Efficiency_ Innovation and Collaboration by yaofenjin

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									Efficiency, Innovation and Collaboration
How the NHS in Wales is meeting the challenge
Efficiency, Innovation and Collaboration
How the NHS in Wales is meeting the challenge




     Introduction


     The state of public finances in the UK is well rehearsed; very substantial budget shortfalls will occur across
     the public sector over the next few years and the NHS in Wales may be required, as a consequence, to reduce
     expenditure by between £1.3b and £1.9b over the next five years. The scale of such a financial challenge
     is considerable and great improvements in efficiency will be required as well as the development of more
     effective ways of working. This needs to take place:

     •	        Within	individual	NHS	organisations
     •	        Between	NHS	organisations	in	the	form	of	sub-regional,	regional,	and	national	partnerships
     •	        Between	public	and	third	sector	partner	organisations

     This report has been compiled by the Welsh NHS Confederation, on behalf of the ten NHS organisations in
     Wales in order to describe the process by which the NHS will make substantial improvements to its efficiency
     and effectiveness and, to highlight some of the areas where progress is already being made.




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Improving effectiveness and efficiency within the NHS



NHS Structural Reform

In October 2009, the NHS in Wales underwent its most significant restructuring for a generation. As identified
in	the	One	Wales	document,	the	previous	structure,	with	its	22	Local	Health	Boards	and	7	Trusts	was	unwieldy	
and	over-bureaucratic	and	the	artificial	distinction	created	by	having	separate	commissioners	and	providers,	
and between the hospital and primary care sector was preventing the local integration of services.

The programme of restructuring is now complete and the benefits of vertical integration are beginning to
be seen. In addition, despite the inherent risk of undertaking very significant structural reform at a time of
considerable financial and service challenge, the NHS in Wales not only completed the reforms in an effective
and timely manner but also continued to make substantial service improvements through this difficult
period.

Improvement in the performance of NHS Wales during 2009/10 demonstrated:

1. Achievement of the Access 2009 waiting times programme

December 2009 saw the culmination of 4 years work with the delivery of 26 week referral to treatment
targets. In real terms this has delivered a significant improvement for patients across Wales with:
No patient waiting over 26 weeks for treatment, other than for reasons of clinical complexity and/or patient
choice.	This	level	of	performance	has	been	sustained	with	97.8%	waiting	less	than	26	weeks	for	treatment	in	
February 2010, significant reductions in the number of patients waiting over 36 weeks for treatment. In April
2009, the number of patients waiting over 36 weeks for treatment stood at 11,552. This had reduced by the
end of February 2010 to 50.

2. Improved access to cancer services

Performance	against	the	31	day	target	for	non-urgent	suspected	cancer	patients	was	achieved	for	the	first	9	
months	of	the	year,	with	current	performance	levels	standing	at	98.8%;	while	performance	against	the	62	day	
urgent suspected targets was more variable, the underlying trend remained positive.

3. Improved ambulance response

There	has	been	considerable	and	sustained	improvement	in	ambulance	response	times	with	Category	A	8	
minutes performance improving throughout year. This culminated in the national response time standard
for Category A calls being achieved in March 2009 and largely sustained thereafter, with the exception of the
severe winter period. As a result of the work undertaken across Wales, the variation in response times across
unitary authorities also continued to reduce with the best recorded performance in Wales being achieved in
March	2010,	where	the	Welsh	Ambulance	Service	Trusts	achieved	the	60%	Category	A	response	target	in	21	
out of 22 local unitary authority areas.




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Efficiency, Innovation and Collaboration
How the NHS in Wales is meeting the challenge




     4. Improved access to sexual health services

     The provision of access to patients requiring core sexual health services within 2 working days was steadily
     improved	over	this	period	from	87.3%	in	April	2009	to	95.3%	in	February	2010.

     5. Better management of people with chronic conditions

     The average length of stay for patients with chronic obstructive pulmonary disease, coronary heart disease
     or	diabetes	has	decreased	from	6.4	days	in	2006/07	to	5.0	days.	This	has	been	supported	by	the	reduction	in	
     multiple	admission	rates	from	16.8%	to	14.8%.

     6. Improvement in the quality of clinical care through a reduction in waste, harm and variation

     This has resulted in notable successes between 2005/2006 and September 2009 including:

     •	   a reduction of 0.5 bed days per hospital episode and a total of 66,000 bed days saved. The improvement
          made in orthopaedics is considerable with average length of stay decreasing by 1.2 days since 2005/06,




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     resulting a saving of 36,000 bed days. A total of 41,000 bed days have been saved on emergency hospital
     stays
•	   a	reduction	of	1.3%	in	acute	follow	up	did-not-attend	rates	and	a	total	saving	of	over	46,000	
     appointments
•	   a	reduction	from	2.2	follow-ups	for	every	new	patient	to	1.9	with	an	overall	saving	of	230,000	clinic	slots
•	   a	reduction	of	7,200	in	theatres	operations	cancelled	at	short	notice	
•	   A reduction in staff sickness absence levels, with 43,000 lost days saved.



