Draft - IMTP NHS Planning Framework Version 1.4 Powys ... · Draft - IMTP NHS Planning Framework...

Draft - IMTP NHS Planning Framework Version 1.4

Powys Teaching Health Board

Sheets

C1 Outcomes Framework - Delivery of Measures

C1.1 Commissioned RTT Profile

C2 Bed Capacity

C3 Outpatient RTT

C4 IPDC RTT

C5 Direct Access Diagnostics

C6 Service Change

C22 Recruitment Difficulties

C23 Education Commissioning

DRAFT IMTP Profile and Performance for 2015/16 Financial Year

Measure

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

Profile Profile Profile Profile Profile Profile Profile Profile Profile Profile Profile Profile

Monthly142 132 142 142 142 142 137 137 137 137 132 132 132 132

Monthly7 7 7 7 7 7 7 7 7 7 7 7 7 7

Over 65's 66.5% 66.5% 70%

Under 65's in at risk groups 48.1% 48.1% 52%

Pregnant women 46.4% 46.4% 50%

Healthcare workers 50% 50.2% 50.2% 53%

5 in1 age 1 93% 95% 95%

MenC age 1 95% 95% 95%

MMR1 age 2 94% 95% 95%

PCV age 2 94% 95% 95%

HibMenC Booster age 2 93% 95% 95%

Quarterly

assessment

5%

(end of fin year)1.9% 3.0% 4.4%

Quarterly

assessment

40%

(end of fin year)38.5% 40% 40%

Annual

assessmentReduction N/A Reduction

95% 95% 95%

Public Health

Quarterly

assessment

% uptake of

childhood

scheduled

vaccines

95%

Profile Profile Profile

95%

Primary &

Community

Care

Number of emergency admissions for basket of 8 chronic

conditions - Powys ResidentsReduction

Number of emergency readmissions for basket of 8 chronic

conditions - Powys Residents

Public HealthAnnual

assessment

% uptake of

the influenza

vaccine in the

following

groups:

75%

95%

95% 95% 95%

95% 95% 95% 95%

% smokers treated by NHS smoking cessation services who

are CO- validated as successful40% 40% 40% 40%

95% 95%

95% 95% 95% 95%

95% 95%

2015/16 Profiles

Welsh

Government

2015/16 Target

Latest

Position

Estimated

March 15

position

Internal

Powys

2015/16

Target

STAYING HEALTHY - I am well informed & supported to manage my own

physical & mental health

Flu is measured as a cumulative figure the profile is to meet the targets set for 2015/16

Latest

Position

Estimated

March 15

position

Internal

Powys

2015/16

Target

Calendar Quarterly Subset -

Quarter 2


Quarter 3


Quarter 4


Quarter 1

Profile

% of reception class children (aged 4/5) classified as

overweight or obese

Only 2 data points are available for this indicator (2011/12 and 2012/13), which doesn't provide enough information to understand trends in childhood

obesity and therefore set a numerical target. However, Powys tHB is committed to reducing childhood obesity rates through a programme of work being lead

through a partnership approach via the Healthy Weight Steering Group.

Comments for Measures

Child hood vaccinations commentsThe latest COVER report has shown a downturn in performance, which may represent a true downward trend or quarterly variation. Information from Public Health Wales has been used to set immunisation

trajectories for 2015/16 as well as year end positions.

% estimated LHB smoking population treated by NHS smoking

cessation services1.1% 1.1% 1.1% 1.1%

Comments for smoking measure This is based on a Tier 1 target of 900 treated smokers.

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C1.Delivery Measures



Monthly 11.22% 10.00% Crude mortalitly will be monitored on a qualitative basis and given the nature of the case mix is not appropriate to set a specific target or profile

Monthly 103 100 RAMI 2013 will be monitored but given the nature of this measure and its relation to Powys tHB it is not appropriate to set a specific target or profile.

Monthly 95% 97.7% 98% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Monthly 98% 99.7% 99% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

Annual

assessmentImprovement 16 16

Annual

assessmentImprovement

Primary &

Community

Care

Annual

assessmentImprovement

*39.76%

2013/14

EFFECTIVE CARE - I receive the right care & support as locally as possible & I contribute

to making that care successful

Measure

Welsh

Government

2014/15 Target

Latest

Position

Estimated

March 15

position

Internal

Powys

2015/16

Target

Medical

Directorate

Crude Mortality - Powys Provider

Reduction

RAMI 2013 - Welsh Commissioners

Planning &

Performance

% valid principle diagnosis code 3 months after episode end

date - monthly

% valid principle diagnosis code 3 months after episode end

date - rolling 12 months

Number of NISCHR clinical research profile studies and

Commercially Sponsored studies19 non commercial and 2 commercial studies are profiled for the 2015/16 financial year

Number of Audits the organisation is participating in against the

national clinical Audit ProgrammeAs the National Audit programme for 2015/16 has yet to be announced it is anticipated that it will be very similar to 2014/15

% people aged 45+ who have a GP record of blood pressure

measurement in the last 5 yrs. Currently investigating a data source to allow profiling and reporting of the new measure

Medical

Directorate


Crude Mortality Comments

No major service developments are being planned, therefore we can expect our crude mortality rate to remain constant over the next 12 months. It should be noted that 85% of deaths in Powys hospitals are of

patients who are specifically receiving End of Life Care. 11% of deaths are of patients with known multiple morbidities who are considered to have had an unsurprising but not anticipated death whilst only 4% of

patients (<10 per annum) are considered to have had a truly unexpected death. Full review of these cases rarely results in the identification of any cases where the outcome could have been realistically altered. As

above crude mortality will be monitored on a qualitative basis and given the nature of the case mix is not appropriate to set a specific target or profile.

Audits participated commentsWith regards to audit the National Audit programme for 2015/16 has still to be announced but content will be similar to 2014/15

Participation for the year 2014/15 as follows: Note that Powys tHB participated in all the National Audits for which it was eligible to participate

-National Audit programme consists of 36 audits (counting the components of the National Diabetes Audit as one audit)

-Powys participated in 8 audits or programmes from the national list

-National Diabetes Audit – first section reported: Powys GP scored between average and above average

-National Paediatric Diabetes Audit – report to be published shortly

-All Wales Audiology audit – just started in December

-Fundamentals of Care Audit – data being extracted by nursing directorate at the moment

-Childhood Epilepsy Audit – report to be published shortly

-Sentinel Stroke audit – rehabilitation care only part

-Two “audits” are actually continual monitoring tools

-SHOT – serious hazards of transfusion

-Cardiac Rehabilitation register

% people aged 45+ who have a GP record of blood pressure measurement in

the last 5 yrs.

Currently blood pressure information is collected from Qof (BP001). The new requested measure does not relate to the current measurement which is Age 40+ for 2013/14 financial year (*latest available). The

measure for the current financial year is set at Age 50+ 2014/15 but the annual figure will not be available until the end of March 2015. Currently we are investigating a new data source to allow the measure to be

profiled and reported.




Annual

assessment100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Annual

assessment100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Monthly 95% 99.1% 97.8% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%

Monthly 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Monthly

Monthly Improvement 97.5% 90% 100% 85% 85% 85% 85% 85% 85% 90% 90% 95% 95% 100% 100%

Monthly 95% 99.8% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%

Monthly 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Monthly 65% 50.2% 65% 50% 50% 50% 52% 52% 52% 53% 53% 53% 55% 55% 55%

Monthly Reduction No Data Currently we have no regular data to create a profile (10/03/2015)

Monthly 98% 95.7% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

Monthly 96% 96.4% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

Monthly 95% 93.5% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Monthly 85% 81.5% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%

Annual

assessmentImprovement 60% 60% 62% 62%

Monthly 1 - First hours bundle

Monthly 2 - First days bundle

Monthly 3 - First 3 days bundle

Monthly 4 - First 7 days bundle

Internal

Powys

2015/16

Target

Stroke data reporting and profiling is still under development by the Health board its Providers and Welsh Government are actively pursuing a resolve. We have data that confirms that operational

standards are being met but currently we are unable to populate the stroke bundles.

TIMELY CARE - I have timely access to services based on clinical need & am actively

involved in decisions about my care

Measure

Welsh

Government

2014/15 Target

Latest

Position

Estimated

March 15

position

% of patients waiting less than 8 weeks for diagnostics

% GP practices offering appointments between 17:00 and

18:30 at least 2 days a weekImprovement

% of GP practices open during daily core hours or within 1 hour

of the daily care hours

% of patients waiting less than 26 weeks for treatment – all

specialties - Powys Provider

Number of 36 week breaches – all specialities - Powys Provider

Commissioned RTT waits profile

Therapies &

Health

Science

% compliance

with acute

stroke

bundles:

95%

% of new patients spend no longer than 4 hours in MIU

Number of patients spending 12 hours or more in MIU

% of Cat A Ambulance responses within 8 minutes

Number of over 1 hour handovers

% of patients referred as non-urgent suspected cancer seen

within 31 days (Welsh)

% of patients referred as non-urgent suspected cancer seen

within 31 days (England)

% of patients referred as urgent suspected cancer seen within

62 days (Welsh)

% of patients referred as urgent suspected cancer seen within

62 days (England)

Patients treated by an NHS dentist in the last 24 months as %

of population

Primary &

Community

Care

Please look to separate Commissioned Services RTT profile sheet


GP practice performance comments

The Health Board's responsible medical practices are experiencing difficulty in recruiting new GPs when vacancies occur. Some practices have vacancies currently which have been vacant for some time. This is

placing strain on the existing partners who are attempting to provide the service whilst being understaffed at the practice. Some practices have also experienced difficulties in recruiting replacement practice nurses.

Age profile of both GPs and practice nurses continues to be a great concern for Powys.

Diagnostic profile commentsTo meet the profile for Obstetric ultrasound we will have additional sonographer support in place by May 2015. To maintain our performance in 2015/16 with diagnostic endoscopy there will be a consultant nurse

endoscopist appointed.

Patients treated by an NHS dentist commentaryAny improvement to this figure would require additional capacity to be commissioned either via new dental practices or the increase to existing contracts. This would equate to an additional 17 dentists required to

attain 100%.




Monthly 80% 82.6% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80%

Monthly 90% 86.9% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

Monthly 90% 95.3% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

6 monthly

assessment100% 100% 100% 100% 100% 100%

Primary &

Community

Care

Annual

assessmentImprovement *0.75% all ages

Primary &

Community

Care

Monthly Improvement 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

INDIVIDUAL CARE - I am treated as an individual, with my own needs & responsibilities

Measure

Welsh

Government

2014/15 Target

Latest

Position

Estimated

March 15

position

Internal

Powys

2015/16

Target

Nursing

Directorate

% of assessments by the LPMHSS undertaken within 28 days

from the date of referral

% of therapeutic interventions started within 56 days following

assessment by LPMHSS

% of LHB residents (all ages) to have a valid CTP completed at

the end of each month

% of hospitals with arrangements to ensure advocacy available

to qualifying patients

Data not routinely available at Health Board (however QoF dementia registers in place).

