government and with our partners in the public

and third sector. Our programmes have contributed to the actions of health boards and

trusts as they strive towards becoming organisations of excellence and to improve patient

services and citizen wellbeing.

NLIAH Annual Review 2011/12


Continuing to support NHS Wales

The major service change and the drive towards integrated health and social care means the

need for all-Wales services such as NLIAH must continue to provide and develop relevant

and responsive approaches which leave a sustainable legacy and show value for money. It

has been recognised that the multiplicity of functions which make up NLIAH, and which have

grown over time, needed to be reviewed in order to continue to meet this need.

NLIAH has worked with all stakeholders, including staff, health bodies and Welsh

Government, over the last 18 months to review the functions currently provided and how

best they could be re-aligned to support the strategic goals of NHS Wales; enabling it to

deliver transformational change and sustainable improvement.

This review has endorsed the work of all of the functions within NLIAH and has agreed a

number of changes from April 2013 that simplify, align and streamline functions and

accountabilities.

The improvement functions which are undertaken in various directorates in NLIAH

(1000 Lives Plus, service improvement and organisation development) and the Public

Health Wales NHS Trust will be brought together within Public Health Wales. This

provides a key opportunity for NHS Wales to consolidate its resources with a view to

determining national and local needs.

The equality & human rights service provided by the Centre for Equality & Human

Rights (CEHR) will continue to operate at the all-Wales level and will be hosted by

Public Health Wales.

Leadership development functions provided within NLIAH will come together with

the support previously provided by PSMW as part of the new AcademiWales and will

support leadership models within a wider agenda as proposed in the Programme for

Government.

Workforce functions, including Students Awards Unit, will operate at an all-Wales

level with Welsh Government continuing to retain responsibility for the education

and training budget, and will transfer to NHS Wales Shared Services Partnership.

Specialist functions in NLIAH including events management, the Learning Lab,

communications and programme /project management will continue to support

supporting frontline programmes and will transfer to Public Health Wales.

NLIAH is working closely with the new partner/host organisations to ensure that the

functions and staff transfer smoothly in April 2013, and that high quality programmes and

support continues to be provided to NHS Wales throughout this period of transition.




Workforce planning

Ensuring that NHS Wales has the right people and skills in

place, when they are needed, requires a clear planning

framework, expert skills in workforce planning, the active

contribution of relevant professional and vocational

expertise and the resources to do the job properly.

Workforce planning is not only about determining the

requirements of the future workforce, but also how to influence what resources will be

needed to ensure that workforce considerations are aligned with service and financial

planning. NLIAH works closely with NHS Wales on the development and assessment of their

workforce plans to help organisations.

Medical and dental workforce planning identifies risks of future staffing shortages, giving

organisations time to develop contingency plans ensuring the continuation of clinical

services. Forecasts of future supply and demand for new consultants in Wales inform

medical/dental education commissioning decisions, with the modelling tools used to

produce these forecasts significantly refined and extended following user feedback. An

electronic tool has been developed which profiles each specialty’s medical and dental

workforce on an all-Wales level.

The Welsh Ambulance Services NHS Trust and NLIAH jointly facilitated 3 integrated

workforce simulation workshops where 100 staff from across the organisation engaged in

the development of the Trust’s strategy. Examples of continuing work streams include:

creating one team, one Trust;

making the clinical team leader role work effectively;

developing a workforce with the right skills to deliver the future service strategy.

An e-learning resource to increase capacity and capability in integrated planning skills -

Right People, Right Place, Right Time is now available.

A five day service change through

workforce redesign programme

provides organisations with a

valuable resource to deliver service

change by enabling senior managers

to redesign their workforce.

A successful health visiting event was held to consider clinical practice tutors and innovative

ways of maintaining student health visitors in a rapidly changing environment.

200 people have completed the service change

through workforce redesign programme. 100%

of recent participants rated the programme as

“excellent” or “good” with 92% saying they

would use the skills learnt at least weekly.



Workforce modernisation

The Safer Nursing Care Tool is an online tool which uses acuity and dependency to help plan

for future workforce requirement. It will be implemented in phases in acute and community

hospitals across Wales.

Modernising Scientific Careers (MSC) in Wales has:

developed Practitioner Training Programme courses within Wales which will start in

September 2013.

recruited trainees from a number of healthcare science disciplines to the Scientist

Training Programme, starting September 2012;

developed a Scientist Training Programme for Medical Physics;

contributed to the ongoing national development of a career framework for levels 2–4

Higher Specialist Scientific Training curricula and occupational coding for the

healthcare science workforce within the electronic staff record (ESR); and

held two healthcare science workforce communication events showcasing the newly

established Academy for Healthcare Science, the Health Professions Council and the

National School for Healthcare Science.

Induction principles for Healthcare support workers (HCSW) have been developed as part

of the development of a Code of Conduct for HCSW and a Code of Practice for Employers.

The common portfolio framework Advance Practioner: The Portfolio

was launched by the Minister for Health and Social Services. By

assessing the competencies of advanced practitioners, the portfolio

supports the standardisation of good practice to ensure high quality

patient care is delivered across NHS Wales. The Minister stated “the

development of higher levels of practice is an enabler for meeting the

service and workforce challenges of the future. The development of

advanced practitioners has presented significant opportunities for

role development and service innovation.”