Five -Year Service, Workforce and Financial Strategic Framework for
NHS Wales



Alongside the reform of structures in NHS Wales, the Director General, Health and Social Services,
commissioned the development of a strategic framework that sets out a programme of change to enable
NHS Wales to meet the challenges ahead. This strategic approach includes a matrix of activities, processes
and behaviours that will drive the change necessary in a way that integrates local and national priorities, into
a short and longer term agenda for action.

The	aim	of	the	Five-Year	Service,	Workforce	and	Financial	Strategic	Framework	for	NHS	Wales	is	to	secure:

•	      improvements	in	quality	of	service	that	reduce	variation,	waste	and	harm
•	      patient-centred	care
•	      a	cohesive,	motivated	and	professional	workforce
•	      better	value	for	money
•	      affordable	world	class	health	and	social	care	services	for	the	citizens	of	Wales


To effect this transformation, there will be four core areas of focus:

1. Improving performance, quality and financial stability by reducing harm, waste and variation:
   building on the solid foundations of the 1000 Lives Campaign and intelligent targets to promote
   adoption of best practices (on an adopt or justify basis) that will efficiently deliver the best possible care

2. Capturing the opportunity of integration: balancing health improvement and health care, creating
   integrated care, and aligning all the support systems, with a stronger focus on the role of the patient,
   carer,	and	citizen	as	co-producers/directors	of	their	own	health	and	care	packages

3. Empowering the front line:	providing	clinical	and	non-clinical	staff	with	the	tools	they	need	to	lead	
   change and deliver highly quality care

4. Supporting services to deliver through good government and strong partnerships: ensuring that the
   combined role of Chief Executive of NHS Wales and Director General of Health and Social Services within
   the	Welsh	Assembly	Government	is	used	to	the	full	to	drive	joined-up	working	between	NHS	Wales	and	




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Efficiency, Innovation and Collaboration
How the NHS in Wales is meeting the challenge




          government, and a much wider partnership working agenda across government and public service to
          improve	quality	of	life	and	well-being.

     Delivering the Strategy

     In order to deliver the transformation to services envisaged in the strategy, both a transactional and
     transformational approach will be required. Key aspects of the Strategy include:

     •	   a vision focused on NHS Wales delivering integrated care with its partners

     •	   an ongoing relentless drive on operational and clinical efficiency through the Annual Operating
          Framework

     •	   a	structured	delivery	plan	which	includes	the	seven	Health	Board	and	three	Trusts	local	plans	and	which	
          will incorporate very significant cost improvement programmes

     •	   the identification of 14 high value opportunities to deliver both improvement and efficiency in areas
          where NHS Wales can achieve both service improvement and quantifiable efficiencies by changing
          practice (for example shifting diagnostics into home settings, creating joint health and social care teams,
          diverting A&E attendances into appropriate settings and improved patient information)




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•	   11 national programmes which generate or identify best practice. Their products will feed directly into the
     Health	Boards’	Local	Delivery	Plans	on	an	adopt	or	justify	basis.


Working together within the NHS in Wales

In	addition	to	working	individually	to	improve	efficiency	and	effectively	through	the	Five-Year	Strategic	
framework,	NHS	organisations	continue	to	work	together	to	deliver	services,	both	clinical	and	back-office,	in	a	
streamlined way. Working collaboratively and supporting the concept of one organisation taking the lead for
an area of work across a region or the country has brought great benefits to NHS Wales. Appendix 1 describes
some examples of long standing practice. Further effort is being made to extend this method of working in
other areas where efficiencies can be made.

The NHS working collaboratively across the Public Sector in Wales

The NHS recognises that, in common with all parts of the public sector in Wales, it has much to do to improve
its own efficiency and effectiveness and to improve the quality of what it does while reducing cost. It also
recognises, however, that meeting both the demographic challenges ahead and the need to deliver services
in	a	more	citizen	centred	way	will	require	collaborative	working	of	the	highest	order.

Driving this new approach to the redesign of the delivery of services is a priority of the Welsh Assembly
Government and is reflected in the development of the Wales Efficiency and Innovation Work Programme,
with its emphasis on:

•	      Transforming	operational	efficiency
•	      Catalysing	innovation	in	the	way	services	are	designed	and	delivered
•	      Promoting	collaboration	

The New Models of Service Delivery work stream, under the Chairmanship of Andrew Goodall, CEO of
Aneurin	Bevan	Local	Health	Board,	has	been	established	to	provide	leadership	in	the	achievement	of	the	
second and third of these themes. Much work has taken place over the past weeks to map out the many
examples of innovative practice taking place between the NHS and its partner organisations that will
contribute	to	the	delivery	of	more	citizen	centred	and	cost	effective	services.