DIGNIFIED CARE - I am treated with dignity & respect & treat others the same

Measure Target

% procedures postponed on >1 occasion, had procedure <=14

days/earliest convenience


% of over 65 registered as having dementia with their GP practice

The Health board currently has access to Dementia data via CMWEB interface and QOF. *The current view within CMWEB provides dementia figures without the age cutoff that is requested in the measure. NWIS

have been requested to supply the relevant data.

% of over 65 registered as having dementia with their GP

practice




Nursing

DirectorateMonthly 7.4 6.4 4.4 6.2 6.1 5.9 5.7 5.6 5.4 5.2 5.1 4.9 4.7 4.6 4.4

Primary &

Community

Care

Monthly 236.2 211.9 169.5 208.4 204.8 201.3 197.8 194.2 190.7 187.2 196.5 205.9 193.8 181.6 169.5

Monthly Reduction 5 0 0 0 0 0 0 0 0 0 0 0 0 0

Monthly14 cases

YTD

18 total for

2014/15

10

avoidable

Monthly 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Monthly 41 38 Reduction 37 36 36 35 35 34 33 33 32 31 31 30

Monthly 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DToC delivery per 10,000 LHB population - mental health

Reduction rolling

12 monthsDToC delivery per 10,000 LHB population - non mental health

(75 years and over)

SAFE CARE - I am protected from harm & protect myself from known harm

Measure

Welsh

Government

2014/15 Target

Latest

Position

Estimated

March 15

position

Internal

Powys

2015/16

Target

Therapies &

Health

Science

Number of healthcare acquired pressure sores in a hospital

setting

Number of total cases of C Difficile per month

Number of new Serious Incidents

Reduction

Number of new Never Events


Mental Health DTOC commentary There has been an improvement this year – and the profile shows we plan to sustain it and further improve performance so it is closer to the Welsh average.

C Difficile infections have been profiled to 10 cases in total for the 2015/16 year

Number of total cases of MRSA per month

Quarterly

assessment

% compliance with patient safety solutions - alerts

Improvement

% compliance with patient safety alerts - rapid response notices

Infection Control (C Difficile and MRSA rates)

Powys Infection control lead has spoken to WHAIP (PHW) and taken Infection Prevention advice from WG as she feels its inappropriate as a HBS that we have profiles for each month going

forward. She feels that this recommendation is a blanket requirement for the other HB who are not meeting the WG target and does not apply to PtHB. Both experts were in agreement and feel that

a monthly profile is unnecessary. The WG Target for C diff is 31 per 100,000 popn. Unlike the rest of Wales, PtHB have not been set a reduction target, due to the relatively low numbers we

diagnose. PtHB rate of C diff from 1 April - 31 Dec 2014 is 7 per 100,000 according to PHW data analysis. However, I have reported a further 7 cases from across the border in January and there

could be some more from Welsh labs. Despite our cases standing at 14 in total we still fall below the national target rate.




Workforce &

ODMonthly Reduction 4.84% 5.0% 4.32% 4.70% 4.52% 4.32% 4.22% 4.32% 4.52% 4.22% 4.32% 4.62% 4.62% 4.32% 4.32%

Medical

Directorate

Annual

assessmentImprovement 90.9% 95.0% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Workforce &

OD

Annual

assessmentImprovement 67.2% 80.0% 95% 65% 68% 75% 80% 85% 87% 90% 93% 95% 95% 95% 95%

OUR STAFF & RESOURCES - I can find information about how the NHS is open &

transparent on its use of resources & I can make careful use of them

Measure

Welsh

Government

2014/15 Target

Latest

Position

Estimated

March 15

position

Internal

Powys

2015/16

Target

Performance appraisals commentary

Although the PADR Compliance target has declined since April 2014 from its peak in March 2014 and we are currently some 17% underperforming against the tier 1 target of 85% and 22% below

our local target of 90%. Going forward into 2015-16 we should aim for 95% compliance as appraisals are one of the key enablers to staff engagement and high performance as part of the OD

strategy.

% staff absence due to sickness

% of total medical staff undertaking performance appraisals

% of total non medical staff undertaking performance

appraisals


Staff Sickness commentary

During the past 12 months WOD have been working closely with all managers to ensure that staff are being managed consistently in accordance with the sickness absence policy, focus has been

on any individuals who have more than 5+ episodes of sickness in a rolling 12 month period to ensure that they are in the sickness process. We have also concentrated on individuals who are on

long term sickness to ensure they are all being managed and in the sickness process and receiving the appropriate support to enable their return to work. This position is reviewed monthly by

WOD and followed up with relevant managers.

To compliment this work an Absence Call Back Scheme pilot project is working with hot spot areas to reduce their sickness absence, individuals are contacted on the first day of sickness to ensure

that they have the right support, an early referral to occupational health or are signposted to other appropriate agencies. This pilot has highlighted issues with timely input of sickness into ESR and

WOD have addressed these issues with the relevant managers to ensure the policies are applied. This initiative has been successful for invest to save funding. During 2015 we will be looking to

extend the pilot areas to include other hot spot areas within the organisation.

The management of sickness absence also links to the Health and Well Being agenda. The North Locality have run Mindfulness taster sessions for staff to look at ways in which to deal with

pressures or stresses in their work or personal lives. Further taster sessions are due to be rolled out during 2015 with a view to running an 8 week course for any interested participants.

The occupational health department have actively promoted the ‘flu campaign’ amongst the workforce with a encouraging take up. Further work continues to promote the campaign especially to

front line staff.


To produce this profile we have based it on the assumptions below

Provider

Name

Estimate of year

end position Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

% of patients waiting < 26 weeks for treatment 83.1% 83.6% 84.2% 84.8% 85.3% 85.9% 86.5% 87.1% 87.7% 88.3% 88.9% 89.5% 90.1%

Number of patients waiting < 26 weeks for

treatment 1046 1049 1051 1054 1056 1059 1062 1064 1067 1070 1072 1075 1078

Number of patients waiting 26 - 35 weeks 115 115 116 116 116 116 117 117 117 118 118 118 118


Number of patients waiting 52 weeks and over 26 24 22 20 17 15 13 11 9 7 4 2 0

Total Patients waiting 1259 1254 1248 1243 1238 1233 1228 1222 1217 1212 1207 1201 1196



treatment 1014 1017 1019 1022 1024 1027 1029 1032 1034 1037 1040 1042 1045







treatment 160 160 161 161 162 162 162 163 163 164 164 164 165







treatment 206 207 207 208 208 209 209 210 210 211 211 212 212







treatment 141 141 142 142 142 143 143 143 144 144 145 145 145







treatment 470 471 472 474 475 476 477 478 479 481 482 483 484







treatment 1033 1036 1038 1041 1043 1046 1049 1051 1054 1056 1059 1062 1064







treatment 1466 1470 1473 1477 1481 1484 1488 1492 1496 1499 1503 1507 1511







treatment 976 978 981 983 986 988 991 993 996 998 1001 1003 1006





Assume booked patients >52 weeks are treated

Assume Powys Provider secures capacity to maintain 26 weeks

Assume the performance against the 26 week target remains constant (this therefore gives us our estimate of how many Powys patients will be waiting in total which, when combined with our assumptions about the 26

week target and the long waiters, leads to our estimate of those in the 26-35 week band).

DRAFT Commissioned RTT profile for 2015/16 financial year

Assume long waiters (>36 weeks) will reduce to 0 by year end and further assume this will happen 'smoothly' over the 12 months.

Assume an alternative offer scheme will operate during 15/16 where Providers lack capacity to deliver target

Assume Commissioned services baselines are set at 2014/15 outturn to meet demand

Assume Providers are able to deliver sufficient capacity for complex cases

This profile does not yet recognise change in patient/service pathways nor change in Provider pathways

The estimate of year end position is based on average of the latest 12 months available for first 2 bands but long waiter position assumed as equal to latest month available- this to be updated as more up to date

information becomes available until such time as we actually have year end (i.e. end March 2015) position.Growth based on 3% for the year. This taken as 1/12 of the 3% each month for each of the 12 months.

Assume provider capacity remains relatively constant.

Aneurin

Bevan Local

Health Board

Betsi

Cadwaladr

University

Local Health

Board

Wye Valley

NHS Trust

Robert Jones

& Agnes Hunt

Orthopaedic

& District

Trust

Shrewsbury

& Telford

Hospital NHS

Trust

Cardiff & Vale

University

Local Health

Board

Cwm Taf

Local Health

Board

Hywel Dda

Local Health

Board

Abertawe Bro

Morgannwg

University

Local Health

Board

DRAFT Powys Teaching Healthboard Bed Capacity

Projected Number

March 15

Any proposed changes

in year

Date of

change

12 Community Rehab beds

12

Date of

change

30

15

20

13

21

14

16

15

21

165

Date of

change

3

Assessment beds can

be used in bed crisis,

normally at 30 Beds TBC

0

0

0

-5 Return to 21 beds 01/02/2014

0

2 Return to 16 beds 01/02/2014

0

3 return to 21 beds TBC

3 0

Bronllys

Ystradgynlais

Knighton

Llandrindod

Machynlleth

Total additional

community bed capacity

Knighton

Llanidloes

Newtown

Llandrindod

Welshpool

Machynlleth

Llanidloes

Newtown

Total community Hospital

Additional Community bed capacity

Brecon

Bronllys

Ystradgynlais

Welshpool

Total secondary care

Community Hospital

Brecon

Core capacity funded and

staffed beds

Secondary care

Glan Irfon (Nursing home)

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C2.Bed Capacity

DRAFT Planned Care Activity and Performance Profile

Powys Teaching Healthboard 2015/16

March 15

(Actual)Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

2015/16

Total /

March

2016

Position

Comments

1. Recurrent Demand 2647 2647 2697 2697 2697 2697 2697 2697 2697 2697 2697 2697 32264

average activity 2014/15 for all localities + W&C April-Dec extrapolated to full

year + 3% uplift in demand discussed via waiting list meetings ( all activity

taken from outpatient activity on IFOR, excluding AMI, old age psychiatry,

urodynamics as captured in diagnostcs, prostate nurse clinics, day hospital,

urology specialist nurse clinics, haematology clinics). Mental health clinics are

excluded since not Powys provider; others excluded since not reportable

under RTT.