National Governance Framework for the health and social care support worker role

(HSCSW) was produced jointly with Care Council for Wales. The framework:

identifies the governance issues in relation

to the HSCSW role;

clarifies the legal position and recommended

governance arrangements, thereby

promoting safe practice;

informs good risk management and

provides guidance on training and

qualifications.



Apprenticeships for clinical imaging at levels 2 and 3 were developed in conjunction with

the awarding body AGORED and the service. Health boards and trusts have endorsed the

apprenticeship programme which support better productivity, retention of staff and

provision of a suitably qualified workforce.

Education commissioning – training healthcare students

Aided by professional advice, guidance has been developed on the workforce model for a

potential hub and spoke approach to future maternity services in Wales. Healthcare support

worker students have completed a level 4 certificate in higher education at the University of

Glamorgan, demonstrating their individual professional growth and development through

the course.

Strategic Education Development Group (SEDG) is the multi-professional strategic group

set up by Welsh Government to oversee current and future education and training

developments, including advising on the utilisation of the central education and training

budget. Sub groups of SEDG:

focus on the non medical professional workforce issues including utilisation of the non

medical education and training budget and academic levels of programmes and

consider the wider workforce needs and provide a strategic steer to the utilisation of

funding currently used for support staff or non professional specific qualifications.

This advisory group will also oversee the activity associated with the quality assurance of the

approval mechanisms for quality assured lifelong learning units for use in NHS Wales on

behalf of the Department for Education and Skills, WG.

Flying Start – health visitors remains a priority area, with a Welsh Government commitment

to increase numbers across Wales. To support this NLIAH have increased the number of

education places from 36 in 2010-11 to 103 in 2011-12.

Student attrition in Wales in Wales keeps

falling and is far lower than in England and

Scotland. The last full year of attrition figures

covers the 2010/11 academic year. Pre-

registration nursing attrition in Wales was

10.6% - its lowest level; English and Scottish

data are above 20%.

The pilot of the graduate and post graduate certificate in non-medical authorisation of

blood transfusion has evaluated very well: all students having a significant increase in

knowledge and understanding of all aspects of the blood transfusion processes. Being

identified as competent to authorise the transfusion of blood components will have a

positive impact on waiting times and patient safety.



Wales Health Student Forum is an open forum to identify, share

and discuss education issues in Wales which are pertinent to

healthcare students. It provides an opportunity to meet with

policy makers and education providers to ensure an excellent

training experience for all staff.

Healthcare scientists: modernising & meeting demand: as part of the four country

programme for modernising scientific careers, 15 trainees have been funded to participate

in the new Scientist Training Programme (STP) at masters level across a range of pathways.

NLIAH funded trainees had a great year in the Institute of Medical Illustrators (IMI) annual

award with Welsh trainees receiving a number of awards. There was also success for a

number of former Welsh trainees now working in Wales and across the rest of the UK.

Workforce information, intelligence and productivity

The availability of robust workforce information and intelligence is essential and to support

this, recent work has focussed on the successful management of the workforce. Key

programme activity during 2011-12 includes:

the development of an electronic tool to produce profiles of key workforce data

including staff in post, pay-bill and sickness;

improved electronic staff record (ESR) data quality;

extending the functionality of ESR, e.g. sickness absence reason reporting and FTE paid

and worked reporting from the data warehouse.

The Workforce Information System (WfIS) programme

recently won the 2012 UK Healthcare People

Management association (HPMA) Excellence in Human

Resource Management Awards for Best Practice and

Innovation.

Student Awards Unit

The Student Awards Unit provides financial support for people studying to become nurses

and other healthcare professionals.

In 2012/13, NLIAH made payments to, or on behalf of, over 6,000 students, including

bursaries, means tested bursaries, contribution to salary costs, childcare allowances and

allowances to disabled students.




Leadership and Organisational Development supports

existing leaders and develops leadership talent at all

levels and across all disciplines within NHS Wales.

This is critical to meet the challenges of the strategic

change agenda and deliver the service change and

development required to modernise the NHS in Wales.

Future workforce

Eight graduate management trainees successfully completed the first year Advanced

Development Programme (ADP), demonstrating their learning, development and ability to

lead change through detailed performance reviews and service improvement projects. The

trainees started their second year in November 2011. Recruitment for the second ADP

cohort started in January 2012, with 11 trainees being offered posts in health boards, trusts

and NHS Wales Shared Services Partnership.

The Maximising the Potential of Organisation framework, developed in collaboration with

assistant directors of organisation development, helps NHS Wales to understand the skills,

experience and capabilities needed to deliver its objectives. It provides guidance for local

succession planning and talent management within health boards and trusts.

People identified at a local level as having potential and requiring accelerated development

will be offered access to Development Centres offering diagnostic tools, learning activities

and coaching support. The approach has been tested with a team of senior IT managers

within Abertawe Bro Morgannwg University Health Board and could eventually be

implemented locally for wider staff engagement and nationally for more senior leaders.

The Advanced Leadership Initiative (ALI) programme was developed for individuals

expected to step up to a chief executive post. It has included a number of innovative

development activities including consultancy assignments in Northern Ireland, Scotland and

Denmark investigating other health systems. The programme also developed an interactive

social media workshop, providing the opportunity to explore how using social media might

support effective communication, health promotion and education and public engagement.