The challenge now is to ensure that such projects deliver more effective services in a cost effective way, and
to identify a more limited number of the most significant projects that can be further developed and rolled
out as exemplars across Wales.

Attention	is	understandably	focussing	on	those	projects	that	will	bring	greatest	benefit	to	citizens	and	
the public services that support them. Keeping older people active, well and independent in their local
communities is one such priority area.

Appendix 2 highlights some of the many and varied examples of collaborative working that is taking place
between the NHS and its partners. It is evident, however, that there are many registers of such good practice
and it may be timely to consider how to streamline the capture, analysis, and dissemination of such projects
in a more effective and coherent way.




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                                                                                             Unit 3
                                                                                      Waterton Park
                                                                                          Bridgend
                                                                                          CF31 3PH

                                                                                 Tel 01656 643800
                                                                      E-mail info@welshconfed.org




About the Welsh NHS Confederation

The Welsh NHS Confederation represents the organisations making up the NHS in Wales: local
health boards and trusts. We act as a voice in the drive for better health and better health-
care through our policy and influencing work, and by supporting members with events,
information	and	training.		To	find	out	more	about	us	go	to	-




                www.welshconfed.org




                                                                            Registered Charity no. 1090329
Efficiency, Innovation and Collaboration
How the NHS in Wales is meeting the challenge


Appendices
Appendix 1
                    NHS Services Arranged and Delivered
                       on Regional or National Basis
                                  Cancer
•   Cancer Services Co-ordinating Group
    Cancer Services Co-ordinating Group brings together all organisations involved in
    planning, commissioning and delivery of cancer care across Wales.
•   National Collaborating Centre for Cancer (NCC-C)
    The National Collaborating Centre for Cancer (NCC-C), launched in April 2003, is the
    most recent of the seven collaborating centres set up by NICE. The NCC-C is
    responsible for developing NICE guidelines for the NHS in England and Wales on
    treating and caring for people with cancer.
    The NCC-C is hosted by Velindre NHS Trust in Cardiff and operates in partnership
    with Cardiff University and other organisations, which are represented on the NCC-C
    Management Board. The NCC-C also has a health economics team based at
    the Health Services Research Unit, London School of Hygiene & Tropical Medicine.
•   North Wales Cancer Network
    The North Wales Cancer Network brings together all organisations involved in
    the planning, commissioning and delivery of cancer care across North Wales.

•   South East Wales Cancer Network
    The South East Wales Cancer Network was established in 2002. Its role is to co-
    ordinate the planning, organisation and delivery of cancer and palliative care services
    to 1.42 million people living in an area stretching from Bridgend in the west to the
    English border, and north to the Brecknockshire area of Powys.

                                 Corporate Services
•   Business Services Centre
    The NHS Wales Business Services Centre (BSC) is part of Powys Local Health Board -
    established April 2003 to provide “shared services” support to the former 22 Local
    Health Boards and other clients in NHS Wales.
    It has evolved from the former 5 health authorities and operates out of three main
    offices – Mold, Pontypool, Swansea with its HQ in Pontypool. There are also two
    smaller offices at Parc Menai, Bangor (formerly in Caernarfon) and Cardiff delivering
    specific services.


                                          Heart

•   Mid & South West Wales Cardiac Network
    Brings together key people and organisations in Mid & West Wales involved in
    planning and delivering services for people with heart disease, or at risk of heart
    disease.
    ! The Network engages with a wide range of people and organisations across the
        region and Wales including:
    ! Patients and Carers
    ! NHS clinical staff including: Cardiologists; Cardiac Surgeons; Cardiac Nurses;
      Radiology staff; Cardiac Physiologists; Physiotherapists; Dieticians; Paramedics;
      Ambulance Technicians; Exercise Professionals; Occupational Therapists; Clinical
      Psychologists.
    ! NHS Managers
    ! Local Authority staff
•   North Wales Cardiac Network
    The Network is a coalition of stakeholders bringing together key organisations
    involved in the planning and delivery of cardiac services across North Wales.
    The Network serves a population of approximately 750,000 and works in partnership
    to provide a source of expert clinical advice to support the planning and delivery of
    equitable and effective services for patients and their families with or at risk of
    cardiac disease in North Wales.
    The Network covers Anglesey, Conwy, Denbighshire, Gwynedd, Flintshire and
    Wrexham which is conterminous with the new Betsi Cadwaladr University Health
    Board (BCUHB) in North Wales.
•   South East Wales Cardiac Network
    The South East Wales Cardiac Network brings together key organisations involved in
    the planning and delivery of cardiac services across South East Wales to improve
    services for patients.
    The Health Boards within the Network are:-
    ! Aneurin Bevan Health Board (formerly Gwent Healthcare NHS Trust; Blaenau
       Gwent LHB, Caerphilly LHB, Monouthshire LHB, Newport LHB and Torfaen LHB)
    ! Cardiff and Vale University Local Health Board (formerly Cardiff and Vale NHS
       Trust, Cardiff LHB and Vale of Glamorgan LHB)
    ! Cwm Taf LHB (formerly Cwm Taf NHS Trust, Merthyr and Rhondda Cynon Taff
       Teaching LHBs)
    ! Welsh Ambulance Services NHS Trust