2. Backlog to Deliver target

waiting time0 0 0 0 0 0 0 0 0 0 0 0 0

assume 26 weeks met in 2014/15

3. Current core capacity 14/15 2516 2516 2516 2516 2516 2516 2516 2516 2516 2516 2516 2516 30192capacity derived from 2014/15 activity (does not include 3% uplift) minus the

non recurrent capacity last year (approx 50 patients per month)

4. Additional recurrent capacity

for 15/1620 20 70 70 70 80 80 80 80 110 120 130 930

extra oral surgery from jan (South), extra nurse endoscopy OPD sessions

from June (Mid & South), extra ophthalmology and fracture clinic Mid & South

- towards end of year ; additional 150 for North to replace lost activity over last

year profiled throughout year as gradual increase

5. Additional non recurrent

capacity 80 80 80 80 80 80 80 80 80 80 80 80 960

number of patients to be seen through extra sessions to maintain waiting list

below 26 weeks and meet anticipated increased demand. 2014/15 average

40 patients per month in Mid/South, 10 per month on provided services only in

north (total 50 per month); anticipate extra 30 patients per month to be seen in

extra sessions across Powys to reflect the increase in demand anticipated

ROTT

(Capacity)

6. Removals other than

Treament (ROTT)15 15 15 15 15 15 15 15 15 15 15 15 180

number of patients removed from lists on average prior to treatment; excludes

DNA/CNA since also excluded from demand

Waiting List 7. Total New Outpatient Open

Pathway Volumes2647 2663 2679 2695 2711 2727 2733 2739 2745 2751 2727 2693 2649 2649

pre-calculated cells

Profile8. No of New Outpatients

waiting in excess of 26 Weeks0 0 0 0 0 0 0 0 0 0 0 0 0 0

assume 26 weeks met in 2014/15 and maintained

All localities and W&C

New Outpatient - All Specialties

Demand

Planned

Activity

(Capacity)

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C3.Outpatient RTT

March 15


2015/16

Total /

March

2016

Position

Comments New Outpatient - All Specialties

2647 2647 2697 2697 2697 2697 2697 2697 2697 2697 2697 2697 32264pre-calculated

2631 2631 2681 2681 2681 2691 2691 2691 2691 2721 2731 2741 32262

pre-calculated

0

to be completed in year

0to be completed in year

0to be completed in year

2647 2647 2647 2647 2647 2647 2647 2647 2647 2647 2647 2647 2647 2647pre-calculated

0 0to be completed in year

2616 2616 2666 2666 2666 2676 2676 2676 2676 2706 2716 2726

Actual Total ROTT (To be completed during

2014/15 by the Health Board)

Actual New Outpatient Open Pathway

Volume

Actual New Outpatients waiting in excess of

26 Weeks

Total anticipated Demand including backlog

(1 + 2)

Total Planned Capacity including ROTT

(3 + 4 + 5 + 6)

Actual Total Demand (To be completed

during 2014/15 by the Health Board)

Actual Total Activity (To be completed during


0

500

1000

1500

2000

2500

3000

3500

4000

March 15 (Actual)

42095 42125 42156 42186 42217 42248 42278 42309 42339 42370 42401 42430

New Outpatient - Open Pathway and No. waiting in excess of 26 Weeks (Profile v Actual)

New Outpatient Total (Profile) New Outpatient >26 Weeks (Profile)

New Outpatient Total (Actual) New Outpatient >26 Weeks (Actual)

0

200

400

600

800

1000

1200

1400

42095 42125 42156 42186 42217 42248 42278 42309 42339 42370 42401 42430

New Outpatient - Recurrent and non recurrent Activity volumes (Planned v Actual)

New Outpatient Activity (Actual) New Outpatient Activity (Profile)

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C3.Outpatient RTT



March 15


2015/16 Total

/ March 2016

Position

Comments

1. Recurrent Demand 151 151 151 151 151 151 151 151 151 151 151 151 1812 theatre activity for 2014/15 April-Dec profiled for 12 months, + 3% increase in

demand reflecting anticipated increase in OPD demand


waiting time0 0 0 0 0 0 0 0 0 0 0 0 0

assume meet 26 week RTT March15

3. Conversions from OPD

activity0 0 0 0 0 0 0 0 0 0 0 0 0

captured in recurrent demand - unable to break down

4. Conversions from

Diagnostics 0 0 0 0 0 0 0 0 0 0 0 0 0

captured in recurrent demand - unable to break down

5. Direct referrals to treatment

stage0 0 0 0 0 0 0 0 0 0 0 0 0

no direct referrals

6. Current core capacity 14/15 113 113 113 113 113 113 113 113 113 113 113 113 1356 average monthly activity 2014/15 minus average non-recurrent capacity (average

number of patients seen in extra sessions and recurrent capacity agreed for in year


for 15/1616 16 16 16 16 16 16 16 20 20 20 20 208 extra 4 sessions per month agreed for Oral Surgery starting March; + 1 theatre

session for ophthalmology, assume to start in Dec if OPD started in Sept


capacity 18 18 23 18 18 23 18 18 23 18 18 23 236

extra session in ophthalmology ((8 patients); extra session orthopaedics (5patients);

extra session max fax (5 patients); shortfall of 20 patients per year following 3%

increase - profiled as an extra 4 sessions each seeing 5 patients (1 per quarter)

ROTT

(Capacity)


Treament (ROTT)1 1 1 1 1 1 1 1 1 1 1 1 12

very few once reached theatre stages of pathway

Waiting List 10. Total Treatment Open

Pathway Volumes232 235 238 236 239 242 240 243 246 240 239 238 232 232

calculated in spreadsheet

Profile11. No of Treatments waiting in

excess of 36 Weeks0 0 0 0 0 0 0 0 0 0 0 0 0 0

assume 26 weeks RTT met in March 2015

Planned

Activity

(Capacity)

PtHB (theatre daycase only)

Treatments - All Specialties

Demand

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C4.IPDC RTT

March 15


2015/16 Total

/ March 2016

Position

CommentsTreatments - All Specialties

151 151 151 151 151 151 151 151 151 151 151 151 1812

148 148 153 148 148 153 148 148 157 152 152 157 1812

0

0

0

232 232 232 232 232 232 232 232 232 232 232 232 232 232

0 0

147 147 152 147 147 152 147 147 156 151 151 156

Actual Treatments waiting in excess of 36

Weeks


(1 + 2 +3 + 4 + 5)


(6 + 7 + 8 + 9)







Actual Treatment Open Pathway Volume

0

500

1000

1500

2000

2500

3000

3500

4000

March 15 (Actual)

42095 42125 42156 42186 42217 42248 42278 42309 42339 42370 42401 42430

IPDC Pathway and No. waiting in excess of 36 Weeks (Profile v Actual)

IPDC Total (Profile) IPDC >36 Weeks (Profile) IPDC Total (Actual) IPDC >36 Weeks (Actual)

0

500

1000

1500

2000

2500

42095 42125 42156 42186 42217 42248 42278 42309 42339 42370 42401 42430

IPDC - Recurrent and non recurrent Activity & ROTT volumes (Planned v Actual)

IPDC Activity (Actual) IPDC Activity (Profile)

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C4.IPDC RTT



March 15


2015/16 Total

/ March 2016

Position

1. Recurrent Demand 2157 2157 2157 2177 2177 2177 2177 2177 2177 2177 2177 2177 26064endoscopy, x ray, ultrasound (obstetric and non-obstetric), fluoroscopy, urodynamics activity 14/15

profiled for 12 months + 3% increase. Factored in 20 patients extra per month demand following

introduction of consultant nurse endoscopist for endoscopy (repatriated demand)


waiting time16 0 0 0 0 0 0 0 0 0 0 0 16

assume some ultrasound patients waiting above 8 weeks in April - awaiting confirmation of extra sessions

3. Current core capacity 14/15 2079 2079 2079 2079 2079 2079 2079 2079 2079 2079 2079 2079 24948 activity 2014/15 - avg number of patients seen in extra sessions per month this year (16)


for 15/160 0 0 72 72 72 72 72 72 72 72 72 648

introduce endoscopy sessions by consultant nurse endoscopist July 2015


capacity 60 33 33 33 33 33 33 33 33 33 33 33 423

extra sessions for endoscopy/ultrasound needed to meet demand (based on what was needed last year

approx 16 per month) + 17 patients per month to account for increase in demand. Higher number in April

to account for backlog from last year

ROTT

(Capacity)


Treament (ROTT)5 5 5 5 5 5 5 5 5 5 5 5 60

assume 5 per month (high rate in X ray)

Waiting List 7. Total Diagnostic Open

Pathway Volumes390 403 443 483 471 459 447 435 423 411 399 387 375 375

march - approx 100 endoscopy, 290 ultrasound/x ray still waiting

Profile8. No of Diagnostics waiting in

excess of 8 Weeks16 0 0 0 0 0 0 0 0 0 0 0 0 0

assume 0 once extra sessions held

Planned

Activity

(Capacity)

North Mid & South, W&C

Diagnostic - All Specialties

Demand

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C5.Direct Access Diagnostics

March 15


2015/16 Total

/ March 2016

Position

Diagnostic - All Specialties

2173 2157 2157 2177 2177 2177 2177 2177 2177 2177 2177 2177 26080

2144 2117 2117 2189 2189 2189 2189 2189 2189 2189 2189 2189 26079

0

0

0

390 390 390 390 390 390 390 390 390 390 390 390 390 390

16 0

2139 2112 2112 2184 2184 2184 2184 2184 2184 2184 2184 2184

Actual Diagnostics waiting in excess of 8

Weeks


(1 + 2)


(3 + 4 + 5 + 6)







Actual Diagnostic Open Pathway Volume

0

500

1000

1500

2000

2500

March 15 (Actual)

42095 42125 42156 42186 42217 42248 42278 42309 42339 42370 42401 42430

DIagnostic- Open Pathway and No. waiting in excess of 8 Weeks (Profile v Actual)

Diagnostic WL Total (Profile) Diagnostic >8 Weeks (Profile)

Diagnostic WL Total (Actual) Diagnostic >8 Weeks (Actual)

0

100

200

300

400

500

600

700

800

900

42095 42125 42156 42186 42217 42248 42278 42309 42339 42370 42401 42430

Diagnostic- Recurrent and non recurrent Activity volumes (Planned v Actual)

New Outpatient Activity (Actual) New Outpatient Activity (Profile)

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C5.Direct Access Diagnostics

YEAR 2 YEAR 3

Q1 Q2 Q3 Q4

Non delivery of unscheduled care targetsInterim General Manager Mid and

South Localities

Development of Virtual

Ward/Community Resource Team

Model in Mid and North Powys

Primary Care Yes Feasibility studies underway

Design of the most appropriate model;

agreement within Locality and other

stakeholders

Project planning completed and

underwayImplementation of new model underway Ongoing implementation and review Evaluate service so far

Escalation of costs in secondary careDirector of Primary and

Community Care / USCB

Reduction in non Mental Health

DTOCsUnscheduled Care No

Scope work required to achieve 20%

reduction

deliver project plan thru USCB and

ICPOP

Monitor improvements made through

internal changes and use and effective

use of the ICF

Ensure maintenance of progress in

Winter periodOngoing implementation and review Evaluate service so far


Community Care / USCB

Improved patient flow through

Community HospitalsUnscheduled Care No

Work underway to scope Brecon as an

example . Patient tracker in place and

escalation processes in place

Scoping of work with ABUHB and

English Trusts on optimum flow

Test out new system metrics and

performance in Brecon Commence roll out to other sites Ongoing implementation and review Evaluate service so far


Community Care / USCBEnhanced Care Co-ordination Unscheduled Care No Initial scoping with Shropdoc underway

Develop consistent method of working

and pathways

Introduce CCC as mainstay of DGH and

Community Hospital provision

Review satisfaction with service and

effectiveness of placement thru points

prevalence

Ongoing implementation and review Evaluate service so far

Non delivery of diagnostic waiting timesInterim General Manager Mid and

South Localities

Development of sonography

services for local ultrasound

scanning

Primary Care No Business plan approved Recruitment processes underway

Training underway for any newly

recruited staff; if training posts required

detailed training scheme agreed

Ongoing training and implementation of

service

Ongoing implementation, review and

development of serviceService fully operational

Non delivery of RTTImproved access to local

diagnostics Primary Care yes Pre-pilot planning underway; pilot study

Pilot completed and evaluation

completed

Business plan completed with

recommendations to proceedProject underway as per new plan

Implementation underway; option to

procure or commission as agreed Service implementation

Failure to deliver improved patient

experienceTBC

Implementation of local

Chemotherapy serviceCancer Services No

Project planning underway; project Board

convened

Modelling work undertaken for approval

by executive team

Implementation plan devised and

underwayOngoing work as per project plan Service in place by end of year 2 Business as usual