14 senior managers from NHS Wales participated in

the Enhanced Leadership Programme (ELP). Using

the Deep Dive approach initially developed in the

ALI programme, participants worked alongside the

wider public sector to examine the challenge of

developing future services including wellness for

cancer, diabetes and elderly mentally ill.



Building current workforce

The 2012 annual professional development event for Consultant Nurses, Midwives and

Allied Health Professionals provided the opportunity to work with Professor Kate Gerrish

who has developed a toolkit for UK consultant nurses to demonstrate the impact consultant

nurses make on the organisation and delivery of quality patient care.

The Changing Care programme helped professional and clinical leaders at all levels work

together to shape the future for patient services for Betsi Cadwaladr University Health

Board. Nearly 40 clinicians and managers contributed to five collaborative change projects

looking at the delivery of national programmes within a local context. They were supported

through virtual action learning sets using WebEx technology, which reduced the time away

from the workplace and travel costs as well taking advantage of innovations in technology.

Leading for Quality and Improvement (LQI) is delivered locally by teams trained by NLIAH

using a “train the trainer” style programme. It develops the facilitator’s ability to apply

learning and cascade it to clinical and management staff locally so that appropriate and

effective service improvements are made. The facilitators help people recognise what they

already know, as well as teaching new skills and knowledge and building leadership

capabilities. Working collaboratively increases the capacity and capability of health boards

to provide workshops and the mixed cohorts allow staff to experience different ways of

working and can share their experiences in a safe learning environment. Facilitators are

supported by the LQI Network which is facilitated by NLIAH.

Organisational development

Organisational development (OD) specialists working in the public sector need to ensure

they have appropriate skills in organisational development and organisational design.

Associate directors of OD from NHS Wales and their counterparts from social services came

together in two mixed cohorts to enrol on the CIPD Advanced Award in Organisation Design

and Development qualification in March 2012. By providing a theoretical understanding of

OD and design issues, together with practical knowledge and skills, the qualification will help

individuals gain the competence and confidence necessary to deliver tangible results.

NLIAH supported the facilitation of Abertawe Bro-

Morgannwg UHB’s Changing for the Better

programme which considers how services could look

and be sustainable in the future. Following an initial

Deep Dive exercise which looked at current service

provision, a number of large scale facilitated

workshops brought together clinicians, service

managers, patients and carers and other

stakeholders to understand the need for change

and to identify future service options.



Coaching and mentoring

NLIAH provides skilled and experienced coaches who, alongside externally commissioned

coaches, support the participants on programmes and also respond to ad hoc requests.

Funding was made available for staff from across the service to qualify in coaching from the

Institute of Leadership and Management (ILM).

Coaching Wales, an online service where individuals can find a coach, was launched in June

2011 in partnership with PSMW. Qualified and experienced coaches from across the public

sector are able to post their profiles so that potential coachees can choose a coach matching

their criteria. The Coaching Collaborative hosted by PSMW, has 60 members, many of

whom are NHS colleagues. The collaborative offers quarterly CPD events and ongoing

support.

NHS Wales/Scotland e-Mentor exchange programme (Cross Country e-mentoring

Challenge), run over six months and using Skype or WebEx technology, six NHS Wales

mentors were matched with six colleagues from NHS Scotland. Yet to be evaluated

formally, early indications are that participants are finding the process effective and

rewarding.

e-leadership

New technologies offer opportunities for learning and development and are used to support

NLIAH programmes. NLIAH has integrated technology and interpersonal skills in a virtual

environment.

Virtual Action Learning Sets (VALS) use video conferencing technology to enable people in

different locations to work together effectively. Action learning in a virtual environment

stretches the critical skill sets of both the facilitator and the participants. Participants from

the Changing Care programme and the Advanced Development Programme, as well as

professional groups such as consultant nurses, midwives and allied health professionals,

have benefited from using a virtual approach to action learning.

The recently published Virtual Action Learning Guide

is a comprehensive introduction to the principles that

underpin effective action learning in a virtual

environment.

The Learning Channel is an online learning support

tool which offers leadership programme participants

access to video, podcasts and other resources to

enhance their professional development.

The Channel can be accessed through the NLIAH

website www.nliah.wales.nhs.uk.

http://www.nliah.wales.nhs.uk/




1000 Lives Plus is the national improvement

programme supporting organisations and individuals

to deliver the highest quality and safest healthcare for

the people of Wales. NLIAH helps to deliver the

programme working alongside Public Health Wales

and the Welsh Government.

Improvement programmes

Here are some examples of how 1000 Lives Plus has

influenced services:

Enhanced recovery after surgery optimises surgical outcomes by ensuring early

mobilisation and scaled back use of pain relieving drugs. All health boards providing

colorectal or orthopaedic surgery are involved in the programme. The work won the

‘Research into Action’ category at the national UK 2012 Advancing Healthcare Awards.

The National Early Warning Score (NEWS) is a simple

evidence-based system to assess whether hospital

patients are developing potentially life-threatening

illnesses. Recommended by the Royal College of

Physicians, Wales is the first country to implement the

system.

The initial focus of Transforming Maternity Services

was to improve the recognition and response to women who become acutely ill during

pregnancy and the postnatal period. It also seeks to reduce the risk of potentially fatal

venous thrombosis. A recent additional focus will provide interventions to reduce

preventable stillbirth in Wales.