                          Information and Technology

•   Health Solutions Wales (HSW)
    HSW have been associated with Velindre NHS Trust since 2001, providing a range of
    specialist services at local, regional and all Wales levels. HSW provides Information,
    Information Technology, Telecommunications and Consultancy services to the NHS.
    HSW supports the NHS by the provision of expertise, services and information.
    ! HSW enables the NHS to provide healthcare.
    ! HSW informs the NHS to allow planning, operation and evaluation of health
       services.
    ! HSW innovates to allow the NHS to move forward.
•   Informing Healthcare
    Informing Healthcare is a Welsh Assembly Government programme set up to
    improve health services in Wales by introducing new ways of accessing, using and
    storing information.
                           Medical or Clinical Related
•   All Wales Medical Genetics Service (AWMGS)
    The AWMGS provides specialist genetic services to individuals and families with, or
    concerned about, rare genetic conditions. The service is made up of clinical and
    laboratory services which together provide medical genetics services to the
    population of Wales. Cardiff and Vale University Health Board hosts the AWMGS at
    the University Hospital of Wales (UHW), Heath, Cardiff. Specialist consultant
    geneticists, doctors and genetic counselors provide genetic services in all the main
    hospitals throughout Wales.

•   Artificial Limb and Appliance Service (ALAS)
    The Artificial Limb and Appliance Service offer a consistent and equitable service to
    people in Wales who have a permanent or long-term impairment. It is provided by a
    unique collaboration between three NHS Trusts and is commissioned via Health
    Commission Wales (HCW). The three ALAS centres (ALAC's) are situated in Cardiff,
    Swansea and Wrexham, working together to provide an All-Wales service.
    Services are provided on a lifetime basis, with approximately 100 directly employed
    staff (medical, nursing, therapy, technical, clerical and managerial). They work
    closely as a multi-disciplinary team with sub-contractors and suppliers to deliver a
    suitable solution and maximise users potential for rehabilitation into their community.


•   Mid and West Wales Critical Care Network
    The Mid and West Wales Critical Care Network was established in 2007. It brings
    together all organisations involved in the planning, commissioning and delivery of
    Critical Care to work together to promote the highest quality critical care.
    The main focus of the Network is adult critical care but links are being forged with
    specialised areas providing critical care including cancer, cardiac, neurosciences,
    burns and plastic surgery and renal (kidney).
     The Mid and West Wales Critical Care Network work closely with the Critical Care
    Networks in North Wales and South East Wales and with other regional Networks
    (including Cancer, Cardiac and Renal) in order to identify and address issues which
    cut across clinical services regionally or nationally.
•   NHS Direct Wales
    NHS Direct Wales is a health advice and information service available 24 hours a day,
    every day.
•   North Wales Critical Care Network
    The North Wales Critical Care Network was established in 2007. It brings together all
    organisations involved in the planning, commissioning and delivery of Critical Care
    across North Wales to promote the highest quality critical care services for the
    region.
    The Network takes a whole system approach to ensuring the delivery of safe and
    effective services across the North Wales health community. In order to provide
    valuable expertise, advice and facilitation for planners, Betsi Cadwaladr University
    Health Board and Welsh Health Specialised Services Committee, the Network is
    affiliated to the Anaesthesia, Critical Care and Pain Management Clinical Programme
    Group. The Network Work Programme is therefore aligned to the Second Strategic
    Framework for Adult Critical Care in Wales, published by the Minister in August
    2008.
    The North Wales Critical Care Network also works closely with the Critical Care
    Networks in South & East Wales and Mid & West Wales and with other regional
    Networks (including Cancer, Cardiac and Renal) in order to identify and address
    issues which interface across clinical services regionally or nationally.
•   South East Wales Critical Care Network
    The South East Wales Critical Care Network (established 2007) is a collaborative
    partnership bringing together clinical services to work together to promote the
    highest quality critical care services for the region.
    Critical care is a vital hospital service and the Intensive Care Unit (ICU) is the area
    where the sickest patients in hospital are treated. Staff of the critical care unit use
    modern high-technology organ support to save patients’ lives. Critical Care services
    also provide a key role within the hospital to support the medical and surgical
    specialties in the early recognition of, and response to, acute illness in adults in
    hospital.
    The main focus of the Network is adult critical care but links are being forged with
    specialised areas providing critical care including cancer, cardiac, neurosciences and
    renal and paediatric intensive care.
    The Network takes a whole system approach to ensuring the delivery of safe and
    effective services across the South East Wales health community in order to provide
    valuable expertise, advice and facilitation.
    The South East Wales Critical Care Network works closely with the Critical Care
    Networks in North Wales and Mid & West Wales and with other regional Networks
    (including Cancer, Cardiac and Renal) in order to identify and address issues which
    interface across clinical services regionally or nationally.
    The South East Wales region encompasses 3 Local Health Boards and 1 NHS Trust
    providing specialist cancer services.
    This includes:-
    ! Cardiff & Vale University LHB (University Hospital of Wales and Llandough
        Hospital)
    ! Aneurin Bevan LHB (Royal Gwent and Nevill Hall Hospital)
    ! Cwm Taff LHB (Royal Glamorgan and Prince Charles Hospital)
    ! Velindre
•   Welsh Blood Service (WBS)
    WBS covers South, West and part of Mid Wales. WBS collects voluntary, non-
    remunerated blood donations from the general public. These donations are
    processed and tested before distribution to hospitals where they support patient
    care. WBS also hold blood-derived products (both NHS and commercial) for
    purchase by our customer hospitals.
    WBS provide an antenatal screening service to several hospitals and offer all
    customer hospitals reference laboratory services to assist in the investigation of
    complex serological problems.
    The Welsh Transplantation & Immunogenetics Laboratory, within the WBS, provides
    direct support to local providers of Renal and Stem Cell Transplant Services. It
    operates a national panel of unrelated potential blood stem cell donors - the Welsh
    Bone Marrow Donor Registry.
    Medical Consultant support is provided to Hospital Blood Transfusion Committees
    which includes support in achieving the objectives of WHC (2002)137 – Better Blood
    Transfusion. Clinical advice is provided to customer hospitals as required.
    WBS contribute to the maintenance of quality standards in the transfusion and
    transplantation community by hosting the UK NEQAS external quality assessment
    scheme for Histocompatibility and Immunogenetics and the Welsh Assessment of
    Serological Proficiency scheme (WASPS).
    The WBS is a division of Velindre NHS Trust. The Divisional Director is supported by
    a Senior Management Team which acts as the Executive for WBS, monitoring and
    controlling all major operational and financial issues. Performance Indicators for the
    WBS are set by the Blood Standards and Quality Group (chaired by the Chief Medical
    Officer).