Non delivery of RTTInterim General Manager Mid and

South Localities

Development of orthopaedics

services to include Fracture

Clinics and further development of

CMATs

Planned Care Yes

Clinical audit and evaluation of CMATs

services underway; recommendations for

development identified

Business case completed for fracture

clinics

Pathway redesign work; negotiations with

providers to secure additional sessions

required for fracture clinics; engagement

Fracture clinic service implemented by

the end of the year

New model in place and operational;

review of changesBusiness as usual

Non delivery of USC targetsLocality General Manager

supported by LGM

Refinement / Evaluation and

further development of Health and

Wellbeing Centre Models across

Powys

Primary Care yesNew model established at Bronllys

operational

Model design underway based on

feedback from changes in model at

Bronllys Hospital

Planning ImplementationHealth and Wellbeing Centre Models

implemented across SouthBusiness as usual

Non delivery of RTTLGM'S Supported by patient

service managers

Reduce incidence of DNAs at

practice level by developing the

use of texting appointment

reminders (cluster priority South)

Planned Care No Request to join NWIS pilot Ongoing Ongoing Ongoing Review position following NWIS pilot

Escalation of costs in secondary careUSC Board through Director of

Primary and Community Care

Establish same day rapid access

to secondary care

assessment/advice to support

people remaining in the

community

Unscheduled Care No Identify lead via Care Planning GroupOngoing discussion with relevant

providersProtocols agreed Access implemented

Escalation of emergency admissionsLGM / Director of Primary and

Community Care

Introduction of Lifestyle LES and a

psychological support to the

management of long term

conditions

Primary Care Yes Implementation in South Ongoing engagement with Mid Practices Ongoing engagement with Mid Practices Sign up and agreement of Mid practices Implementation underway in Mid Powys

Non delivery of USC targetsUSC Board through Director of

Primary and Community Care

introducing new ways of working

to reduce Length of Stay: new

clinical protocols specified for

rehabilitation and frail/elderly

beds; introduction of new

discharge protocols for nurses

Unscheduled Care NoDevelopment of protocols; agreement

and engagement

Protocols agreed, implementation plan

produced

Implementation underway to start to

reduce LOSOngoing implementation

Risk of failure of GP practice

Director of Primary and

Community Care/ Primary Care

Team

Review practice viability and

sustainability across Powys to

highlight high risk areas and

implement support mechanisms.

Primary Care No

Non delivery of therapy waiting timeInterim General Manager Mid and

South Localities

Implement a sustainable model

for audiology services.Planned Care Yes

Non delivery of USC targets North Locality General ManagerImplement Discharge to Assess

(D2A)Unscheduled Care Yes

Implementation of the D2A agreed three

pathways

Implementation of the D2A agreed three

pathways

Maintain Implementation of the D2A

agreed three pathways







Non delivery of USC targets Locality Lead Nurse

Integrated Reablement Beds to

support VW and 'Discharge to

Assess'

Unscheduled Care

and Primary Care No Finalise business case Go to contract. Implementation Implementation Maintain Implementation Maintain Implementation

Increase in respiratory emergency

admissionsLocality Lead Nurse

Redesign of Respiratory

Specialist Nursing Team &

Therapy support.

Unscheduled Care NoFinalise business case with support from

speciality lead.Consult with staff and stakeholders Implementation Implementation Implementation Implementation

YEAR 1

Primary and

Community

Care

Detailed

plan in

place

DirectorateImpact of non delivery Officer Lead

Change/Scheme Ref in IMTP

YEAR 2 YEAR 3

Q1 Q2 Q3 Q4

YEAR 1Detailed

plan in

place



North Locality General ManagerRationalisation of Local Enhanced

ServicesPrimary Care No

By Q1 there will be agreement on

activities undertaken within General

practice that are not incorporated in the

General Medical Services Contract.

Local Enhanced Services will be

developed and agreed focused on the

repatriation of work from secondary into

primary care.

By Q2 Local Enhanced Services will be

operational in relation to: phlebotomy

requests from secondary care; ECGs;

24hr BP monitoring; Vaginal Pessary

insertion; Intravenous injections, for

example Bisphosphonates.

Transfer of funding from secondary care

to support transfer of work to primary

care

Implementation Implementation Implementation

More out of county deaths in the end of

life pathwayNorth Locality General Manager

Introduction of Palliative Care

Suites into Community Hospitals

to enhance local provision.

Yes

Finalise business case and public

funding from Macmillan and league of

Friends

Estates development. Skills development

for staff with support from Severn

Hospice

Implementation Maintain implementation Maintain implementation Maintain implementation


experienceNorth Locality General Manager

Improve cancer delays in

treatment. Improve

communication and co-ordination

between primary and secondary

care.

Cancer Services No

Business case for appointment of locality

cancer journey coordinator to monitor

progress of patients receiving secondary

cancer care and to act as a conduit for

flow of information. Discussion and

agreement with secondary care

providers for standards for

communication with primary care.

Explore funding for cancer care co-

ordinator with Macmillan.

Representation to secondary care

providers with requirements and

standards for communication with

primary care. Explore funding for co-

ordinator with Macmillan (indicated by

Macmillan cancer charity in 2014)

Appointment of Cancer Care Co-

ordinator.Implementation Implementation Implementation

Reputational risk Locality Lead Nurse

Scoping the requirements for a

redevelopment of Minor Injuries

Unit in North Powys to reflect

patient need and future service

configuration

Unscheduled Care YesAgree the business case and service

model

Commence recruitment and

development of skills for existing staffImplementation Implementation Maintain Implementation Maintain Implementation

Increased complications in diabetes in

later stages of diseaseNorth Locality General Manager

Establish Diabetes Education

GroupsDiabetes No Develop business case Present to Directors and Agree funding Recruit staff Implement education programme Maintain Maintain

Escalating cost Locality Lead NurseRedesign of continence service to

reduce product use.Finance Yes

Action business case developed in

2014/14Appoint staff Implement Implement Implement Implement

Escalating cost TBC

Review referrals to external

paediatric service and identify

those appropriate to receive

services in Powys

Childrens services Yes

review pilot triage (2012-13) develop

model for implementation of paediatric

referral triage

review pilot triage (2012-13) develop

model for implementation of paediatric

referral triage

Implement Implement audit, review and identify gaps in service

Escalating cost TBCDevelop robust children's

community serviceChildrens services Yes review of populations needs develop plan consultation on plan Implement


experience

Head of Midwifery and Sexual

Health Services

Develop midwife led USS and day

assessment servicesMaternity services Yes

Continue with USS development as part

of Powys wide development

Continue with USS development as part

of Powys wide developmentadvertise midwifery USS posts appoint to midwifery USS posts commence midwifery led USS service

Escalating cost CAHMS ManagerCAMHs community assessment

and treatment teamChildrens services Yes Implement team Implement team Implement team Implement team

More obese children

Head of Childrens Public Health

Nursing and Community

Paediatric

Implement the National Healthy

Child Wales programme

Health Visiting and

School NursingNo

Raise staff awareness of new

programmeTraining Implement Review and monitor Review and monitor Review and monitor



Paediatric

Develop services to improve

infant mental health Health Visiting No

Understand scope of problem within

PowysDevelop a strategy Develop a strategy Consult on strategy

Set up a multi-agency working group to

develop an action planImplement



Paediatric

Extend the school nurse led

enuresis clinics to all areas within

Powys

School nursing No

Share good practice and success from

other areas and identify further areas

where service can be implemented

Training and competency assessment of

staffImplement Review and Monitor

Consider use of PGD to prescribe

desmopressinReview and Monitor

Locality General Manager

supported by LGM

development of Children's CHC

nursing serviceEfficiency No Ongoing work on model of care

development and approval of business

caserecruitment implementation of service

Escalating costs in secondary care Clinical Dental DirectorDevelop services to improve

access to oral surgeryOral Health Yes Recruitment Skill mix Increase sessional availability Reduce waiting list

Stay within 26 week assessment to

treatment timesReview and monitor

Primary and

Community

Care

YEAR 2 YEAR 3

Q1 Q2 Q3 Q4

YEAR 1Detailed

plan in

place



Failure to achieve smoking cessation

activity targetConsultant in Public Health

Undertake a strategic review of

smoking cessation services

Prevention and

Health ImprovementNo

Review current services in place and

identify actions to improve smoking

cessation service activity

Make recommendations for priority

actions for 2015-16 and idenitfy areas

requiring further investment



Strengthen referral pathways to

smoking cessation services,

focusing on referrals from GPs,

out-patients and partner

organisations

Prevention and

Health ImprovementYes

Engage with GP Practices to increase

knowledge of services and develop

referral pathways

Obtain feedback from pharmacies on

best practice to increase smoking

cessation activity



referral pathways



referral pathways

Develop and / or strengthen out patient

referral pathways to smoking cessation

services



referral pathways

Engage with partner organisation to

develop referral pathways to services

Review effectiveness of pathways Monitor and review



Implementation of a

communication action plan to

raise awareness of smoking

cessation services

Prevention and

Health ImprovementYes Finalise action plan

Prioritise actions for implementation in

2015/16

Implement priority actions for 2015/16

Identify actions that require investment in

2016/17 and develop and present a

business case for approval

Implement interventions as agreed

through business caseMonitor and review

Failure to develop a joined up approach

to tobacco control and reducing smoking

prevalence

Consultant in Public Health

Hold a Tobacco Control

Conference to develop a

community of practice to

Champion “Smoke Free Powys”

