Appendix 3 — Presentation Attachment 4 Programme for

Appendix 3 - Presentation Attachment 4 Programme for Health Service Improvement Stakeholder Forum 27 th November CARDIFF AND VALE NHS TRUST YMDDIRIEDOLAETH GIG CAERDYDD A’R FRO

PHSI – Stakeholder Forum Welcome Siân Richards Chief Executive, Cardiff Local Health Board Chair, PHSI Project Board CARDIFF AND VALE NHS TRUST YMDDIRIEDOLAETH GIG CAERDYDD A’R FRO

Stakeholder Forum – Why? ¡ Raise awareness of PHSI – its aims and objectives ¡ Enable feedback on emerging thinking ¡ Inform future public engagement activities

The questions we will be asking you today… ¡ ¡ ¡ Is there broad acceptance of the need for change? What are your views on our vision? Are there other areas we should consider? Are there any other changes happening across Cardiff and the Vale of Glamorgan that we need to build in to our plans for local services? What is most important for you as we work to improve local services? How should we approach the formal engagement phase?

PHSI – Stakeholder Forum Aims and Objectives Sue Gregory Nurse Director, Cardiff and Vale NHS Trust Chair, PHSI Clinical Services Planning Group CARDIFF AND VALE NHS TRUST YMDDIRIEDOLAETH GIG CAERDYDD A’R FRO

Our underpinning philosophy ¡ A shift of focus from illness to health ¡ People to be treated and cared for at home, or as near their home as possible ¡ Providing the right care, at the right time, by the right professional ¡ Making the most of resources to achieve excellence

Hazard Warning ¡ Important to: l l l Predicting the future is difficult and we will get some things wrong Establish key principles Agree some core assumptions Ensure we build in flexibility

Key principles ¡ ¡ ¡ Improve quality, safety and outcomes Right care, right time, right place, right professional Emergency and planned care pathways separated as far as possible Local work and specialised work separated as far as possible Focus on services and patient experience Maximise resources to achieve excellence

Key Assumptions… ¡ Our users will: l l l Be more confident in using information and technology Expect responsive, personal and high quality integrated services Want to receive more care at home, or as close to home as possible

Key Assumptions (2) ¡ Demographic change will be significant in some areas: International Sports Village ¡ St Athan ¡ Age profile changes ¡ The rate of growth in funding will reduce after 2008/09 ¡ Pressures for centralisation and devolution will continue ¡

Key Assumptions (3) If capacity, service models and incentives are aligned we could improve outcomes and: Reduce emergency admissions to acute hospitals ¡ ¡ Reduce outpatient attendances ¡ Reduce A&E attendances

Summary An opportunity to share progress to date ¡ An opportunity to capture views, issues, concerns ¡ An opportunity to influence next steps ¡ An opportunity to advise and inform ¡

PHSI - Progress so far… Katie Norton Programme Director, PHSI Director of Service Planning, Cardiff and Vale NHS Trust CARDIFF AND VALE NHS TRUST YMDDIRIEDOLAETH GIG CAERDYDD A’R FRO

Background National changes – improved access, more personalised care and empowerment of patients to improve their health ¡ Cardiff and Vale of Glamorgan LHBs and Cardiff and Vale NHS Trust working together to improve health, and health care services ¡

Designed For Life (1) Improved Performance Sustainability Reducing Inequalitie s Clinical Networks Clinical Excellence Designed for Life Creating World Class Health and Social Care IM&T Strong Commissioning Workforce redesign Community involvemen t Research & Development

Designed For Life (2) Levels of Care Cardiff and Vale NHS Trust Tertiary and highly specialist services Bro Morgannwg NHS Trust Specialist and Critical Care Centres Local acute services Services provided at home & in the community Policy Development Determinants of Health Effectiveness Local Needs Best Practice

Why change? ¡ ¡ ¡ ¡ ¡ Changing expectations (public and professionals) Quality and clinical outcomes Health inequalities Demographic change Technology Workforce Teaching and research Affordability Accountability