                                   Other Services
•   Eye Care Wales
    The Welsh Assembly Government funded, the Welsh Eye Care Initiative aims to
    preserve sight through the early detection of eye disease and to give help to those
    who have low vision and whose sight is unlikely to improve.
    There are four strands to the Welsh Eye Care Initiative:
    • Eye Health Examination/PEARS Scheme
    • Low Vision
    • The Children's Low Vision Project
    • Diabetic Retinopathy Screening


                                      Screening


•   Antenatal Screening Wales
    Antenatal Screening Wales is funded by the National Assembly for Wales to support
    improvements in the standard of antenatal screening offered to women.
•   Bowel Screening Wales
    The Bowel Screening Wales programme is funded by the Welsh Assembly
    Government at a cost of £5.3 million this year rising to £8.7 million in 2014/15. The
    service is run by the Welsh Bowel Screening Centre in Llantrisant and is part of the
    screening services division of Velindre NHS Trust.
•   Breast Test Wales
    Breast Test Wales (BTW) was established in 1988 to deliver the National Health
    Service breast screening programme in Wales. Screening started in February 1989.
    BTW is divided into three geographical divisions with centres in Cardiff, Swansea and
    Llandudno (with a satellite centre in Wrexham). Ten mobile units work across Wales
    to support these centres, visiting over 100 sites in every three year round of
    screening.
•   Cervical Screening Wales
    Cervical Screening Wales is responsible for the NHS cervical screening programme
    in Wales.

•   New Born Hearing Screening Wales (NBHSW)
    Newborn hearing screening was introduced in Wales in March 2003 and once fully
    implemented across Wales became the first national newborn screening programme
    in the UK.
    The programme is committed to providing a high quality service, working to all Wales
    policies, standards and protocols to ensure that newborn hearing screening is
    delivered in a consistent manner. The Newborn Hearing Screening Programme was
    commissioned by the Welsh Assembly Government and is hosted within the
    Screening Services Division of Velindre NHS Trust.
    The Newborn Hearing Screening Programme in Wales is managed as a clinical
    network, crossing organisational and professional boundaries, with overall
    responsibility for the implementation and ongoing management of the programme
    resting with the Associate Director of the programme. The Associate Director reports
    to the Director of the Screening Division of Velindre NHS Trust.
    Dedicated teams of screeners are based across Wales and centrally managed by
    NBHSW. The screeners are managed within by Programme Managers and report
    clinically to a Divisional Coordinator.