Prevention and

Health ImprovementYes Hold conference

Identify learning from conference ,

including key actions to further develop a

"Smoke Free Powys" approach

Scope development of a community of

practice in Powys

Launch a community of practice

approachMonitor and review

Worse health outcomes for pregnant

women and children, as well as

increased healthcare utilisation and

increased health inequalities


Increase the number of pregnant

women accessing smoking

cessation services

Prevention and


Evaluate the impact of use of CO

monitors by midwives in Powys

Identify learning from the breastfeeding

programme to further tailor smoking

cessation support to pregnant women

Develop an antenatal pathway to provide

continued support to pregnant women

who have given up smoking or who wish

to quit

Review and monitor

Failure to reduce smoking prevalence,

with associated worse health outcomes,

increased health inequalities and

increased healthcare utilisation


Identify evidence based

interventions to prevent uptake of

smoking in children and young

people e.g. in school settings

Prevention and


Review activity already underway to

prevent smoking amongst children and

young people

Identify evidence based actions to

prevent uptake of smoking and identify

actions requiring further investment

Develop and present a business case for

approval



Failure to support staff to improve their

health and wellbeing. Failure to be a

exemplar health promoting organisation


Address smoking amongst Powys

teaching Health Board staff by

undertaking a staff survey,

developing smoking cessation

pathways for staff and launching

the refreshed Powys tHB Smoke

Free Policy

Prevention and


Undertake a staff survey

Launch refreshed Powys tHB Smoke

Free Policy

Strengthen smoking cessation pathways

for staff

Identify actions requiring further

investment to increase access to

smoking cessation services by Powys

tHB staff and develop and present a

business case



Failure to reduce childhood obesity

levels (Welsh Government target)Consultant in Public Health

Identify priority interventions that

will have an impact on childhood

obesity levels (as measured by

the CMP) and develop a business

case for implementation of

interventions

Prevention and


Identify evidence based interventions

that will have an impact on childhood

obesity levels in Reception aged children

Identify priority interventions for

implementation in Powys

Identify models for delivery, including

requirement for further investment in

2016/17 and develop a business case, if

appropriate

Present business case for approval and /

or develop plans for delivery of

interventions

Delivery of interventions Monitor and review

Failure to have adequate services to

delivery the CMO Obesity PathwayConsultant in Public Health

Weight management services

(Level 2) for overweight and

obese children

Prevention and


Review the impact of loss of funding for

MEND (child weight management

services) and alternative solutions for

delivery of a weight management

programme for children and young

people

Identify preferred option for delivery of

weight management

Develop a business case and present for

approval


through business caseImplementation and monitoring

Failure to have adequate services to

deliver the CMO Obesity Pathway and

failure to address a specific

recommendation by Welsh Government

to have Level 3 weight management

services in place

Consultant in Public HealthLevel 3 weight management

services

Prevention and


Business case to be presented for

approval. Implementation group to be set

up

Develop implementation plans for

delivery and / or commissioning of

services

Implementation of plans Delivery of interventionsDelivery of interventions

Monitor and review

Failure to achieve 95% childhood

vaccination target and risk of outbreaks

of vaccine preventable disease


Scope the feasibility and potential

impact of an Active Follow Up

approach in Powys, and develop

a business case for

implementation, if appropriate

Prevention and


Scope feasibility and possible impact of

Active Follow UpDevelop business case, if appropriate Present business case


through business case

Delivery of interventions

Monitor and review


vaccination target and risk of outbreaks

of vaccine preventable disease


Pilot pathways for health visitors

and GP practices to follow up

children who have missed

scheduled vaccinations

Prevention and


Agree pilot sites for implementation of

pathways Implementation of pathways Review and roll out pathways Roll out of pathways Review impact

Failure to achieve 95% vaccination

uptake in children and young people and

risk of outbreaks of vaccine preventable

disease


Work with schools to increase

pupil knowledge of vaccination, in

order to increase teenage

vaccination uptake rates

Prevention and

Health ImprovementYes Scope gaps and possible interventions

Identify priority actions for

implementation in 2015/16

Implementation of actions.

Identify actions for 2016/7, including

those that require investment


approval




vaccination targetConsultant in Public Health

Increase Child Health Data

accuracy and ensure data is used

to best effect

Prevention and


Review findings from CHIPS audit and

identify actions to further improve data

accuracy

Identify actions for 2015/16 and actions

requiring further investment in 2016/17

Delivery of in year actions and develop a

business case for investment in 2016/17


approval



Failure to achieve 75% flu vaccination

target

Funding to risk share flu vaccine

purchasing with GP PracticesPrimary Care No

Engage with GPs regarding sufficient

purchasing of flu vaccines and agree

next steps to ensure vaccine availability

is not a limiting factor to increasing flu

vaccination uptake

MonitorReview effectiveness and approach for

2016/17


targetConsultant in Public Health

Further consider the role of

midwives in vaccination of

pregnant women

Prevention and


Review 2014/15 vaccination programme

and identify areas for improvement

Identify actions for increasing uptake

amongst pregnant women and

implementation of action plan

Implementation of action plan Delivery and monitoring of action plan



Implement lessons learned from

2014/15 to strengthen the Flu

Vaccination Action Plan for

2015/16

Prevention and


Hold a debrief of the 2014/15

programme and identify lessons learned

& areas for improvement

Strengthen the Flu vaccination action

planImplementation of action plan Delivery and monitoring of action plan

Review 2015/16 action plan and

strengthen for 2016/17



Work with 3rd sector staff to

promote flu vaccination

Prevention and


Review evaluation from 2014/15 project

and develop plans to roll out programme

Work with third sector organisations to

roll out scheme. Implementation Implementation and monitoring Review of approach

Worse health outcomes for children and

young people, resulting in increased

health and social care use


Promote the resilience of children

and young people through the

development of a strategy to

deliver a range of programmes

Prevention and


Develop a strategy to deliver a range of

programmes

Implement the resilience building

programme

Promote further anti-bullying work

Implementation of roll out of programme,

working through CYPP

Failure to embed health promotion into

the working practices of all Powys tHB

staff


Develop and deliver a Making

Every Contact Count approach in

Powys

Prevention and


Facilitate the development of training

options, in line with national direction

Develop a model of sustainable delivery

of training

Establish a community of practice across

Powys

Evaluate the engagement with and

outputs from the programme

Public Health

YEAR 2 YEAR 3

Q1 Q2 Q3 Q4

YEAR 1Detailed

plan in

place



Failure to develop sustainable medium to

long term clinical strategyHead of PMO

Commence Strategic Delivery

Model Programme

Emerging Service

ModelYes

*Confirmed programme funding.

*Start early engagement

* Develop our principles as a basis for

developing services

*Develop governance arrangements

* Undertake risk assessment

* Secure programme resource

* formally launch programme

*Initial work on clinical evidence base for

change underway

Ongoing early engagement.

*Public engagement on clinical principles

and understanding views and opinions of

public and stakeholders

* Gather evidence base to support case

for change inc service reviews.

* 5 Facet Survey completed.

* Section 1 of estate strategy prepared.

*Agree evaluation approach and hold

first meeting with the panel.

* Start work on developing clinical

service strategy.

* Development of the long list of options.

* Clinical strategy work completed and

external assurance undertaken.

* Public engagement on long list of

options.

* Feasibility around long list.

* Public engagement on short list of

options.

* External assurance on the short list

options

*Technical configuration and appraisal of

short list of options

*Preferred option and external

assurance

*Consultation on the preferred option.

Failure to deliver service reform

programme and associated savings

programme.

Head of PMODeliver Phase 2 of the Demand

and Capacity Modelling Project Yes

* Staff engagement on the outcome of

the modelling.

* Re-model 13/14 data.

* Agree delivery mechanism.

* Agree key focus areas.

* Develop programme of work and

phasing of financial benefits.

* Start to develop business case/change

plans for priority areas.

* Understand impact on commissioning.

* Continue to develop business case

/change plans for priority areas.

* Confirm commissioning intentions for

2016/17

* Approval of Service Reform

Programme and phasing of schemes

over 3 years.; establish project board for

Bronllys site

*Further clarity after Q1.

* Ongoing implementation of change

plans



plans



plans



plans

Catastrophic failure of estate and failure

to deliver service reform programme due

to lack of clinical space.

Head of EstatesPrepare a Medium Term 3 year

Estates StrategyEstates No *Implement annual capital programme

Review short/medium term capital

priorities against compliance and service

priorities.

Develop prioritised capital investment

plan; submit business case for

Llandrindod Wells

*5 Facet Survey completed

*Section 1 of estate strategy prepared

*Approval of Medium Term 3 year

(bridging) Estates Strategy

Implementation

Risk of judicial review of service change Head of PMOPrepare Stakeholder Engagement

Strategy in partnership with LSB

Strategic

PartnershipsNo

Develop Stakeholder Engagement

Strategy

Develop Stakeholder Engagement

Strategy

Approve Stakeholder Engagement

Strategy Implementation Review and Evaluation

Failure to deliver overall corporate

performanceHead of Buisness Intelligence

Prepare and agree performance

management frameworkGovernance No

Develop integrated performance

management framework Approval of framework Implementation Review and Evaluation

Failure to integrate with Powys Council Head of PMO

Develop and agree planning cycle

with Powys Council to align IMTP

and One Powys Plan processes

Strategic

PartnershipsNo

Map LA and HB planning processes

including mapping process, systems and

timelines to maximise alignment.

Develop proposal for alignment of IMTP

and Powys One Plan processes. Implement aligned planning processes. Implement aligned processes Review and Evaluation

Risk of judicial review of service change Head of PMOLead public consultation in Powys

around Future Fit Programme

Strategic

PartnershipsYes

Support service modelling preparatory

work and on-going engagement process

*Develop detailed plan for public

consultation within Powys to meet the

Future Fit Programme consultation plan,.

Plan Consultation Engagement Implement Consultation Plan. Report analysis of consultation

Report Outcome of Consultation to

Boards and make recommendations on

options

Reputational risk Head of PMOTake forward Mid-Wales

Collaborative

Strategic

PartnershipsNo

*Once Independent Chair appointed,

formally establish Mid Wales

Collaborative. *Participate in

Mid Wales Rural Health Conference.

Define and implement Mid Wales

Collaborative Work Programme.

Head of Buisness Intelligence

Develop a data quality strategy

and management function to

manage all reference data used

within systems

No

Scope project identifying all electronic

systems used within the organisation.

Gain IG approval for change

Establish a robust data request system

to allow service users to request

additional fields to be used within

systems.

Work with system administrators to

amend and establish procedures to

move to national or agreed local

reference data tables

Move to business as usual

Cost escalation Head of PMOEstablish Commissioning Reform

ProgrammeCommissioning No

Establish Commissioning Board; appoint

Assistant Director of Commissioning;

Scope Programme Brief

Further milestones will defined in

programme brief

Cost escalationEstablish WHSSC Commissioning

work streamCommissioning No

Develop job description; appoint

specialist commissioner for Powys;

establish gateway process in English

provider organisations

Scope project through data analysis and

set out programme of workDependent on Q2 findings

Failure to deliver USC targetsEstablish EASC Commissioning

Work streamCommissioning No

Develop work programme with support of

EASC and present to the BoardDependent on Q1 action

Planning and

Performance

YEAR 2 YEAR 3

Q1 Q2 Q3 Q4

YEAR 1Detailed

plan in

place



Requires investment of £0.160M in

2015/16. Non funding will result in non

delivery of CCIS which is a core

supporting tool for front line service

integration

ICT Programme ManagerImplement Community care

Information System (CCIS)ICT No

Commission joint project and start

readinessproject readiness

project readiness / start of

implementationContinue implementation Complete Implementation

Non delivery would mean no

improvement in clinical risks of sharing of

data between English providers and

Welsh practices

ICT Programme Manager Implement Cross Border ICT ICT Yes Readiness Implementation

ICT Programme Manager Implement MtED national system ICT Yes Commission project readiness / pilot readiness / pilot implementation and completion

Non delivery would mean a core platform

for better interface between health and

social care would not be in place

ICT Programme Manager PtHb LYNC deployment ICT No Readiness Implementation

Non delivery would mean planned

clinical risk mitigation would not be in

place

ICT Programme ManagerImplement Case Note tracking in

MyrddinICT No ? ? ? ?