Programme for Health Service Improvement in Cardiff and the Vale of Glamorgan - - Joint programme of Cardiff and Vale Trust and the two LHBs (with LA and HCW involvement) New approach to service planning Strategic Outline Programme November 2006 - Single strategic document Describes our model of care for the future Describes our capital requirements for next 3 – 5 years CARDIFF AND VALE NHS TRUST YMDDIRIEDOLAETH GIG CAERDYDD A’R FRO

Where we have come from? ¡ Change is not new to this health community l l l Emergency services Maternity services Children’s services Mental health services Etc. ,

What we have heard so far…. Phase I engagement – key issues emerging ¡ ¡ Consensus that change is needed Main issues/priorities emerging l l l l Access to primary care – particularly GPs and dentists Waiting times for elective care Communication and patient focus More use of technology Prevention and health promotion Rehabilitation and intermediate care Integration and development of “one stop shop” services Less managers/admin and more clinical staff

The Strategic Outline Programme Our Strategic Outline Programme aims to: ¡ Set our priorities for developing capacity in the community to enable primary and community based services to work with communities to maintain health ¡ Set our priorities for improving access to and quality of hospital based services ¡ Signal to WAG capital requirements to support service improvement

Resource Context ¡ Staffing l ¡ Financial l l ¡ Contractual changes impacting on all staff Levels of growth expected to decrease with associated funding shortfalls increasing NHS bodies and our two local authorities experiencing significant financial pressures Estates and Information Technology l l Much Trust estate no longer fit for purpose New technology provides opportunity for transformation change

Current Service Map 71 GP practices ¡ 4 Community Hospitals ¡ Community services, including 21 health centres ¡ 1 Mental health hospital (2 nd inpatient unit adjacent to acute hospital) ¡ 2 Acute Hospital sites ¡ Independent, private and voluntary sector ¡

Clinical Service Strategy Out of Hospital Care

Clinical Services Strategy Workstreams ¡ Primary & Community Services including l l l Long term condition management Unscheduled care Rehabilitation & intermediate care Acute and emergency care ¡ Tertiary and Specialist (including Cancer & children’s services) ¡ Mental Health ¡ Clinical support ¡

Primary and Community Services – emerging model ¡ ¡ Network of high quality primary care practices working within defined localities (4 in Cardiff, 3 in Vale) 7 localities as basis for managing access to core community based services managed through resource centres aimed at enabling individuals to maintain their health and independence Enhanced focus on supporting people with long term conditions e. g. diabetes and heart disease Enhanced focus on needs of children and young people

Cardiff Localities 81, 700 (11 practices) 93, 902 (12 practices) 91, 693 (18 practices) 82, 640 (13 practices)

Vale Localities Western Vale 26, 678 (3 practices East Vale 38, 003 (7 practices) Central Vale 54, 974 (7 practices)

Resource Centres Rehabilitation and reablement teams Diagnostics Therapy services (podiatry, physiotherapy, OT, SALT Patient education and support Community nursing teams Locality Resource Local Centre Voluntary Authority Sector Co-ordinating Services “out of hospital” services for local communities Day case surgery (local anaesthetic) Specialist rehabilitation Minor emergency services Outpatient clinics Day therapy services Child health clinics Community mental health teams

Integrated Community Based Rehabilitation and Reablement Services – Emerging Model ¡ Multi-disciplinary teams working on locality basis l l Community based rehabilitation and reablement l ¡ Rapid assessment, rapid response services Maintenance and prevention services Direct access to specialist support working across localities l Day treatment l Specialist community inpatient beds l Specific condition based teams e. g. stroke, continence