                             Statistics and Research
•   Congenital Anomaly Register and Information Service (CARIS)
    From 1st October 2009, the Congenital Anomaly Register and Information Service for
    Wales (CARIS) has been merged into the new NHS Trust, Public Health Wales. CARIS
    is based at Singleton Hospital, Swansea.
    CARIS aims to collect reliable data about congenital anomalies that can then be used
    to help:

    •   build up and monitor the picture of congenital anomalies in Wales
    •   assess interventions intended to help prevent or detect congenital anomalies
    •   plan and co-ordinate provision of health services for affected babies and children
    •   assess possible clusters of birth defects and their causes
    CARIS collects information about any fetus or baby who has or is suspected of having
    a congenital anomaly and whose mother is normally resident in Wales at time of
    birth. It includes babies in whom anomalies are diagnosed at any time from
    conception to the end of the first year of life. Data collection commenced on 1st
    January 1998 and includes any baby where pregnancy ended after this date.


•   Health Solutions Wales Information and Statistics (HSW)
    HSW is an NHS Wales Organisation; a Division of Velindre NHS Trust. HSW is based
    in Cardiff and has offices at Caerphilly. The organisation is responsible for a wide
    range of specialist services which can be described against four main service
    headings:
     ! Corporate Services Unit
     ! Information Products Unit
     ! Software & Communications Unit
     ! Prescribing Services Unit
    The main work of the Information Products Unit (IPU) is the collection, management,
    and analysis of data held in a number of national databases, and the production and
    distribution of information derived from these databases. Specialist staff in the unit
    also provide advice in the fields of data standards and clinical coding.
    IPU manages and maintains the main NHS Wales repository for all-Wales health
    data, especially that relating to hospital activity. The Health Solutions Wales
    Information and Statistics internet site has been developed to support the
    information requirements of NHS, Government and other Public Bodies, Research.


•   Welsh Cancer Intelligence and Surveillance Unit (WCISU)
    From 1st October 2009, responsibility for the functions and services of the WCISU
    has been taken on by the new NHS Trust, Public Health Wales.

    WCISU was established in 1997 when management responsibility for the registration
    of cancers was transferred to Velindre NHS Trust. All duties and responsibilities for
    cancer registration have been retained and in addition new roles are being
    developed.
    ! Cancer Intelligence - in relation to the Calman Hine Initiative for commissioning of
        cancer services.
    ! Cancer Surveillance -in support of the Welsh Assembly and the Public Health
        service for Wales.
    WCISU is a full member of the UK Association of Cancer Registries who
    work together to ensure both national and international standards for cancer
    registration are maintained.

    WCISU’s primary aim is the systematic collection, analysis and dissemination of
    information about cancer incidence, mortality and survival within the resident
    population. Information is used to make judgements about demand for screening and
    treatment, service effectiveness, epidemiological research into the causes of cancer,
    research into cancer prevention, clinical research and for the education of the public.
                            Supporting Organisations
•   National Leadership & Innovation Agency for Healthcare (NLIAH)
    (NLIAH) is part of NHS Wales and works with Trusts and Local Health
    Boards to deliver better quality and safer patient services. NLIAH employs 100 staff,
    based in Llanharan, Cardiff and Wrexham. The work of NLIAH operates across five
    main areas: Workforce Development, Leadership & Organisational
    Development, Partnership Development, Service Improvement and QuIP (Quality
    Improvement Plan) Delivery Support. Each area runs a number of themed
    programmes as agreed through formal agreement with WAG.

    As an innovation agency, NLIAH supports NHS Wales in working towards the
    provision of a world class health service. NLIAH has set up strong UK and
    international links with leaders in these fields and places a strong emphasis on
    collaborative working and shared learning.
•   NHS Centre for Equality and Human Rights (NHS CEHR)
    Established in 1994, the NHS CEHR is a national, strategic resource for NHS Wales
    in building capacity and capability to ensure that patients and staff are treated
    fairly and in accordance with their needs and to support the delivery of the equality
    and human rights dimensions embedded within Designed for Life and Designed to
    Work.

    NHS CEHR work focuses on the delivery of organisational and cultural change to
    secure equality outcomes in employment and to address inequality in the planning,
    commissioning and delivery of services through a mainstreaming approach.
•   NHS Counter Fraud Service (Wales) (NHS CFS)
    The primary aim of the NHS CFS is to reduce fraud within the NHS. By keeping low
    levels of fraud maintained, this means that the right funds are available for better
    patient care and services.
    Counter fraud work ranges from issuing penalty notices as a result of patients falsely
    claiming prescription charges to the multi-million-pound claims against drug
    companies for alleged price-fixing.
    The counter fraud process ensures that action is taken across the complete range of
    work seeking to :
    • create an anti-fraud culture
    • maximise the deterrence of fraud
    • prevent fraud
    • detect fraud quickly
    • professionally investigate detected fraud
    • apply effective penalties, including legal action
    • restore money defrauded.

    NHS CFS has achieved 551 successful prosecutions and recovered almost
    £60,000,000 since 1998.