Non delivery would mean the core

strategy by which all ICT flows through

would not be delivered, compromising

the entire ICT strategy in Powys tHB

ICT Programme Manager Roll out Welsh clinical portal ICT No Readiness readiness / pilot

Non delivery would mean innovative

technology to support enhanced clinical

practice would not be in place

ICT Programme Manager Digital Powys tech trials ICT No Phase 3 design phase 3 trials

Finance

YEAR 2 YEAR 3

Q1 Q2 Q3 Q4

YEAR 1Detailed

plan in

place



Non-delivery as a result of not increasing

Organisational Development capacity to

support this initiative will result in

reduced pace of delivery, potential

change failure and reduced productivity

of the workforce and reduction in staff

engagement as demonstrated through

the staff survey.

Assistant Director of Workforce

and Organisational Development

Implementation of OD Strategy

and Chat to Change (staff

engagement programme) at all

levels of the organisation.

Yes

Social Media of Twitter, Facebook and

Linked In launch. Promote the changes

that have occurred, using "You said",

"This Happened" Develop Project Plan in

partnership with Chat2Change

Champions. Plan for the delivery of the

development programmes and team

based journey in light of new structures.

Commence Chat to Change forums to

progress key objectives.

Identify Board Level lead for Staff

Engagement and feature Staff

Engagement and Staff Stories as a

regular feature at board meetings.

Commence delivery of development

programmes.

Review of impact 12 months on from

Chat to Change

Continue to implement Project Plan and

achieve Chat to Change objectives ü ü



Values and Behaviour Framework

developed and used to inform

recruitment, appraisals, staff

development and ways of

working.

Yes

Values and Behaviour Framework

launched.

Redesign of appraisal materials to

support Values and Behaviour

Framework and to ensure meaningful

appraisals. Establish a project group to

implement Values Based Recruitment

across organisation and agree

approaches.

Further Values in Action products

launched. Identification of appointing

officers and develop training action plan


launched. Training for all appointing

officers and panel members.


launched. Training for all appointing

officers and panel members

Review of impact 12 months on. All

recruitment to be undertaken based on

Values Based Recruitment.

Review. All recruitment to be undertaken

based on Values Based Recruitment.



Launch of Leadership and

Management Core Competence

Framework. Identification and

meeting of any skills gaps (both

technical and soft skills)

YesQualifications uploaded into ESR and

skills gaps identified

Options for development to meet skills

gaps identified

Monitoring of take up of development

gaps

Monitoring of take up of development

gaps Review Framework and skills gaps Review Framework and skills gaps

Non-delivery as a result of not increasing

Organisational Development capacity to

support this initiative will result in

reduced pace of delivery, potential

change failure and reduced productivity

of the workforce and reduction in staff

engagement as demonstrated through

the staff survey.



A refreshed and more bespoke

Team Based Working programme

aligned with values and

behaviours, IQT, Managing

Change, Leadership and

Management development.

Yes

Linking together appraisal, team based

working, IQT, values and behaviour

framework with the annual planning

process and vision for the organisation 3

community areas begin their Team

Journey

3 community areas begin their Team

Journey


Journey


Journey Review and further roll out

Further roll out until Team Journey

implemented across the whole

organisation

Lack of a safe and sustainable workforce Deputy Director of Workforce and

Organisational Development

Implement recruitment and

retention strategy. Develop

succession planning and Talent

Management.

No

Review current status of recruitment

shortages. Review workforce profile and

identify priority areas for succession

planning. Identify opportunities for

modern apprenticeships.

Develop and implement action plan to

meet recruitment shortages. Develop

and implement action plan to support

succession planning.

Review Academy Wales

recommendations on Talent

Management.

Develop Talent Management strategy.

Implement Talent Management strategy.

Review and improve succession

planning

Review and improve Talent Management

strategy

Unable to introduce new ways of working

and upskilling of registered workforce as

a result of not developing Support

Workforce.



Develop our HCSW Strategy

based on our known priorities for

the next 3 years to: Evaluate

Band 4 posts, maximise the

potential of all support workers

within their current bands,

continue to develop support

workers according to service

priorities and needs (Credit Based

Learning), implement the NHS

Wales Skills and Career

Framework for Clinical Healthcare

Support Workers

professionalising the roles,

development for managers in

delegation and deployment of

HCSWs.

Yes

Task force to be identified to develop

HCSW strategy, undertake TNA, and

plan the implementation of the NHS

Wales Skills and Career Framework for

Clinical Healthcare Support Workers.25

Admin support workers commence the

Level 3 QCF diploma in Business

administration

Assess and review Job Descriptions in

light of NHS Wales Skills and Career

Framework for Clinical Healthcare

Support Workers. Delivery of Credit

Based Learning for HCSWs according to

TNA and service priorities. development

for managers in delegation and

deployment of HCSWs.

Delivery of Credit Based Learning for

HCSWs according to TNA and service

priorities. Review of Band 4 posts

Delivery of Credit Based Learning for

HCSWs according to TNA and service

priorities

Review of HCSW Strategy and Delivery

of Credit Based Learning for HCSWs

according to TNA and service priorities

Review of HCSW Strategy and Delivery

of Credit Based Learning for HCSWs

according to TNA and service priorities

Unable to repatriate services and deliver

care closer to home Deputy Director of Nursing

Develop Advanced Practitioners

in the following fields 1. CMATS

(Clinical Musculo-Skeletal

Assessment Treatment Service)

Physiotherapy

2. Stroke and Neuro-rehabilitation

3. Paediatric and 14+

Physiotherapy Service

4. Cardiac and Heart Failure

Service

5. Continence and Urology

6. Diabetes Service

7. Lymphoedema Nurse Services

8. Minor Injury Services

9. Parkinson’s Service

10. Respiratory Service

11. Tissue Viability

12. Primary Care

Yes

Expressions of interest by appropriately

qualified (Educated to master’s module

level) staff from within these services

who are already working at band 7

The first cohort of between 6 and 12

selected applicants are supported

through an Action Learning Set to

develop their personal Advanced

Practice Portfolio

Ongoing review, monitoring and rollout Ongoing review, monitoring and rollout Ongoing review, monitoring and rollout Ongoing review, monitoring and rollout

Lack of a safe and sustainable

workforce. Patient safety and increase in

admissions to acute hospitals

Deputy Director of Workforce and


Primary Care Recruitment -

Support GP practices to recruit to

hard to fill vacancies in GPs and

Practice Nurses. Explore possible

alternatives of Physician

Associates and development of

Advanced Practice Roles for

Nursing. Co-ordinate the Primary

Care Workforce Development

Group.

Yes

Implement GP recruitment campaign.

Further investigate the feasibility and

benefits of employing Physician

Associates - Site visit to Birmingham GP

practice to view Physician Associates

working in Practice. Working with Cardiff

University to give opportunities to

trainees to experience rural medical

practice - 300 trainees to visit Powys.

Ongoing support to explore and develop

Primary Care recruitment strategies and

campaigns.



campaigns.



campaigns.

Review support and development of


campaigns.

Review support and development of


campaigns.



Attendance Management ensure

consistent application of Sickness

Policy and associated policies to

ensure employees are supported

to maximise their attendance at

work

Yes

Implement revised All Wales Policy and

devise training programme

provide a case conference approach to

sickness.

Extend Absence Call-back pilot areas to

establish more tangible data to

undertake an evaluation of the scheme.

Implement training programme on

sickness policy in partnership with Trade

Union and Occupational Health.

Undertake an evaluation of the Absence

Call-back scheme to assess viability to

extend to whole organisation.

Monitor and evaluate Monitor and evaluate Review Review



Refocus work of WBaW group

aligning to the Health and

Wellbeing and OD strategy.

Yes

Alignment of the OD Strategy with the

Health and Wellbeing work stream.

Focus groups established. Seek bids

against £15000 funding for wellbeing at

work activities. Self assessment of Gold

standard

Focus groups to meet bi-monthly and

feed in to Well Being at Work Group.

Health and Wellbeing Roadshows pan

Powys. Formal revalidation of Gold

Standard

Ongoing. Maintain Gold standard and

working towards Platinum.

Ongoing. Maintain Gold standard and

working towards PlatinumOngoing. Achieve Platinum standard Ongoing. Maintain Platinum standard

Workforce & OD

YEAR 2 YEAR 3

Q1 Q2 Q3 Q4

YEAR 1Detailed

plan in

place



Staff not working in efficient ways which

may compromise their capacity to deliver

services to patients



To fully realise the benefits from

full deployment of electronic

systems, in particular Electronic

Staff Record (ESR) and ESR 2

including Self Service and

Manager Self Service and ensure

integration with other systems and

OD work

No Implementation plan Start rollout Continue rolloutComplete Manager Self Service by

March 2016Completion

Ineffective deployment of staff Deputy Director of Workforce and


Development of a business case

and implementation plan for e-

Rostering

No Appoint project team Undertake procurement exercise Establishment of implementation plan Commence rollout Continue rollout Complete

Director of Workforce and


Implementation of the

Organisation Partnership

Development Programme to

support the One Plan.

Yes

Scope 3 projects exploring an integrated

approach across Health Board and

County Council. 1) Shared corporate

services commencing with Workforce

and OD. 2) Leadership and Management

development and Talent Management.

3) Staff engagement.

Review recommendations from projects

and develop implementation plan.Ongoing Ongoing Ongoing Ongoing

Communications officer

Communication strategy

implementation

YesCommunications plan agreed by board.

Implimentation has begun.

Web redevelopment project is underway.

Branding guidelines are in draft format

for presentation to Executive team.

Communications strategy will be written

after the completion of the Web and

branding sections of the plan

ongoing ongoing ongoing ongoing

Very limited capacity available to develop

relationships, put in place systems and

provide robust assurance on the quality

and safety of care provided by

commissioned services to Powys

residents. Will not be sufficient to allow

improvement in services and meet

current and future targets.

Quality and Service Improvement Risk

Assistant Director Quality and

Safety

Development of organisational

capacity to support delivery of

quality and safety monitoring to

allow improvement in services

and meet current and future

targets.

yes No

Complete role evaluation and go out to

recruitment for senior clinical quality and

patient safety data analyst post

Appoint senior clinical quality and patient

safety data analyst

Review existing processes for gathering

and analysing data

Put in place improvements to strengthen

processes working alongside the

Information department

No strategic vision and direction on

patient experience for staff, patients,

visitors and other stakeholders. No

recognised approaches to patient

experience activity and risk of

inconsistent approaches being applied.

Reputational risk


Safety

Finalise the Patient Experience

Strategy and Supporting

Implementation Plan

yes No Produce a framework to structure the

strategy.

Develop an implementation plan

engaging with service users and

representative groups

Board approval of the Patient

Experience Strategy and Implementation

Plan

Report progress to the Board Annual Report on Patient Experience

Annual Report on Patient Experience

Review Strategy and implementation

plan

Patient experience surveys and activity

cannot be relied upon, will affect validity

and accuracy of results and will not be

able to benchmark improvements.

Reputational Risk


Safety

Produce a framework to use for

patient experience survey work

and data collection

yes No Engage individuals with research and

evaluation skills

produce a framework to use for patient

experience and survey work

Appendix the framework to the Patient

Experience Strategy prior to Board

approval

Introduce the framework to Localities/

Service Directorates

Review the framework and its impact on

the patient experience agenda

No mechanism to challenge

performance of providers and take

action.