Primary and Community based Services - Summary including reablement and rehabilitation Strategic case Capital requirements Strategic expansion of capacity in community settings. to support health improvement in line with recommendations from the Review of Health and Social Care in Wales. £ 28 m to support practice improvements in Investment targeted to reduce health inequalities and reduce demand on acute hospital services through the development of evidence based services. £ 18. 5 m to support additional community based services including dental services and diagnostics Remodelling of rehabilitation and rehabilitation services to maximise independence and recovery. £ 49 m to support improvements in rehabilitation and recovery services in community settings This will support a strategic shift to a new model of care, reducing reliance on inappropriate inpatient facilities and enabling the closure of Westwing and Rookwood line with LHB Primary Care Estates Strategy including a network of Resource Centres

Primary and Community Services - Key Issues ¡ Creating capacity in primary care ¡ Location of resource centres ¡ Number and location of community inpatient facilities ¡ Need to develop clear view on stroke, spinal and neuro rehabilitation ¡ Ensuring service can respond to needs of all adults, not just older people ¡ Capacity within independent sector

Mental Health Services – Emerging Model ¡ Reprovision of Whitchurch by 2009/2010 l l l Continued development of community based services including rehabilitation New adult acute unit on Whitchurch site Elderly care assessment unit at Llandough

Mental Health - summary Strategic case Capital requirements Modernisation of services for adults £ 20 m to support community care phase 1 and older people in line with National and 2 Service Frameworks and Designed for Life. Focusing on development of community £ 25 m to support older persons mental health unit at Llandough based services to support individuals effectively through a comprehensive range of services which then reduce reliance on £ 35 m to re-provide acute inpatient facility institutional care. on Whitchurch site

Mental Health Services - Key Issues ¡ Links with locality model/ Resource Centres ¡ Continued development of community based services for adults and older people ¡ Independent sector to support continuing care for older people with mental health needs

Unscheduled Care – Emerging Model ¡ Single point of access 24/7 ¡ Urgent care/treatment centres ¡ More integrated working ¡ Provision of comprehensive alternatives to admission

Unscheduled Care - Summary Strategic case Capital requirements Improved management of urgent and £ 5 m to improve access to unscheduled care to reflect the policy care services, including the development of direction set out within DECS urgent care centres £ 2 m to develop medical day treatment capacity

Unscheduled Care – Key Issues ¡ Urgent care centre locations (Barry, UHW? ) ¡ Ensuring models address issues associated with medical responsibility

Acute Hospital Care – Emerging Model Aim is to achieve … ¡ Clear separation of emergency and elective workstreams ¡ Clearer separation of local and specialist workstreams ¡ Environment fit for purpose ¡ High quality teaching opportunities

Emerging Acute Hospital Profiles UHW ¡ A&E/Trauma ¡ Acute medicine (Central & East Cardiff) ¡ General Medicine ¡ All emergency surgery ¡ All complex surgery ¡ Specialist/tertiary services ¡ All inpatient paeds ¡ Obstetrics/MLU Llandough ¡ Acute medical admissions (Vale and W Cardiff) ¡ General Medicine ¡ All intermediate surgery ¡ Elective orthopaedics ¡ Midwifery unit ¡ EMI assessment ¡ ? Cancer surgical centre… Supported by appropriate diagnostic & support services including rationalised labs etc. ,

Acute Hospital Service Transformation Summary Strategic case Modernisation of hospital care pathways ensure that health to community demonstrates performance in the upper quartile of comparator. providers Model of care proposes balanced approach to general/acute medicine across two acute sites with clearer separation of elective and emergency surgical streams with development of short stay/low dependency planned surgery at Llandough, and UHW as base for emergency/specialist surgical services. Models also seek to recognise unique role of the Cardiff and Vale Trust in relation to undergraduate and postgraduate teaching and research in partnership with Cardiff University Capital requirements £ 52 m to support implementation of service models on UHW site including ward modernisation, critical care capacity, womens services implementation £ 66 m to support implementation of service models on Llandough site including low dependency surgical treatment centre, ward modernisation, orthopaedic centre £ 54 m to develop range of schemes to support service modernisation across health community including outpatient services, surgical cancer services, pathology services