•   Welsh Health Estates
    The origins of the organisation go back to the Welsh Hospital Board set up in 1947,
    through various re-organisations, including Welsh Health Technical Services
    Organisation and Welsh Health Common Services Authority to our present
    incarnation as Welsh Health Estates, established in 1996.
    The varied nature of the built environment requires that a mix of highly skilled
    professional and technical staff provide advice to the Welsh Assembly Government on
    strategic issues and support to the NHS on the delivery of their operational plans.
    Chartered Architects, Engineers and Surveyors, together with other specialists use
    their expertise in areas as diverse as property management, procurement of primary
    care facilities, environmental management, diagnostic imaging and sterilizer testing.
    Welsh Health Estates have achieved certification to BS EN ISO 9001: Quality
    Management Systems and BS EN ISO 14001: Environmental Management Systems.
•   Welsh Health Legal Services (WHLS)
    Welsh Health Legal Services is an NHS Body that acts for all the Trusts and Local
    Health Boards in Wales.
    WHLS has specialist experience, knowledge and an understanding of the legal,
    administrative, and policy issues which affect the operation of the NHS in Wales.
    WHLS core work consists of clinical negligence case management, provision of
    general legal advice on healthcare related issues, personal injury and employment
    claims management.
•   Welsh Health Supplies
    Welsh Health Supplies is a service provider to the National Health Service in Wales
    and is managed by ABM LHB. Its role is to provide two key links in the Supply Chain
    to the NHS, the negotiation of contracts and a materials management service.
•   Welsh Risk Pool
    The Welsh Risk Pool was established as a mutual pooling system to reimburse
    losses to NHS organisations in Wales. In addition it supported healthcare
    organisations in establishing systems and processes to manage risk and reduce the
    incidence of losses.
Appendix 2
                                                                                   Appendix 2


Aneurin Bevan Health Board:
Contact: Joanne Absalom- Director Primary, Community & Mental Health
Dual Diagnosis
Monnow Vale Integrated Health & Social Care Facility
Start teams Monmouthshire
Recovery programme from psychosis (pertaining to Schizophrenia )
BUPA Foundation Awards Torfaen
Intermediate Services – Gwent Frailty Project
Newport Multi- Agency Face to Face
Joint Hospital Discharge Team
Gwent Deprivation of Liberty Safeguards Team
Collaborative Projects GOALS and Community Prescribing
Collaborative Projects North Resource Centre
Joint Community Obesity Prevention and Management Pathway
Step-down Service
Integrated Health & Social Care Centre for frail and older adults and people with mental
health issues
ABM Health Board:
Contact: Alex Howells Director Primary, Community & Mental Health
Joint Locality Director - Bridgend
Typical Class II Cellulitis Pathway-Out Patient Ambulatory Treatment (OPAT)
Adult Uncomplicated Cellulitis Out Patient Treatment-Patient Information !
Clinical Decision making Algorithm-“Equivocal or Suboptimal” Ultrasound Scans
Patient Pathway for the Diagnosis and Management of suspected Deep Vein Thrombosis in
GP led Minor Injury Unit
Mental Health Daytime Operations
Redesign of Diabetes Service
Musculoskeletal Redesign
Integration Leisure Services for Chronic conditions Management
COPD Storyboard
Community Integrated Intermediate Care
Moving More Often
Olympage Games
Oral Health for Older Persons
Malnutrition Medicines Management
1000 Lives Medicines Management
Clinical Decision making Algorithm-“Equivocal or Suboptimal” Ultrasound Scans
CHC Team (Marie Curie) Multi visit service
Development and improvements in the stroke pathway for AMBUHB
Stroke Care – Partnership working in stroke care – a quality measure
LANGUAGE LINK – Working Together
SPEECH LINK – Working Together
Betsi Cadwaladr Health Board:
Contact: Grace Lewis –Parry, Director of Governance & Communications
Wrexham Frailty project
Clinical pathway for patients with Upper Gastro-Intestinal Cancer / meeting National
Cancer Targets
                                                                                     Appendix 2


Adult Mental Health and Social Care Partnership- Conwy & Denbighshire
Art Therapy
Assessment discharger & transfer team
Cancer network
Centralisation of major cancer surgery for oesophagi-gastric cancer to one site (Wrexham )
CIC start
Denbighshire children’s services & CaMHs
Dietetics – community focused tool to identify older people at risk of malnutrition
Disabled Children’s services - Flintshire
Improving the emotional health of children and young people in North Wales Secondary
schools
Elkan Training
Enablement – Collaboration between Conwy Intermediate Care Service and third sector
(pilot project)
Flintshire appetite for life
Ffynnon - joint performance management of the service improvement plan for chronic
conditions
HECS – Home Enhanced Care Service
Integrated Community Equipment Scheme
Local Authority & Health Services
New Designed for Competence
New models of service delivery group
Older persons medicines
Service Model – Mental Health services for older people Conwy
Wrexham children with disability services Platform project steering group
Integrated service for children with disability – Flintshire
Cardiff Health Board
Contact Katie Norton, Director Primary, Community & Mental Health
Cardiff East Locality Team – A Community Based Model of Care
Children’s Speech, Language and Communication Services Project
Proactive Case Management for Vulnerable Older People
- The Introduction of Case Managers
The Cardiff Healthy City Programme
Cardiff & Vale of Glamorgan Health Schools Networks
Pre-operative Smoking Cessation Project Cardiff & Vale UHB /Stop Smoking Wales
Supporting health and wellbeing of vulnerable groups
- The Cardiff Sex Worker Forum
Sexual Health -
Cross boundary partnership working in sexual health in Cardiff &Vale of Glamorgan
The Social Nail Cutting Project in Cardiff & the Vale of Glamorgan – A partnership initiative
between Age Concern Cymru, Cardiff & Vale University Health Board and ACE Feet in
Motion
Cwm Taf Health Board
Contact: Allison Williams Director Primary, Community & Mental Health
Services
Generic Older Peoples Community Outreach Service
Reconfiguration of adult mental health services (Cynon Valley)
                                                                                  Appendix 2


