THREE YEAR INTEGRATED MEDIUM TERM PLAN

2017 - 2020

Summary

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CONTENTS

ABOUT US 4

OUR VALUES AND CORE PRINCIPLES 6

IMPROVING HEALTH & WELL-BEING 6

PREVENTION AND OUR LONGER-TERM INTENT 7

OUR ACHIEVEMENTS IN 2016-2017 8

OUR PERFORMANCE 9

OUR PRIORITIES FOR 2017-2020 10

OUR SERVICE MODEL 11

NEXT STEPS 14

GLOSSARY OF TERMS 15

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INTRODUCTION

Welcome to this summary version of Cwm Taf Health Board’s refreshed three-year integrated

medium term plan (‘the Plan’) for 2017-2020. We are delighted that our Plan has been approved by

the Cabinet Secretary for Health, Well-being & Sport for a fourth consecutive year.

This year’s Plan continues to build upon our achievements of the last three years and outlines the

opportunities and challenges ahead.

Our vision is:

“To be recognised as a population well-being organisation that continually makes a positive

contribution to improving the lives of all Cwm Taf residents”.

To help realise this vision, we have developed a set of Well-being Objectives, which are aimed at

contributing to long-term and sustainable improvements in the health, prosperity, resilience,

cohesiveness and global impact of communities in Cwm Taf. We will:

work with communities to prevent ill health, protect good health and promote better health and well-being;

provide high quality care as locally as possible wherever it is safe and sustainable;

be innovative, reflect the principles of prudent health care and promote better value for users in our service delivery;

work collaboratively with our public service partners and a broader range of partners to join up health and other services where this potentially represents better value for our residents and care users;

work with our staff, partners and communities to build upon strong local relationships and solid foundations of the past through our commitment to corporate social responsibility and to improving health and social equity.

We value and recognise the importance of working in partnership with patients, carers, our staff, the

wider public, third sector organisations and other local public service agencies to involve and engage

them meaningfully in decisions about individual treatment and care, as well as service changes.

We are confident that our Plan puts the Health Board in a strong position ensuring local services are

safe and effective, offer good value for money and are well organised to deliver the best possible

outcomes for our patients and the communities we serve.

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ABOUT US

Cwm Taf University Health Board (‘the Health Board’) is responsible for providing healthcare services to nearly 300,000 people living in Merthyr Tydfil and Rhondda Cynon Taf. We also provide some NHS services to people living in the neighbouring areas of the Upper Rhymney Valley, South Powys, North Cardiff and the Western Vale. The Health Board is the second largest employer in the area, employing almost 8,000 people, a significant number of whom also live in the local area. Within primary care, GPs own and manage a large number of premises, many of which the Health Board shares or uses to provide complementary services to some extent. In the primary care sector, Merthyr Tydfil and Rhondda Cynon Taf has: We manage two District General Hospitals, five community hospitals, and 27 health centres/clinics/ support facilities. Cwm Taf’s main hospital and community based sites are set out in the following diagram:

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We have an annual budget of £708m, which is used to secure the best value for money and sustainable services fit for patients today and for future generations. The Health Board is governed by a Board of Executive Directors and Independent Members, who make decisions about how this funding is used to deliver services and care to our communities.

KEY FACTS AND FIGURES 2016-2017

Primary Care Services £143.6m

Cwm Taf Services £419.7m

Other NHS Providers £103.3m

Continuing Health Care

£38.3m

3rd Sector and Local

Authorities £3.1m

How we spend £708m

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OUR VALUES AND CORE PRINCIPLES

The Health Board’s central philosophy is ‘Cwm Taf Cares’, which puts patients and the delivery of

quality services at the heart of all we do. This commitment encourages all of our staff to be aware of

their own potential and to take opportunities to be personally responsible to show we are all

passionate about the care given to our patients and their carers. We know that staff need the right

environment to give the best care and it needs to be built on the foundations of dignity, respect,

transparency and trust.

IMPROVING HEALTH & WELL-BEING

Reducing health inequalities within Cwm Taf remains the single largest challenge for the Health

Board and its local partners. We believe that our collective efforts as public service leaders must be

focused towards creating a climate where opportunities to prevent ill health, to improve longer-

term well-being and to increase the resilience of local communities are maximised.

In Cwm Taf, life expectancy and healthy life expectancy has improved and the inequality gap between the most and least deprived has narrowed across all of the parameters. This trend is very positive.

However:

Cwm Taf remains the Health Board with the lowest life expectancy (76.6 years men, 80.9 years women) and healthy life expectancy (61.2 years men, 62.6 years women) in Wales, despite the improvements demonstrated.