Acute Hospital Care - Key Issues ¡ Developing the elective surgical model ensuring support of medical admissions across two sites l Implications for patients in terms of access l Implications for workforce working across two sites ¡ Establishing balanced model for acute/general medicine across two sites with clear locality focus ¡ Surgical Cancer services model

Specialist and Tertiary – Emerging models ¡ Potential for increased role as specialist centre for South Wales Surgical cancer, surgery for children - HCW Reviews – Neurosurgery, thoracic Ensuring specialist services do not compromise the ability to delivery high quality local services and vice versa - ¡ ¡ Ensuring critical mass, quality and cost effectiveness

Tertiary and Specialist Services Summary - Strategic case Recognising the unique role of the Cardiff and Vale Trust in providing highly specialist and tertiary services in line with the commissioning intentions of Health Commission Wales. Strong links with the University are recognised as being vital Capital requirements £ 7. 2 m for the PET research centre £ 38 m for ph 2 of the Children’s Hospital for Wales £ 2. 2 m for the Teenage Cancer Trust Unit (funded by the Teenage Cancer Trust) £ 9. 9 m for the new Renal Unit (part of tertiary block) £ 13. 5 m for the Neurosciences Centre (part of Tertiary block, subject to outcome of consultation) £ 10 m to support cardiothoracic services (subject to outcome of HCW review)

Clinical Support Services – Emerging Model ¡ ¡ ¡ Development of appropriate diagnostic capacity in community settings e. g. plain film x-ray, ultrasound, endoscopy Improving access to support emergency and acute work streams Rationalisation of some pathology services to reduce inappropriate duplication

Other Acute and Community Service Modernisation Summary including Clinical Support and Infrastructure issues Strategic case Capital requirements To ensure that high quality clinical £ 10 m to support pathology rationalisation support servicesare in placeto support and development emerging service models £ 5 m to support the modernisation of outpatient capacity (including community based services as appropriate) To ensure that basic infrastructure £ 101 m across a range of infrastructure issues are addressed support efficient to schemes including: and effective service delivery • catering • electrical infrastructure • switchboard • Information technology

Emerging Clinical Strategy Framework Increasingly local care – less care in main acute hospitals Primary care practices Primary care team and therapy Services Minor procedures Resource centres and community based services Intermediate care and rehabilitation Clinics (for example diabetes and CHD) Day-case surgery – local anaesthetic Specialist community rehab beds Community services Outpatients Diagnostics (such as X-ray) Minor emergencies Well-men and well-women clinics Rehabilitation support Voluntary sector services Local facilities throughout the area ¡ Patient Education and support Day-therapy services Local Authority Services Resource centres serving networks of @ 50 – 80, 000 populations Increasingly specialist care – more care in major hospitals Acute and emergency hospitals Major accident and emergencies Acute women’s and children’s services Elective (nonurgent) surgery Complex diagnostics Specialist outpatients Secondary emergency services Tertiary and specialised services Inpatient cancer services University Hospital of Wales, Llandough

Key Messages Rebalancing services to provide more responsive care for patients ¡ More services provided in local settings ¡ More efficient, effective and responsive hospital services ¡ Services, not buildings ¡ Much that we can do now ¡

Next Steps November 27 th First Stakeholder Forum to discuss SOP November/December Phase II Engagement begins targeting health and social care professionals January – April Phase II Engagement with public focus

Key Issues for Stakeholder Forum ¡ ¡ ¡ Is there broad acceptance of the need for change? What are your views on our vision? Are there other areas we should consider? Are there any other changes happening across Cardiff and the Vale of Glamorgan that we need to build in to our plans for local services? What is most important for you as we work to improve local services? How should we approach the formal engagement phase?

For more information ¡ ¡ ¡ Visit our website at www. wales. nhs. uk/phsi Email us at phsi@cardiffandvale. wales. nhs. uk Call us on 029 2074 4299