Cwm Taf University Health Board held its latest public board meeting on January 15, 2014 at Ynysmeurig House, Abercynon. This briefing sets out the key areas of discussion and aims to ensure everyone is kept up to date with what’s happening in Cwm Taf.
The board papers for the January meeting are available here.
University health board status
Cwm Taf formally became a university health board on December 12, 2013. Health Minister Mark Drakeford will attend an event at Keir Hardie Health Park later this month to officially launch Cwm Taf’s new status.
South Wales Programme
The five health boards – Abertawe Bro Morgannwg, Aneurin Bevan, Cardiff and Vale, Cwm Taf and Powys – and the Welsh Ambulance Services NHS Trust had been due to hold special meetings on December 12 to discuss recommendations about the outcome of the South Wales Programme consultation. However, these meetings were postponed at short notice by the South Wales Programme board to allow further work to be carried out.
The South Wales Programme board is due to meet on Tuesday (January 21) after which further information about when health boards will reconvene to discuss its recommendations should be available.
All information relating to the South Wales Programme is available at www.wales.nhs.uk/swp
Three-year integrated plan 2014-17
It was noted during the morning board development session that a detailed update had been received and discussed on the three-year plan, which is being developed for the end of January submission to Welsh Government. The board agreed the approach being taken and arrangements for submission at the end of the month and that it would be discussed further at the Finance and Performance Committee. Progress will be reported at the February development board and a full version prior to final approval will be considered at the March board meeting.
Together for Health delivery plans
Cwm Taf has developed four Together for Health delivery plans, which relate to critically ill patients; heart failure; diabetes and oral health.
The plans highlight the action the health board will take over the next three years to improve the care for patients in each of the four areas and, in some cases, to improve services where gaps are identified.
The delivery plans have now been approved and will be made available on the Cwm Taf website.
Patient experience in Cwm Taf
The results of the All Wales User Experience Framework, which asks patients 13 core questions about their impressions and understanding of their care, are being reported to the board.
The questionnaire has been piloted across a number of ward areas within Cwm Taf since March 2013 and plans are in place for it to be rolled out across the health board by March 2014, in line with Welsh Government guidance. The priority areas include mental health, community services, pathology, radiology and GP practices.
The results for Cwm Taf show that:
84.1% of patients said people were always polite to them and a further 12.5% said people were usually polite to them;
76.8% said they always felt listened to and 15.1% said they usually felt listened to;
84.1% felt they always had enough privacy and 11.4% usually felt they had enough privacy;
79.7% said the place they were cared for was very clean and 19.2% said it was fairly clean;
73.4% said they were involved in decisions about their care;
75.3% said they always understood what was happening in their care and 16.6% said they usually did;
The majority of people who completed the questionnaire rated their experience a seven out of 10 or more.
The full report is available here.
The health board started the year with a financial challenge of £40.5m. To date it has identified savings for around half of this amount and had been forecasting an end-of-year deficit of £20.8m.
The Welsh Government confirmed additional non-recurring funding of £16.86m for Cwm Taf, some of which had already been assumed within the health board’s financial plans. Taking the additional funding from the government into account, the residual gap is £8.1m. Further work has been ongoing to identify how this gap can be reduced and his has enable Cwm Taf to revise the end-of-year forecast to £5.5m.
The Welsh Government has said it expects Cwm Taf to do everything possible to deliver a year-end break-even position for 2013-14; at the very worst, Cwm Taf must deliver a deficit no worse than £3.9m.
The health board must therefore continue the hard work to identify where savings can be made to enable it to meet the financial target set for the end of March 2014 and be in a stronger position going forward into next year.
The new integrated performance dashboard contained in this month’s board papers brings together indicators and targets related to the health board’s core business, including quality, performance, finance and workforce.
Unscheduled care – performance against the four-hour A&E target had risen to 93.4% in November; there was also an improvement in ambulance handover times at A&E with 87.3% of patients handed over within 15 minutes but category A ambulance response times fell in November from 60% across the health board to 56.7%;
Referral to treatment times have improved – the number of people waiting more than 52 weeks has fallen slightly. Twelve patients were cancelled in November because of a lack of beds – this low number reflects the improvements made in unscheduled care.
Cancer targets – the health board has achieved the 31-day target and performance against the 62-day target stands at 88%, which is a significant improvement on recent performance.
Older people’s mental health services
Cwm Taf has been working to improve mental health services for all adults living in Merthyr Tydfil and Rhondda Cynon Taf. A first phase of work, which looked at services for people of working age, has been completed. A second phase of work concentrating on services for older people is now underway.
Older people’s mental health services have traditionally been available for people over the age of 65. It is proposed that eligibility for the new services for Cwm Taf will be based on what best meets the needs of patients and not age.
Dr Mark Winston, clinical director of adult mental health services, said: “We want to provide a good service for older people – we’ve started that journey for younger adults, now we need to continue it for older adults.
“We want to provide equity of access to services and to outcomes appropriate to the life stage of patients.
“We would like to mirror the recovery model for young adults. The first aspect of that will be to rebalance services – we have far too many inpatient beds.
“Crucial to this will be to develop good community-based services for older people – hospital liaison services and an enhanced crisis resolution service.”
A number of areas of work have been identified as part of this work, which is called recovery model phase two:
Develop and enhance the role of the crisis team
Extend home treatment to include all ages – this will help reduce admission rates and length of stay
An “ageless” primary care mental health support service – this will offer general and age-appropriate services across the age spectrum
Improve discharge efficiency
Improve services to nursing home residents
Develop additional day care services
Improve services to primary care
Address inequitable workloads at consultant and locality levels.
The next step will be a six-week engagement period with health board staff, Cwm Taf Community Health Council and the public about the ideas to improve older people’s mental health services.
Child and adolescent mental health services
The first annual report about child and adolescent mental health services (CAMHS) provides detailed information about this small but specialised service area.
Cwm Taf University Health Board provides CAMHS on behalf of Abertawe Bro Morgannwg, Cardiff and Vale and Cwm Taf health board areas; it also provides highly-specialised inpatient services at Ty Llydiard at the Princess of Wales Hospital, in Bridgend.
The annual report explains the tiered structure of CAMHS and some of the challenges facing the service. It is available here.
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