Across Cwm Taf, the inequality gap (difference between the most and least deprived in the Borough) for life expectancy is 7.4 years for men and 3.7 years for women. This is not as big a gap as in some other parts of Wales, but does reflect the extent of deprivation across the area. The gap for healthy life expectancy is 14.8 years for men and 15.0 years for women.

For male life expectancy in Rhondda Cynon Taf, the inequality gap has increased from 7.4 years to 7.8 years.

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PREVENTION AND OUR LONGER-TERM INTENT

We know from evidence like the Caerphilly Study i that routinely enjoying four or five healthy behaviours, as opposed to zero or one, can have a huge impact on life expectancy and prevent the development or delay the onset of debilitating chronic diseases: So what are these healthy behaviours? Put very simply the five healthy behaviours are: This infogram shows that we have much work to do to improve life expectancy, healthy life expectancy and to reduce inequalities in Cwm Taf: We are not unique in Wales, but in Cwm Taf, there are fewer people enjoying four or five healthy behaviours than across the rest of Wales. We need to help move the percentages towards four and five behaviours to improve the lives of our population.

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So this is our challenge: To lead and support change with our partners across Cwm Taf to support our staff, patients and people to enjoy four or five healthy behaviours. Help us meet this challenge by making a pledge below to introduce at least one healthy behaviour that will contribute towards improving your own health and well-being.

I pledge to introduce the following healthy behaviour:

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OUR ACHIEVEMENTS IN 2016-2017

Overall, we continue to make good progress in delivering our three-year plan. Some examples of

our major highlights during 2016-2017 are below:

• Extension of the Psychiatric Liaison Service from 5 days to 7 days

• The Paediatric Assessment Unit was piloted in the Royal Glamorgan Hospital (RGH). The results of which demonstrated its successes in reducing the number of avoidable hospital admissions and keeping children’s care as close to home as possible.

• Development of plans for a new Obstetric and Neonatal Unit at Prince Charles Hospital (PCH).

• Board endorsement of the proposal to centralise breast services at the RGH. The Health Board was also a partner in a hugely successful ‘Giving to Pink’ fundraising day in October 2016.

• In partnership with Macmillan, we have progressed plans for a new Palliative Care Unit at RGH.

• Agreement to progress an innovative new Early Cancer Diagnostics pilot in the Cynon Valley Cluster.

• £6m capital funding was secured in November 2016 for developing the first phase of the diagnostic hub, which will expand both CT and MRI capacity in RGH. Construction commenced in December 2016 and will be completed in October 2017.

• Development of an Acute Oncology service to fast-track the care and management of Oncology patients admitted to hospital with acute illness. This is improving length of stay and clinical outcomes.

• Phase 1 of the project to transform Dewi Sant Hospital into a Health Park and the cluster hub for Taff Ely has progressed well and the first tranche of services transferred in January 2017.

• For the second year Cwm Taf’s Executive Directors, as well as the Assistant Directors this year, went ‘Back to the Frontline’ in October 2016 to find out how they could further improve healthcare services through direct engagement with staff and patients.

• A national digital nurse recruitment campaign showcasing life at Cwm Taf was launched in August 2016. The campaign has generated increases in applications for nursing posts.

Whilst challenges remain going forward, we will continue to build on our achievements and

celebrate our success with notable improvements in performance and quality outcomes having been

delivered for our community.

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OUR PERFORMANCE

In terms of quality and performance, we have made a range of improvements during 2016-2017,

some examples of which are highlighted below:

Adult smoking rates are generally decreasing. During 2012-2015, Cwm Taf’s smoking rates decreased from 24% to 23%. Rates in Rhondda Cynon Taff decreased from 25% to 22%, whilst in Merthyr Tydfil, rates increased from 23% to 25%, although as Merthyr Tydfil is a small population size, fluctuations in survey data are often seen.

We were the only Health Board to meet the 36 week Referral to Treatment waiting time target and close to zero breaches (92 breaches) against the diagnostic waiting time target. This was our best performance since 2012.

The Health Board continues to report the best performance of all Welsh Health Boards, for childhood vaccinations, with an overall rate of 87.3% (as at September 2016).

Cwm Taf practices have maintained good performance on patient access to GP appointments, although we recognise this remains a concern to patients and the public in some areas.

We are sustaining our positive performance in hospital acquired infection rates, e.g. Clostridium Difficile and MRSA.

We continue to have the best performance across Wales against the targets for the number of 15 minute and over one-hour emergency ambulance patient handovers.

In terms of percentage of our patients referred as non-urgent suspected cancer seen within 31 days, our position regularly achieves the 98% target, a position we plan to maintain.

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OUR PRIORITIES FOR 2017-2020

For the next three years, we will focus on the following priorities:

Continue to improve patient experience throughout the Health Board.