Anti-psychotics medicines are important for some symptoms of dementia though not all

patients suffering with dementia will benefit. 1000 Lives Plus is supporting care homes and

GPs to check that people with dementia receive anti-psychotic drugs appropriately. The

results are reducing unnecessary cost and improving

patients well being.

Transforming care has released substantial amounts

of time for nurses to spend with patients: on one ward

time spent directly caring for patients rose from 40%

to almost 80%. Pressure ulcers are now exceedingly

rare events in many Welsh hospitals and there have

been significant reductions in patient falls.



Healthcare associated infections are a costly and harmful feature of modern healthcare.

1000 Lives Plus launched the STOP campaign to improve the quality and safety of patient

care through better use of urinary catheters and

intravenous cannulas. Teams in every health board and

trust in Wales have used the materials to protect

patients in hospital from infection.

In one hospital, only one patient out of 20 had a

peripheral IV line (PVC) on their clinical decisions unit

and of the 28 patients on the surgical ward, none had a

PVC in place. Neither ward had catheterised patients.

Similar results are now being seen in other health

boards.

Person driven care

1000 Lives Plus has worked to ensure people are appropriately involved in their own care

and has championed ways which ensure people’s views and experiences are heard. The

voices and stories of patients are an effective and powerful way of making sure services are

centred on the needs of the people using the services.

In November 2012, 1000 Lives Plus and the Continuing NHS Healthcare programme hosted a

workshop which highlighted the progress of the Esther Network in Jonkoping, Sweden. The

workshop particularly highlighted the challenges in building a patient-centred healthcare

system which is integrated with social services.

Life After Stroke aims to improve the support available for stroke survivors when they

return home from hospital through better co-ordination and accessibility of services across

the health, social care and voluntary sectors. It was launched in March 2012 with a special

event that brought together stroke survivors and carers from across Wales to share their

views on the support they feel would improve their care and quality of life.

The 1000 Lives Plus Faculty

34 clinical and improvement leaders from across Wales provide local and national expertise

to 1000 Lives Plus improvement programmes. They have lead responsibility for the ‘How To’

guides and other learning resources available on the 1000 Lives Plus website and for

specialist content of all learning events and materials. Faculty members produced several

white papers including ‘Quality, Development and Leadership – Lessons to learn from

Jonkoping.’

1000 Lives Plus is supporting trusts and health boards to establish a local faculty linking

organisation objectives to clinical work.



Equipping the workforce of tomorrow

Engaging and equipping the workforce of tomorrow to

make a difference today is a primary aim of the

programme. The academic community in Wales has

been supported to integrate and develop quality

improvement into the curriculum of healthcare

professionals.

The 1000 Lives Plus Student Chapter is an active

network of student volunteers enthused by quality

improvement and patient safety. The Chapter currently has nearly 1,800 members and in

March 2012 hosted the IHI Open School (UK) Conference attended by students from across

the UK.

Improvement methodology

1000 Lives Plus equips NHS Wales staff with a standard

method to underpin all improvement work. Its Quality

Improvement Guide brings together learning from

around Wales into a simple-to-follow format in order to

establish a ‘common language for improvement’.

Over 9,000 copies of the Quality Improvement Guide

have been distributed. Tailored editions have been

produced for the RCN (Nursing) and RPS (Pharmacy) as

well as a version for educators and students.

Publications and resources

Five new ‘How to’ guides were produced to support the individual programme areas,

bringing the total to 20. Alongside these, seven ‘Tools for Improvement’ provide additional

material on broader advice to support improvement.

Six white papers addressing major issues in healthcare have been produced., including:

Improving Quality Reduces Costs - Quality as the

Business Strategy; Person Driven Care, a study of the

Esther Network in Sweden, and Is healthcare getting

safer? based on a seminar with Professor Charles

Vincent.

Over 145 videos are now available on the 1000 Lives

Plus website, providing updates on programme areas, progress made by local teams and

insights from experts in healthcare improvement.



Events

1000 Lives Plus helps staff learn from international

experts in healthcare improvement and patient safety

through events and through mini-collaboratives

bringing together clinical teams to test improvements.

During 2011-2012, 46 events were held including two

National Learning Events, the IHI Open School (UK)

Conference, and a number of high profile seminars:

Is Healthcare Getting Safer? with Professor

Charles Vincent.

Mid Staffordshire: A dark event in the history of the NHS – Causes and Lessons with

Professor Brian Edwards.

Attaining Peak Performance in Clinical Practice with Dr Dafydd Williams, A&E

Consultant and NASA astronaut.

In total, over 2,000 people attended these events, with 95% of delegates rating them as

either very good or excellent.

Communications

Effective communications is pivotal to the programme’s work and impact:

re-launched in November 2011, the website averages 4,000 visitors a month;

5,000+ people receive the monthly e-newsletter;

600+ people follow 1000 Lives Plus on Twitter;

Since the launch in May 2011, it has gained a strong presence in the media, including 219 newspaper and magazine articles; 117 online-only news articles and features, and 77 professional publications (print and online).

The programme has exhibited and contributed at key events and conferences across

Wales and further afield. These include stands, posters and platform time at the

International Forum on Quality and Safety for the past three years and the UK

Patient Safety Congress.

Evaluation

The programme has partnered with Cardiff University to evaluate the Global Trigger Tool

and organisational impact of the 1000 Lives Campaign.

Service Improvement


Service Improvement

Service Improvement supports health

communities to improve patient services. This is

achieved through a range of programmes

delivered across Wales. Staff also support various

programmes within 1000 Lives Plus.