Quality and Patient Safety Risk; financial

risk


Safety

Pilot the commissioning

performance framework and

escalation plan

yes Yes

Finalise the development of the draft

commissioning performance framework

and escalation plan

Pilot the framework and escalation plan

with Localities/ Service Directorates

Review outcome of pilot and put

improvements in place

Implementation of finalised framework

and escalation plan

Review effectiveness of framework and

escalation plan

Build on the learning from Year 1

Share the learning

Review effectiveness of framework and

escalation plan Build

on the learning from Year 2 Share

the learning

Potential HSE enforcement actions as

current model of health & safety may not

be ‘fit for purpose’; potential increase in

incidents, complaints and personal injury

claims could lead to financial loss

Patient and staff safety risk; financial risk


Safety

Appoint an external consultant to

advise on a health and safety

model that befits the needs of the

Health Board

yes No Review applications and arrange for

panel to select external consultant

Appoint external consultant and identify

start date Liaise

with HSE to keep them informed of

progress with appointment as discussed

in January 2015

Monitor work undertaken and provide

regular updates to the Board and

Executive Team

Provide the final report to the Board Implement actions as agreed at Board Monitor and review arrangements put in

place

Risks to the Health Board and Powys

residents of no infection control doctor

means no clinical support to deal with

issues relating to healthcare associated

infections, outbreak management,

building risks, decontamination, policies

and procedures, etc. The Health Board

operating in a vulnerable state.

Quality and Patient Safety risk, financial

risk; reputational risk.


Safety

Finalise the arrangements with

Public Health Wales to secure

and implement microbiology

support to provide medical advice

on infection prevention & control

issues

yes Yes

Finalise the Service Level Agreement

with Public Health Wales for 3 sessions

for medical support. Agree a start

date for the SLA.

Put a paper to the executive team to

seek approval of funding for 1 session

for antimicrobial stewardship support.

The named infection control doctor to

participate in infection prevention and

control (IP&C) committees

Ongoing engagement of the named

infection control doctor in developing and

delivering on the IP&C agenda

Review the SLA and its delivery prior to

securing service for Year 2


securing service for Year 3


securing service further

Not able to work towards a centralised

approach to management of records or

able to work towards long term goal of

electronic records. Risk of ICO fines.

Quality and Patient Safety Risk; financial

risk


Safety

Appoint a Project Manager to take

forward the records appraisal and

develop a business case

proposing solutions for managing

patient’s medical records.

yes Yes Seek funding to support project manager

role recruit project manager complete records appraisal

develop solutions for management of

medical records in conjunction with

Powys County Council

paper to Board outlining solutions for

approval

take forward preferred solution

Monitor and review arrangements put in

place

Workforce & OD

Therapies &

Health Sciences

YEAR 2 YEAR 3

Q1 Q2 Q3 Q4

YEAR 1Detailed

plan in

place



ReProvision of Pharmacy

distribution service - resolving

WDA issue

Medicine Use and

PrescribingNo mapping option appraisal planning for preferred option planning for preferred option commence implementation ongoing

Pharmaceutical support for

discharge

Medicine Use and

PrescribingNo Engagement with stakeholders Engagement with Stakeholders Options and Model agreed Planning/training for implementation Implementation

Ward support for Medicines

Management Issues, including

MTeD and Trusted to Care

response

Medicine Use and

PrescribingNo Engagement with Stakeholders Options and Model agreed Planning/training for implementation Implementation

Integrated Pharmaceutical Care -

Rural Model

Medicine Use and

Prescribing &

Primary Care

No Engagement with Stakeholders Options and Model agreed Planning/training for implementation Implementation

Pharmaceutical Needs

AssessmentPrimary Care No

Discussion with WG, HBs to determine

model

Discussion with WG, HBs to determine

modelPlanning/training for implementation pilot work Implementation

Pharmacy support for Mental

Health Service

Medicine Use and

PrescribingNo Engagement with Stakeholders Business case Planning/training for implementation pilot work Implementation

Empower patients through Self

administration within hospital

wards

Medicine Use and

PrescribingNo

Bid for funding for Patients Own

Medicines Lockers

Follow up invest to save bid for

pharmacy supportPlanning/training for implementation installation of lockers Implementation

Clinical Pharmacy 'at a distance'

for wards

Medicine Use and

PrescribingNo

Finalise plans, bid for relevant resources,

including scanning equipment, options

appraisal

Implementation plans,

installation/recruitment/contractingPlanning/training for implementation implementation snagging/ongoing

Develop medicines support

mechanisms for patients in cared

for environments

Medicines Use and

Prescribing/Elderly

Care

No

Develop plans with AHPs, Comm

Pharmacy, Social Services, for

appropriate models, including shared

budgets

Implementation plans,

installation/recruitment/contractingPlanning/training for implementation implementation snagging/ongoing

Corporate

Governance

Failure to govern the organisation,

escalation of concerns to WG by

inspectors/auditors, reputational

Corporate Governance ManagerImplement a Governance

Improvement Programme

Stewardship &

Governance No

Non delivery of strategic service changeAdult Mental Health Services NHS

Management Arrangements Yes

Phase 2 plan initiated. LTAs revised;

revised Mental Health Committee

arrangements subject to Feb Board

decision

TUPE consultationPotential transfer of NHS staff within

existing NHS structures

Finalise integrated management

structure with PCC

NHS arrangements needed for agreed

service model and integration

Escalation of costs in secondary care

Improve arrangements for people

with continuing and complex

mental health care needs

Yes

Develop "framework approach";

establish local /core service solutions

approach ; Director panel for exceptions;

separate out s117/low secure/joint

expenditure & benchmark with other

HBs; FNC reviewer; management of

integrated s117 register.

Proposed "framework approach" agreed

Local and core service solutions for

patients; improved governance and

financial control.

Continued in-equity in service provisionRe-commissioning of third sector

servicesNo

Re-commission PAVO (brokerage);

agree joint commissioning for 4th

tranche; consultation on revised APB

strategy & continue to strengthen

governance

Revised APB specification Recommissiong of alcohol and

substance misuse services

All-Wales commissioning for

independent advocacy

Services in line with strategy; new model;

and strengthened governance

Non delivery of Mental health targetsImplement on-line CBT plan;

implement Part 1 plan Yes

Implement on-line CBT plan; implement

Part 1 plan


Part 1 plan


Part 1 plan


Part 1 plan Compliance with Part 1 targets

Non delivery of Mental health targets

Integrated training in place

including voice of people using

services

YesIntegrated training in place including

voice of people using services

Extend "Team Around Family " approach

from CYPP to adults

Part 2 compliance; person centred care

and treatment planning

Escalation of costs in secondary careMaximise flexibility of bed use in

Powys for Powys residentsYes

Prepare for Powys management of beds

and policies Aim to reduce from 8% to 4%

Poor physical health for people with

mental health issues

Improve physical health needs of

mental health patientsNo Implement salaried GP pilot Implement salaried GP pilot Evaluation

Non delivery of improved waiting timesExtend the use of psychological

therapies Yes

Finalise proposal for psychology waiting

list initiative; consider roll-out of co-

production approach

Revise NHS management arrangements Improved psychology waiting times

Increased dependancy on health

services

Improve the health of people with

dementiaYes

Implement agreed plan; develop

proposals for home based assessment

team

Higher rates of suicide and self harm Reduce suicide and self-harm Yes Revise Talk To Me

Escalation of costs in secondary care

Implement community intensive

team; agree sustainable

arrangements for YOT mental

health services

Yes

Implement community intensive team;

agree sustainable arrangements for YOT

mental health services

Work with PHW to develop proposals to

improve the mental health of vulnerable

children living away from home

Ensure Stonewall audit influencing

service design

Nursing

Directorate

Medical

Directorate

Integrated Planning Framework - Recruitment Difficulties Summary

This pro-forma links to Planning Stage 1

Nursing & Midwifery Registered Nurse 5 and 7

Additional Clinical Services

Admin & Estates (Inc.

Managers, Senior

Managers and VSMs)

HCA and Support Staff

General Practitioners recruitment to certain practices; Emergency Nurse Practitioner - Band 6

Health Care Scientists

Medical & Dental including

Primary Care

CAMHS, Care of the

Elderly and GP's

Consultant

and GPs

Medical & Dental – The roles in Medical & Dental, Primary and Secondary care that are currently experiencing recruitment difficulties are Consultant CAMHS, Consultant Care of the

Elderly and GP’s. There is definitely a national shortage of doctors and therefore recruitment of doctors is a national issue.

REASONS - Some reasons for this are:

1. National lack of doctors finishing their higher training in the speciality

2. Training schemes are a long way away, doctors tend to be geographically settled when they end their training, so see Powys as inaccessible

3. Training occurs in cities. No confidence in working in rural areas so do not apply.

4. Worries about being isolated and no local training opportunities, so doctors never find out that it is good to work here. No one has heard of Powys.

5. Lower consultant pay in Wales

6. Worries about the need to speak welsh

7. If we got to the stage when someone was applying (CAMHS post - which we did not) the poor estate facilities for offices and patients would put people off

8. In south Wales there is an assumption that Powys is an unattractive place to work. This is sometimes based on evidence (eg accommodation issues above) but it is wider than

that and the same issues are not picked up in north Wales. However all the training in Wales is based around Cardiff and Swansea, so the Welsh trainees do not consider working in

Powys

9. Not enough experience and exposure to rural medical practice. (GPs). 10.

No support provided to partners/families of medical staff wishing to relocate to Powys - partner needs to find own employment if relocates to Powys, children move schools etc

11. Need for incentives packages to encourage medical staff to relocate to Powys e.g increased study leave funding, help paying student debt, sponsorship/scholarships

12. Increased marketing of Powys as a place to work and live

IMPACT - Impact is likely to be:

1. More patients have to travel out of county for their care

2. Slower rate of development of services as consultants bring a leadership capability

3. The more ill and riskiest children get much poorer care as consultants are better at assessing complex situations and managing risk. This can also lead to more inpatient

admissions (CAMHS)

4. Impact on the multidisciplinary team. Children’s mental health can feel lonely and scary if there is not someone who will take ultimate responsibility for a patient. There is a risk

that recruitment issues will then become apparent within the CAMHS team (CAMHS)

5. Children who need medication may not get it. We do now have a nurse prescriber, but there will be some children needing medication who she is not skilled to see (CAMHS)

6. Reduced breadth of training of medical students on their community and psychiatric placements. This will worsen the issues about recruitment into the speciality and reduce the

opportunity to see that rural medicine is exciting and fulfilling. (CAMHS)

7. Lost opportunities to influence the national health agenda, leading to Powys being increasingly overlooked.

In the below box, please specify any posts or specialties that you consider to be having difficulty in recruiting to that does not fit into the definition given above, or any post/specialty that you foresee will be difficult to recruit to in the future:

Shortage of registered nurses to recruit into certain geographical areas within Powys, agency nurses have been used to fill the shortfall in some areas.