‘Kafka Brigade’ Tackling Domestic Violence
Joint Community Resource Team
Integrated Communications Hub
Volunteering and Co-production
Development of generic workforce roles
Development of integrated transport to Health & Social Care facilities
Joint planning re development of local capacity for EMI nursing beds
Joint commissioning for frail/elderly services and preventative services for children
LHB funded, Joint Commissioning Policy Officer – Voluntary Action Merthyr Tydfil
Joint commissioning arrangements - (Cwm Taf / RCT LA) for Age Concern / the Stroke
Association Care and Repair / New Horizons
Cwm Taf LHB Rhondda Cynon Taff and Merthyr Tydfil County Borough Councils Integrated
Community Equipment Service.
Hywel Dda Health Board
Contact: Bernardine Rees, Director Primary, Community & Mental Health
Services
Health & Social Care Board: Carmarthenshire (operational management board with agreed
service outcomes and governance framework -formalised with Section 33 on
! Adult and Older Peoples Services
! Physical Disability Services
! Learning Disability Services
! Mental Health Services
! Housing Services
! Public Health Services
Integrated management arrangements for Community Services
Establishment of three locality teams (GP lead, Nursing lead, Performance and health
needs, Social Care lead) with Co-location of teams in two localities (Aman-Gwendraeth and
Llanelli)
Central Communications Hub -Health & Social Care Services
MDT in-reach community service to A&E / CDU
Joint Equipment Service (Health, Social Care and Voluntary Sector)
Transport solutions -Local Authority and community hospitals, the Acute hospital discharge
team and the third sector
Convalescence beds (alternative to long hospital stays)
Integrated complex discharges and service provision for Continuing Health Care and
Delayed Transfers of Care.
Rural health Innovation Fund Application - Service Integration and Improvement Health &
Social Care
Health & Social Care Service Integration and Improvement Board for Community Services:
(Ceredigion) focusing on
! 2 Locality Networks
! Integrated Independence Services (Re-ablement, Tele-Health and Tele-care, Therapies
    and Equipment)
! Accommodation Strategy Review for older people
! Mental Health and Learning Disabilities
! Family & Children’s services.
Joint posts :
Joint Post of Director of Social Services and County Director – Pembrokeshire
                                                                                Appendix 2


Joint post of Head of Community and Primary Care
Joint Community Rehabilitation Teams
Immediate Response – Night Care Service
Involving Young People in the process of staff recruitment
Health & Well Being Support Services Directory
Carers Training Group
Integrated Commissioning Team
Menter Min Nos / Twilight Service (led by Menter Cwm Gwendraeth)
Basic Foot Care
Carmarthenshire Falls Initiative - Camu ‘Mlaen /Step Forward
Flexible Accommodation - Sheltered Housing
Flexible Accommodation – Transition Social Care and Nursing Beds
Convalescence service in local authority residential care homes
Dementia Support Worker
Generic Health & Social Care Worker
Palliative Care Services in Carmarthenshire 2009/2010
New Models COPD Pathways
South Pembrokeshire Health & Social Care Resource Centre.
Tenby Community Hospital /Local Authority day care
Complex Care Team - Pembrokeshire
SHAPES - joint equipment store - Pembrokeshire
Joint Community Learning Disability Team and Community Mental Health Team –
Pembrokeshire
Crymych Extra Care facility with Day Centre and Primary Care facility
Co-location of the County Team with Social Services - Pembrokeshire
A&E facility at Withybush - interface between acute and community and health and social
care
LHB purchase of spare local authority transport capacity (Pilot project) - Pembrokeshire
Powys Health Board;
Contact: Chrissie Hayes: Director Planning
Integrated Health and Social Care Services for Builth Wells
PtHB/PCC Merger of Communication Function.
PtHB/PCC merger of Legal Advice Function
                                                                                             Unit 3
                                                                                      Waterton Park
                                                                                          Bridgend
                                                                                          CF31 3PH

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