Patient safety

NLIAH supports patient safety incident reporting across Wales. The patient safety team

supported the transfer of the National Reporting and Learning System (NRLS) from the

National Patient Safety Agency to Imperial College London, ensuring Welsh organisations

continue to report into NRLS. Patient safety incident investigation includes root cause

analysis and complex investigations (linked to the Putting Things Right legislation), and a

common training package developed for local use. An All-Wales Alerts Working Group

shares best practice and provides support to organisations on patient safety alerts. The

team supports 1000 Lives Plus national programmes and works with colleagues in higher

education to promote 1000 Live Plus and the function of patient safety in Wales.

Transforming theatres

Transforming Theatres has improved patient safety in the operating theatre by focusing on

team briefing, ergonomic efficiency and improving the environment. Three Human Factors

training sessions were attended by more than 400 people. Two health boards saved over

£150,000 each as a direct result of the programme with improvements including recycling,

reduction in stock, cost effective alternatives and better stock control.

Before Transforming Theatres:

After Transforming Theatres:

Service Improvement


Education programmes for patients Cymru (EPP)

A number of new self management courses were developed and implemented during 2011-

12, with an increase in the number of people with a chronic condition accessing self

management courses. 146 EPP courses were delivered across Wales during 2011-12, 4%

more than the previous year, with more than 1,200 people completing their EPP course. 185

participants achieved Credits for Patients learning credits which can be used in supporting

return to work or further education.

Chronic conditions

NLIAH supported the first National Therapies Conference - Therapies and Citizens Together

for Health by the Welsh Therapies Advisory Committee (WTAC) in March 2012. It was

attended by 80 delegates from across Wales and as a result WTAC are developing a

therapies specific Quality Improvement Guide.

Support to the All-Wales Posture & Mobility Service

(ALAC) focused on helping to implement

recommendations from the ministerial review of

2010. This included work on capacity and demand,

procurement, referrals and engagement and resulted

in significant improvements in waiting.

Other support in 2011/2012 included:

helping Cwm Taf psychologists identify priorities for improvement; understand the

patient perspective through patient stories; and undertake a review of the capacity

and demand of services to older adults;

changing the delivery of domiciliary care for Swansea residents through an

appreciative inquiry approach building on patient stories which identify and

prioritise improvements;

improving the quality and safety, and consistency of communication of the Adult

and Older Persons Mental Health teams in Aneurin Bevan Health Board

Change Agent Team

An all-Wales escalation and de-escalation plan produced with key stakeholders allows the

same triggers for patient flow escalation to be used across Wales. The All Wales Bed

Management Tool Kit was released In January 2012, enabling a consistent approach to bed

management tools and techniques across Wales and ensuring that a common data-set is

being used. An 18-week patient flow programme, ‘One Ward’, supported care and discharge

planning in Betsi Cadwaladar University Health Board.

Service Improvement


The Multiagency Collaborative for Falls has operated

since September 2010. Its aim is to reduce the

mortality and harm to adults that result from falls in a

community setting. There is considerable interest from

a wide variety of sectors with participants from health

and social care and the independent sector. A broad

range of teams are actively implementing the falls

bundles and data collected demonstrated a steady

increase in compliance across all bundles.

Endoscopy

Joint Advisory Group for Gastrointestinal Endoscopy Accreditation (JAG) ensures a unit is

providing high quality services. In January 2012, Bronglais Hospital was the first Welsh unit

to gain full JAG accreditation. Other units are either nearing accreditation or working

towards addressing any outstanding issues including environment or waiting list pressures.

The Gastrointestinal Nursing programme trained 24 facilitators and delivered 23 study days

to over 230 nurses and health care support workers.

The MSc Module Enhanced Practice for Upper and/or

Lower Gastrointestinal Endoscopists, from Swansea

University, offers the theory and clinical practice to

underpin advanced practice as an endoscopist.

The All Wales Competency Framework was developed

and piloted on two units in north Wales and will

become available to all endoscopy nurses working in

Wales.

The Graduate Certificate in Endoscopy Nursing, Swansea University is available for nurses

working in endoscopy units who need to develop specialist knowledge.

Primary Care

NLIAH supported the developing primary care network through a series of Primary Care

Report network meetings covering topics such as access, clinical engagement, leadership

engagement, patient and stakeholder engagement, assurance, communications, team

working, cancer care and pathway development.

Specific support has also helped health boards provide improvement skills learning and

training to primary care staff groups; tested improvement methods and processes at a

cluster or locality level; and helped chief pharmacists make improvements happen.

Early evidence presented within the health boards’ latest primary care reports suggests

small but noticeable improvements to outcomes for patients and practices in primary care.

0

10

20

30

40

50

60

70

80

Ap

r 2010

May 2

010

Jun

2010

Jul 2

010

Aug

2010

Sep

2010

Oct 2

010

No

v 2

010

Dec 2

010

Jan

2011

Feb 2

011

Mar 2011

Ap

r 2011

May 2

011

Jun

2011

Jul 2

011

Aug

2011

Sep

2011

Oct 2

011

Months

% patients who receive the full Assessment Bundle

Fallsfrom Apr 2010 to Oct 2011

Service Improvement


Mental health

Policy support has supported the implementation of the Mental Health (Wales) Measure

2010 and advised the Code of Practice to Parts 1 and 2 of the Measure and the Mental

Health (Secondary Mental Health Services) (Wales) Order 2012. Training materials to

support Part 2 of the Measure have been developed with Lincoln University.