Promote the importance of the prevention agenda, for example by encouraging our patients and staff to adopt ‘one more healthy behaviour’ and supporting the well-being of our communities with our partners.

Demonstrate greater integration across health & social care, particularly in the way in which services are provided to our more vulnerable client groups.

Implement our refreshed primary and community care plans to address significant challenges such as increasing demand, an ageing population, health inequalities, the impact of deprivation and the ongoing recruitment and retention crisis.

Implementation of our next step mental health service improvements, including the next phase of Older People’s Mental Health Service redesign and new approaches to dementia care.

Further develop and engage upon our clinical service strategy, including the implementation of the outcomes of the South Wales Programme (specifically Paediatrics, Obstetrics and Neonates and further development of the Acute Medicine Model in 2017/18).

Implement the next phases of the Ground and First Floor Refurbishment Scheme at Prince Charles Hospital.

Development and participation in regional planning and delivery of services in areas such as Diagnostics, Ophthalmology and Orthopaedics, as well as Vascular and Ear, Nose and Throat service redesign.

Continue to improve scheduled and unscheduled patient care, patient flow and urgent care processes including: maintaining and improving upon the target of no patients waiting for treatment over 36 weeks; maintaining and improving upon the target of no patients waiting over 8 weeks for diagnostics, continuing to work to the 95% 4 hour target (maintaining wherever possible at least 90% performance) and having no patients waiting over 12 hours.

Continue to meet the 31 day target and work to meeting the 62-day cancer target, maintaining at least a 90% position.

Address recruitment and retention challenges with a priority on workforce planning and redesign and development of new roles such as Physician Associates.

Continue our strong involvement and approach to the commissioning of specialist services (such as tertiary services, ambulance services, specialist cancer services)

Engage with an increasing number of members of the public and staff in Cwm Taf through a variety of ways to involve people in the design and delivery of services, both in and out of hospital.

Improve data quality, including reporting and transparency.

Ensure compliance with legislation.

Achieve financial balance.

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OUR SERVICE MODEL

The Health Board is working to develop a new clinical services strategy, seeking to address the

challenges we face in the longer-term. This will be our blueprint for creating healthier communities

and ensuring that effective and high quality healthcare services lie at the heart of our service

delivery and patient experience.

The service model diagram below illustrates the range of universal services available for all to access

when needed, as well as services designed specifically for client groups such as children and young

people; people and their families who live with a learning disability; adults and the frail elderly

population. In addition, we provide support and interventions across all age ranges in relation to

mental health issues, chronic conditions and end of life care.

The following provides just a few examples of our priorities within these categories. For more

information about our services and specific priorities, you can visit our website or read the full Plan

here.

Well-Being

& Self Care

Primary

Care Integrated

Care

Planned and

Unscheduled

Care

Children

& Young

People

Learning

Disabilities

(Children,

Adults and

their

Families

Adults

Specialist

Care

WHOLE POPULATION

Cross Cutting Themes

Client Groups

Well-Being & Self

Care

Primary Care

Integrated Care

Planned &

Unscheduled Care

Children &

Young People

Learning

Disabilities

(Children, Adults

& their Families)

Adults Frail Elderly

Mental Health

Chronic Conditions

End of Life Care

Specialist Care

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Well-being and Self Care

Self-care and staying healthy - ensuring our population has the knowledge, and confidence to look after their own health and to prevent ill health through targeted public health interventions across all age ranges.

Advice and support - provide a range of sources of health information and advice.

Primary Care

Early Intervention – ensuring timely access to GP services by enhancing capacity and improving early detection of disease.

Out of Hours Urgent Care – continued implementation and evaluation of our new model for GP Out of Hours care to ensure prompt and efficient access for our patients.

Continue to address the variation between GP Practices.

GP Sustainability - continue to target the recruitment and retention of GPs and the development of a new model for the longer term.

Community Eye Care - supporting the continuation and further development of post Cataract follow up and Glaucoma Assessment (Ocular Hypertension) services in the community helping to support the delivery of care closer to home.

Dental services - improve access to dental care in Merthyr Tydfil through the commissioning of additional units of dental activity, promoting improved oral health particularly amongst children and formalising the Minor Oral Surgery scheme in primary care.

Integrated Care

Build on the improved pathways between acute and community hospitals and develop a clearer focus for provision of local person-centred, rehabilitative care aimed at supporting patients to achieve their potential to lead an independent life according to their individual physical, cognitive and social abilities.

Mental Health

Children and Young People

Focus on engagement, choice, strengths, goals and care planning.

Improve access by ensuring timely appointments that are fully booked, i.e. no waiting lists.

Ensure service users are seen by a clinician with the right skills.

Adults

Continue the older person service redesign via the development of our ‘Valleys Life’ programme.