Work on suicide prevention included policy guidance for the development of psychological

therapies in Wales and on a new mental health strategy for Wales designed to promote

mental health and wellbeing and improve the quality and delivery of services.

Mental health improvement supports and develops services across Wales, including the

facilitation of the Child and Adolescent Mental Health Services National Expert Reference

Group. The Dementia Action Plans for Wales support the spread of This is Me, the Butterfly

scheme and the cognitive impairment care pathway. Support is also provided to the 1000

Lives Plus programme with targets for depression, dementia, medicines management,

eating disorders and first episode psychosis.

Clinical Governance Support Unit

The Unit’s role is to support NHS Wales and its partners to

deliver safe effective healthcare services and has led the

implementation of the 1000 Lives Plus Leadership programme.

As well as helping build engagement between teams

undertaking front-line improvement work, the programme

supports organisations at executive and board level to improve

internal and external assurance about quality. Learning on

leadership and culture has been shared widely across Wales and

in January 2012, at a leadership conference in Norway.

The Unit has supported organisations to use the Standards for

Health Services in Wales in a way that benefits patients, service

users and staff, with learning widely shared.

National clinical audit allows NHS Wales to compare performance within and outside of

Wales. The Unit helped formulate the NHS Wales National Clinical Audit Outcome and

Review Plan Annual Rolling Programme 2012/13, which supports the vision set out in

Together for Health (2011).

A clinical audit training programme has been developed for use by all professions and

grades of staff across Wales, with very positive feedback.

The Unit has been involved in developing an audit for General Dental Practitioners which

aims to ensure that all antimicrobial prescribing is evidence based. In a phased introduction,

it will be available across Wales during the next nine months.




Partnership Development developed approaches to citizen engagement and supported the

delivery of integrated services and collaborative development programmes.

Effective Citizen Engagement Seminar Workshops

Working in partnership with the Welsh NHS

Confederation and the Consultation Institute, the first

series of engagement seminars were held across Wales

at the beginning of 2012 and have proven to be a

success.

Each event was fully booked and feedback very

positive. The presentations from these events are

available on the NLIAH web site.

Understanding the need for consistent interpretation and application of the NHS Wales

Engagement and Consultation Guidance

Five learning seminars were held across Wales in partnership with the Welsh NHS

Confederation and the Consultation Institute.

These seminars help board members develop awareness and understanding of why a

consistent interpretation and application of the guidance is required (Guidance for Engaging

and Consultation on Changes to Health Services). They also gave the opportunity to discuss

and identify the challenges faced.

Accredited Public Engagement Training Programme

Developed as part of a national approach, the

public engagement accredited programme

drives effective public engagement by

providing staff with a level of skills to develop,

implement, grow and mainstream public

engagement within their own public sector

organisations.

A number of organisations were involved in

the development and joint funding of the

programme: Welsh Government, NLIAH,

Participation Cymru, and Welsh Local

Government Association.

“Engagement with service users

remains a critically important pillar of

the new Government’s drive. Creating

the Wales of the future is something

that involves all of us, we can achieve

little without the input and partnership

of the people of Wales, and our key

stakeholders, at every level.”

Carwyn Jones, First Minister, Welsh

Government

“Good to see staff involvement in strategy

development”

NHS Centre for Equality and Human Rights



The NHS Centre for Equality and Human Rights (NHS CEHR) supports the NHS in Wales to

ensure patients and staff are treated in accordance with their individual needs when

accessing and using healthcare services. The Centre seeks to improve and build capacity

and capability within the service to ensure these needs are met, rather than providing direct

services itself.

Meeting statutory requirements, promoting learning and collaboration

Public sector organisations were required to publish their strategic equality objectives by

2nd April 2012. Throughout 2011/2012, the NHS CEHR supported health bodies to develop

their equality objectives and their Strategic Equality Plans through the provision of

guidance, developing a robust evidence base and promoting inclusive engagement.

Public sector equality duty workshops

In order to support the public sector in Wales,

the NHS CEHR, in conjunction with the Welsh

Local Government Association, ran a series of

11 workshops themed around the Equality

and Human Right Commission’s Non Statutory

Guidance in relation to the Equality Act 2010.

Almost 250 people attended the workshops,

with 99% of delegates rating the workshops as

excellent or very good.

The Minister for Finance and Leader of the House, Jane Hutt AM introduced the Equality

Champions Conference: Delivering Equality Outcomes in Challenging Times seminar which

was targeted at local authority councillors and health board members with the equality lead

portfolio.

Equality Impact Assessment (EqIA)

The NHS CEHR was invited to join a project

management group looking to improve

specialised mental health services for patients

with gender dysphoria and gender

confirmation surgical services. An EqIA

framework was used to anticipate the

consequences of decisions on relevant groups.

By engaging service users at the very

beginning of service design and listening to

their experiences, the EqIA framework

A workshop participant said:

“First chance I have had to have quality time

to think about what the Equality Act will

mean for us…

…. Also so helpful to network with others.

The group exercises were really helpful as I

will use the question to facilitate a

discussion at our Strategic Equality Forum to

help with ownership and delivery”.

“Working with the Centre for Equality and

Human Rights for the last 18 months has

been a very rewarding and community

empowering experience. It has enabled us

to change both minds and hearts in the

Welsh NHS and given us true engagement

with the commissioning and delivery of the

treatment of Trans people across Wales and

this has brought the prospect of real change

in the Gender Dysphoria Service for Wales.”

Jenny-Anne Bishop, UNIQUE



allowed conflicts and differences to be aired, the decision-making process was more

transparent and was shaped by those directly affected by the policy. It built a platform for

partnership working that fostered good relations, and in some way removed the underlying

expectation of discrimination that the transgender community has long felt in their

relationship with health services.

The NHS CEHR will be developing a “Centre of Excellence” approach for EqIA to help

organisations deliver patient-centred, accessible services and ensure it is built into service

planning and decision-making processes.

Enabling NHS Wales to meet the diverse needs of patients, staff and carers

The NHS CEHR, in collaboration with the Leadership and OD

Directorate, facilitated an e- mentoring programme to

support people from black and minority ethnic groups to

develop their careers and enhance their leadership skills

within the health service in Wales. This project provided a

blended approach to learning, combining face-to-face

engagement with e-technologies. Support was provided in

the form of a series of briefings, learning and evaluation

sessions.

Six mentor/mentees relationships were formed with a diverse range of health backgrounds.

As part of the programme, individuals undertook a work-based improvement project, for

example:

The nursing contribution and clinical management of patients referred to the

Frailty Initiative - supporting independent nurse prescribing for the management of

frail patients in the community, promoting autonomous nursing practice and cost

savings from appropriate prescribing. It enhances rapid patient access and transition

between services.

An analysis of ‘length of stay’ for stroke services in a hospital and community

setting - identifying appropriate clinical settings for stroke care based on an analysis

of patient need.

The learning is being shared with trusts and health boards via the web-based NLIAH

Learning Channel and Learning@NHSWales. A full evaluation is available on the NHS CEHR

website.

In collaboration with Cwm Taf Health Board, the Personalising Healthcare Project explored

how understanding the patient experience can improve personalised healthcare. The

project also aimed to explore innovative ways of involving patients and carers in co-

designing new policy and practice. Key learning from the project evaluation informed the

development of the board’s Strategic Equality Plan and Objectives, published in April 2012.



Equality practice for change was run in

partnership with the Welsh Local Government

Association using a programme designed by Public

Sector Management Wales focused on developing

the equality practitioner as an agent for change.

Providing participants with an in-depth

understanding of OD, change management,

innovation and service improvement, it

encompassed professional development and

personal growth through the enhancement of core

leadership and management capabilities.

The NHS CEHR facilitated an equality and human rights action learning set for mental health

nurses on an accelerated development programme with Cardiff and Vale University Health

Board. It provided an opportunity for newly qualified nursing practitioners to learn and

reflect on their learning to support their personal and professional development. NHS CEHR

has been asked to support this project again in 2012/2013.

The NHS CEHR has been promoting supported employment and volunteering opportunities

for people with a learning disability across NHS Wales. Working collaboratively with Elite

Supportive Employment Agency, the potential to introduce an internship programme for

young people with a learning disability based on the Project Search model in England is

currently being explored and will be taken further in 2012/2013.

Other projects supported by the NHS CEHR in 2011/2012 included:

Supporting Betsi Cadwaladr University Health Board with the development and

promotion of an equality e-learning module and exploring its further use in a

procurement exercise in 2012/2013

Working with Cardiff School of Optometry on the development of the MEGAFOCUS

ethnicity and data collection pilot in Aneurin Bevan Health Board. This data will be

used to promote eye care services to those black and minority ethnic groups who

may not normally access them.

Providing an equality learning input into the general practice element of “Making

Good Decisions in Collaboration” (MAGIC), a training pilot around shared decision-

making in healthcare.

Promote learning, collaborative working and best practice on equality

The NHS CEHR continues to facilitate the NHS CEHR Stakeholder Reference Group, aiming

to help representative bodies to collectively influence NHS Wales and WG DGHSS on

equality and human rights.

A workshop participant said:

“Moving away from the position of

being an equality expert required me to

let go of the personal power that

knowing the right answer gave me. By

the end of the programme we had all

moved out of our ‘comfort zone’ and

were willing to try things we had

considered too difficult or

uncomfortable”.

NHS Centre for Equality and Human Rights / Wellbeing Through Work


Working collaboratively with Equality and Human Commission Wales and NHS procurement

strategic leads, the NHS CEHR is raising awareness of the new Public Sector Equality Duty

requirements around procurement and commissioning.

The NHS All Wales Equality Linkworker Network

met four times and engaged with representatives

from the Strategic Migration Partnership, NHS

Confederation and the Extending Working Lives

Project. One session explored the implications of

the forthcoming Welsh Language Measure and

brought together Welsh Language Officers and

Equality Officers and was co-facilitated with the

Welsh Language Unit of the Welsh Government.

Mediation or conflict management is one of a range of practical interventions provided by

the NHS CEHR to assist with resolving conflict inside the workplace. During 2011/2012, the

Centre mediated in 17 cases.

Equality and human rights training, the NHS CEHR has continued to support the Post

Graduate Deanery by delivering a series of learning sessions across NHS Wales to junior

doctors (FP1 and FP2) around equality and human rights in the delivery of healthcare. The

Centre has provided ongoing support to GP trainers through the design and delivery of

bespoke practical learning sessions focussing on equality and human rights with specific

relevance to service delivery and employment.