Develop plans for Ysbyty George Thomas to become a ‘dementia hub’. This will involve: o extending the psychiatric liaison service to a 9 am to 9 pm service, o developing enhanced shared care arrangements within our community hospitals, o improving primary care access to memory clinics, and o continuing to work to stimulate the local care home sector.

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Learning Disabilities (for people and their families)

We will work with our partners to commission and provide integrated services which will deliver

accessible modern services that promote independence, reduce reliance on long term services and

emphasise choice and control.

End of Life Care

Supporting living and dying well; informing and supporting patients to make arrangements in advance for the end of life;

Detecting and identifying patients early; people with palliative care needs are identified early to enable the best care to be planned in advance;

Delivering fast, effective care - People receive fast, effective person centred care in order to maintain quality of life for as long as possible;

Reducing the distress of terminal illness for patients and their families; patients entering the terminal phase of their illness and their families feel well cared for;

Open the new Palliative Care Unit on the Royal Glamorgan Hospital site.

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NEXT STEPS

We hope that you have found this summary informative. Whilst brief, it hopefully serves to provide

you with an understanding of what we do, what our priorities are and how everyone within Cwm Taf

has a part to play in protecting and improving population health and ensuring our services respond

to local needs.

We are particularly keen to promote the key messages outlined throughout this summary and would

encourage you to share this document within your own communities and networks. Anyone wishing

to learn more about our Plan can access the full version on our Website here.

If you would like to become involved in the redesign and/or development of future health care

services, please contact Sharon Jeynes on sharon.jeynes@wales.nhs.uk or 01443 744800.

Alternatively, why not follow us on the following social media channels:

We would love to hear from you – your views and opinions are important to us – so please get in

touch.

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GLOSSARY OF TERMS

Acute Medicine: Short–term treatment, usually in a hospital, for patients with an illness or injury Clostridium Difficile: A type of bacterial infection that can affect the digestive system Cluster Hubs: Groups of GP Practices working together to deliver services Community Services: A network of services provided close to people’s homes. Examples include District Nursing or Health Visiting services Co-production: Patients, carers and health professionals working together in partnership to find the best way of achieving the outcomes that matter to them. Corporate Social Responsibility: Making sure organisations are engaging with and having a positive impact on local communities, the environment and economy. CT: Computed Tomography (CT) scanner is typically a large, box-like machine with a hole, or short tunnel, in the centre. They provide anatomic details of internal organs that cannot be seen in conventional X-rays. Diagnostics: Tests that help determine the nature of a disorder or illness, for example x-rays Healthy Life Expectancy: The period during which a person lives in good health. Integrated Plan: A plan which balances quality with workforce requirement and finances Integrated Services or Intermediate Care: Co-ordinated care for patients across health, social care and the Third Sector MRI: Magnetic Resonance Imaging (MRI) scanner is a short cylinder that is open at both ends. It uses strong magnet and radio frequency waves to generate detailed images of the organs and tissues within your body MRSA: A type of bacterial infection that is resistant to a number of widely used antibiotics Neonatal Services: Services for babies who are under one month old Obstetric Services: The care associated with giving birth Paediatric Services: Services for children and young people Primary Care: GP Practices, Dentists, Optometrists and Community Pharmacists Prudent Healthcare: Healthcare that fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patients benefit Psychiatric Liaison: Providing mental health care to people being treated for physical health conditions in general hospitals

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Public Service Board (PSB): The PSB is a statutory board made up of representatives from the UHB, Local Authority, fire and rescue authority and Natural Resources agencies, all of whom are collectively responsible for fulfilling the board’s statutory duties. Regional Planning Services: Working collaboratively with other public sector bodies, e.g. neighbouring health boards etc, in planning services that will be delivered on a regional basis. Scheduled Care: Care (usually an operation or a procedure) which planned ahead and for which the patient will be given a date to be admitted to hospital Secondary Care: Health care provided in a hospital setting Tertiary Services: Specialised consultative care, usually on referral from primary or secondary care professionals, provided in a setting that has personnel and facilities for advanced medical investigation and treatment. Third Sector: Voluntary and charitable organisations University Health Board: A formal partnership between the Health Board and local Universities to support areas of business such as research and development. Unscheduled Care: Emergency care i Caerphilly Study: In September 1979, this research project followed 2,500 men from Caerphilly with the aim of reviewing the impact on their health if they adopted lifestyle behaviours such as not smoking; a low body mass; a healthy diet; regular physical activity and low alcohol consumption. The results indicate that those men who adopted a healthy lifestyle had a lower risk of certain chronic illnesses and premature mortality, compared with those men who followed none or just one of the behaviours. More information can be found out about this study on the Welsh Government website here.