Wellbeing Through Work

The Wellbeing through Work project is underpinned by European Union funding and

partnership working across NLIAH, Remploy and ABMU. It supports the health and wellbeing

of individuals living or working in Bridgend, Swansea, Neath and Port Talbot at risk of being

off work and not retaining employment.

800 individuals have been supported since autumn 2011 - 20% above target - realising a

range of individual, employer and social benefits. Most individuals become case managed

participants, and 97% are still in employment 26

weeks after their support began. Equality targets for

older and female participants have also been

exceeded. Experience and good practice has been

shared with the publication of six ‘learning papers’.

The project was a UK HPMA (Health People Management

Association) for Excellence in Human Resource

Management runner up.

A network member said:

“Thank you for another interesting and

information packed link worker

meeting … as usual a great meeting

with excellent presentations and a

great opportunity for me to know

what's happening in the service and the

issues/good work going”.

NHS Wales Awards


NHS Wales Awards

NLIAH organises and runs the NHS Wales Awards,

which recognise achievement and good practice in

Wales and stimulate and encourage an evaluative

approach to implementing better ideas in service

delivery.

In 2011, over 130 storyboards entries were received and from these, six recognised

outstanding achievement and best practice in delivering innovative care and work for

patients.

Citizens at the centre of service redesign and delivery

Colorectal Cancer Pathway: An interactive journey to de-mystify the process for

patients, families and friends - Cwm Taf LHB

Developing a flexible and sustainable workforce

An ambitious project to introduce training to overcome shortfall in service provision

for those who are unable to provide their own foot care - Cardiff and Vale uLHB

Improving patient safety

Getting to Zero: A Health Board Approach to eliminating Hospital acquired pressure

ulcers - Abertawe Bro Morgannwg uLHB

Improving quality through better use of resources

Enhanced recovery orthopaedics - Betsi Cadwaladr uLHB

Promoting better health and avoiding disease

Carmarthenshire Multi-Disciplinary Weight Management Clinic- Hywel Dda LHB

Working seamlessly across organisations

Teledermatology – improving GP education in dermatology and, through triage and

waiting list management, improving patient experience - Cardiff and Vale uLHB

More details on the winners and all entries which achieved a score of 5 or more out of 10

are showcased on the Good Practice Wales website.

NHS Wales Chief Executive David Sissling, who announced the winners, said:

“The NHS Awards recognise the innovative work that is being done by our healthcare

staff every day to ensure we provide the best possible care for patients…. … These are

excellent examples of best practice which will be shared across Wales. They are a

tribute to all staff involved."

Good Practice Wales / Learning Lab / Programme Support Team


Good Practice Wales

Improving services is the goal of every public sector organisation. Good Practice Wales

(GPW) has eight partners: NLIAH, Excellence Wales,

Public Service Management Wales, Partnership Support

Unit, Social Services Improvement Agency, Wales Audit

Office, Welsh Government and the Welsh Local

Government Association.

GPW helps Welsh public and voluntary services improve the efficiency and quality of

services. It aims to be the single point of access to good practice across Welsh public

services. Users can search over 1,000 abstract and case study examples, and access

additional learning materials from across the public sector in Wales through the portal at

www.goodpracticewales.com.

Learning Lab

The NLIAH Learning Lab is a free library service specialising

in management, service improvement, leadership and

workforce information as well as housing the resource

collection of the NHS Centre for Equality and Human Rights.

Available free to anyone working for NHS Wales or the

public and voluntary sector in Wales, details on how to join

and the Learning Lab online catalogue are on the NLIAH

website www.nliah.wales.nhs.uk.

Stock is updated regularly and new titles advertised to members. In 2011-12 the Learning

Lab loaned out 1,083 books and CDs and signed up 190 new members.

Programme Support Team

Supported by the Programme Support Team, NLIAH delivered 231 events across 2011/12,

which averages out at 4 events per week. 7,840 delegates attended our learning events,

with 95% saying that their knowledge had increased following attendance at an NLIAH

event, and 92% rating our events as excellent or very good.

As well as delivering traditional events, NLIAH provided 91 web based learning events

across the year, allowing staff to access learning and development closer to their base,

saving both travel time and costs.

NLIAH is dedicated to sourcing event venues

within public sector, NHS, academic or charity

run venues. The graph opposite illustrates how

well this was achieved across the year.

http://www.goodpracticewales.com/

http://www.nliah.wales.nhs.uk/

Contact Us


Contact us

Our offices are based in South and North Wales:

South Wales Office

Innovation House

Bridgend Road

Llanharan

CF72 9RP

Call us on 01443 233 333

North Wales Office

Croesnewydd Hall

Wrexham Technology Park

Wrexham

LL13 7YP

Call us on 01978 727 873 or 727 874

The Student Award Unit is based in Cardiff

NHS Wales Student Awards Unit

6th Floor, Churchill House

17 Churchill Way

Cardiff

CF10 2TW

For Bursary Enquiries Call: 02920 196 167 For Childcare Enquiries Call: 02920 196 168

NLIAH Website

For more information please visit the NLIAH website www.nliah.wales.nhs.uk

You can also follow NLIAH events on Twitter @NLIAHWales

nliah annual review 2011/12 the national … annual...covers the 2010/11 academic year....

Documents