Allied Health ProfessionalsPhysiotherapy -

Community 5 - 7 National shortage of Physiotherapists, applicant numbers has significantly dropped

Additional Professional,

Scientific & Technical

In the below section, a recruitment difficulty is defined as a post or specialty which you have advertised for recruitment more than once, with no appointment having been made due to:

• no applications being received;

• no suitable candidates being identified from those who did apply; or

• an offer of recruitment being turned down by the successful candidate.

Professional Group Role /SpecialtyBand /

GradeReason / impact

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C22.Recruitment Difficulties

Integrated Planning Framework – Multi-Professional Education Commissioning

Ambulance Paramedics 2 years 2018 0 0

Ambulance Paramedics 1 year 2017 0 0

DENTAL

Diploma in Dental Hygiene 2 years 2018 0 0

Degree in Dental Hygiene & Therapy 3 years 2019 0 0

NURSING & MIDWIFERY

Bachelor of Nursing (B.N.) Adult 3 years 2019 60 15

Bachelor of Nursing (B.N.) Child 3 years 2019 1 0

Bachelor of Nursing (B.N.) Mental Health 3 years 2019 0 0

Bachelor of Nursing (B.N.) Learning Disability 3 years 2019 1 0

Return To Practice 6 months 2017 5 0

B.Sc. Midwifery 3 years 2019 3 0

B.Sc. Midwifery 18 months 2018 0 0

COMMUNITY HEALTH STUDIES

District Nursing (Part-time) 2 years 2018 0 0

District Nursing Modules (in modules) 3-6 months 2017 7 0

Health Visiting (Full-time) 1 year 2017 3 0

Health Nursing (Part-time) 2 years 2018 0 0

School Nursing (Full-time) 1 year 2017 1 0

School Nursing (Part-time) 2 years 2018 0 0

School Nursing Modules (in modules) 3-6 months 2017 0 0

Practice Nursing (Part-time) 2 years 2018 0 0

Practice Nursing Modules (in modules) 3-6 months 2017 0 2

Community Paediatric Nursing (Part-time) 2 years 2018 1 0

Community Paediatric Nursing Modules (in modules) 3-6 months 2017 1 0

CPN (Part-time) 2 years 2018 0 0

CPN Modules (in modules) 3-6 months 2017 0 0

CLDN (Part-time) 2 years 2018 0 0

For Academic intake 2016/17

Course Title Course duration Year of output

Commission Requests in

Full Time Equivalent

(FTE) - Employed

workforce (DRAFT)

*Commission Requests in

Full Time Equivalent (FTE)-

Independent Sector/ Local

Authority (see note below)

(DRAFT)

2015_03_13_Draft_IMTP_NHS_Planning_Framework_Powys_THB_v1.4 C23.Education Commissioning

CLDN Modules (in modules) 3-6 months 2017 1 0

Modules to enable individuals who completed previous module(s)

to undertake additional module(s)1 year 2017 12 2

PHARMACY

Pharmacy Technician 2 years 2018 1 0

HEALTHCARE SCIENTIST

Physiological Science - PTP

B.Sc. (Hons) Healthcare Science - Cardiac Physiology 3 years 2019 0 0

B.Sc. (Hons) Healthcare Science - Audiology 3 years 2019 0 0

B.Sc. (Hons) Healthcare Science - Respiratory and Sleep Science 3 years 2019 0 0

B.Sc. (Hons) Healthcare Science - Neurophysiology 3 years 2019 0 0

Physical and Biomedical Engineering - PTP

B.Sc. Clinical Engineering in Rehab 3 years 2019 0 0

B.Sc. (Hons) Healthcare Science - Nuclear Medicine &

Radiotherapy Physics3 years 2019 0 0

Life Science - PTP

B.Sc. (Hons) Healthcare Science - Biomedical Science - Blood,

Infection, Cellular and Genetics3 years 2019 0 0

Clinical Scientist - STP

M.Sc. in Blood Sciences - Clinical Biochemistry 3 years 2019 0 0

M.Sc. in Blood Sciences - Genetics 3 years 2019 0 0

M.Sc. in Clinical Science - Medical Physics 3 years 2019 0 0

M.Sc. in Clinical Engineering 3 years 2019 0 0

M.Sc. in cellular Sciences - Reproductive Sciences - Clinical

Embryology and Andrology3 years 2019 0 0

M.Sc. in Infection Science - Clinical Microbiology 3 years 2019 0 0

M.Sc. in Blood Sciences - Clinical Immunology, with a variation to

support Histocompatibility & Immunogenetics 3 years 2019 0 0

M.Sc. Clinical Science in Neurosensory Sciences - Audiology 3 years 2019 1 0

RADIOGRAPHY

B.Sc. Diagnostic Radiography 3 years 2019 5 0

B.Sc Therapy Radiography 3 years 2019 0 0

Assistant Practitioners Radiography - Diagnostic 1 year 2017 1 0

Assistant Practitioners Radiography - Therapy 1 year 2017 0 0


ALLIED HEALTH PROFESSIONALS

B.Sc. Human Nutrition - Dietician 3 years 2019 2 0

B.Sc. Human Nutrition - Dietician 2 years 2018 0 0

PG Diploma Medical Illustration 2 years 2018 0 0

B.Sc. Occupational Therapy 3 years 2019 4 2

B.Sc. Occupational Therapy 2 years 2018 0 0

Degree in ODP 3 years 2019 1 0

B.Sc. Physiotherapy 3 years 2019 5 0

B.Sc. Podiatry 3 years 2019 6 0

Orthoptist 3 years 2019 0 0

PhD Clinical Psychology Doctorate 3 years 2019 2 0

B.Sc. Speech & Language Therapy 4 years 2020 1 0

B.Sc. Speech & Language Therapy - Welsh Language 4 years 2020 1 0

NON MEDICAL PRESCRIBING

Full Independent Prescribing 1 year 2017 4 0

Supplementary Prescribing 1 year 2017 6 0

Limited Independent Prescribing 1 year 2017 4 0

Band

Pre Reg Pharmacy 1 year 2018 0

Pharmacy Diploma 2 years 2019 0

Course Title Course duration Year of outputCommission Requests in

Full Time Equivalent (FTE)

For Academic intake 2017/18


Additional / new education requirements

Please complete the table below with details of any additional / new education requirements to consider

for example, Physicians Associates.

Course Title and Educational Level Course duration Year Numbers Required Comments

Level 4 Education for rehabilitation/therapy support workers2 years part time/modules2018 8 not currently available

Community Practice Teacher 2016/2017 1 to supervise the SCPHN students

* Health Boards/Trusts should liaise with their local Independent / Private Sector and Local Authorities organisations to ensure


Advanced Practitioner Requirements for Academic Intake 2016/17

For each speciality identify by staff group how many staff you require to undertake either a full Masters award or Masters level modules

SpecialtyStaff Group (e.g.

Nursing, Physiotherapy)Modular Numbers Full Masters Numbers University

nursing 3 0 tbc

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

nursing 2 0 tbc

0

0

0

Nursing 10 0 tbc

Physiotherapy 6 0 tbc

Emergency Medicine

Other

Neonatology

Mental Health

Paramedic

Primary Care


Information to inform education commissioning of Medical & Dental Staff

Information on organisations’ anticipated future requirement for medical and dental staff is needed to

inform education commissioning decisions. In addition to the information on Practice Nurses and

Dental Care Practitioners requested in the previous pages, please complete the tables overleaf.

Please note:

“Net change” means the anticipated increase/decrease in the size of that workforce (in Full Time Equivalent) compared to the previous years.

- In other words, if an organisation anticipates that it will simply replace all retirees /

leavers on a “one for one” basis (i.e. with a new doctor/dentist of the same

grade/specialty), then the “net change” would be zero.

- However, if the organisation anticipates that it will replace all retirees/leavers on a “one

for one” basis and also recruit an additional doctor (1.0FTE) in a particular specialty,

then the “net change” for that specialty would be +1.0FTE.

The following should be excluded from the tables on the next few pages:

o Training grade doctors entering/leaving an organisation as a normal part of their rotation.

o Doctors moving organisations under TUPE arrangements.

Please record all figures as Full Time Equivalent (FTE)

In each of the tables, please record what your organisation anticipates will be the net change of its medical/dental workforce during the next three


1) Medical/Dental Consultants (FTE)

Projected change

2021

2015 2016 2017

Acute Medicine 0 0 0 0

Allergy 0 0 0 0

Audiological Medicine 0 0 0 0

Cardiology 0 0 0 0

Clinical Cytogenetics &

Molecular Genetics0 0 0 0

Clinical Genetics 0 0 0 0

Clinical

Neurophysiology 0 0 0 0

Clinical Pharmacology &

Therapeutics0 0 0 0

Dermatology 0 0 0 0

Endocrinology &

Diabetes0 0 0 0

Gastroenterology 0 0 0 0

General (Internal)

Medicine0 0 0 0

Genito-Urinary

Medicine0 0 0 0

Geriatric Medicine 0 0 0 0

Infectious Diseases

(& Tropical Medicine)

Medical Oncology 0 0 0 0

Neurology 0 0 0 0

Occupational Medicine 0 0 0 0

Palliative Medicine 0 0 0 0

Rehabilitation Medicine 0 0 0 0

Renal Medicine 0 0 0 0

Respiratory Medicine 0 0 0 0

Rheumatology 0 0 0 0

Sport & Exercise

Medicine0 0 0 0

0 0 0

Group

0

Medicine

Specialty

Anticipated net change in the size of the workforce during each year

(Full Time Equivalent)


Chemical Pathology 0 0 0 0

Haematology 0 0 0 0

Histopathology

(includes

Neuropathology)

0 0 0 0

Immunology 0 0 0 0

Medical Microbiology 0 0 0 0

Paediatrics 0 0 0 0

Paediatric Cardiology 0 0 0 0

Paediatric Neurology 0 0 0 0

Child & Adolescent

Psychiatry

Forensic Psychiatry 0 0 0 0

General Psychiatry 0 0 0 0

Old Age Psychiatry 0 0 0 0

Psychiatry of Learning

Disability0 0 0 0

Psychotherapy

Clinical Oncology 0 0 0 0

Clinical Radiology 0 0 0 0

Nuclear Medicine 0 0 0 0

Cardiothoracic Surgery 0 0 0 0

General Surgery 0 0 0 0

Neurosurgery 0 0 0 0

Maxillofacial Surgery 0 0 0 0

Otolaryngology (ENT) 0 0 0 0

Pathology

Paeds

Psychiatry

Radiology

Surgery


2) Medical/Dental Consultants (FTE) (continued)

Projected change

2021

2015 2016 2017

Paediatric Surgery 0 0 0 0

Plastic Surgery 0 0 0 0

Trauma & Orthopaedic

Surgery0 0 0 0

Urology 0 0 0 0

Anaesthetics 0 0 0 0

Intensive Care medicine 0 0 0 0

Emergency Medicine 0 0 0 0

Obstetrics &

Gynaecology0 0 0 0

Ophthalmology /

Medical Ophthalmology0 0 0 0

Public Health (excluding

Dental)0 0 0 0

Dental Public Health 0 0 0 0

Dental & Maxillofacial

Radiology0 0 0 0

Endodontics 0.4 0 0 0

Oral Surgery 0.8 0 0 0

Oral & Maxillofacial

Pathology0 0 0 0

Oral Medicine 0 0 0 0

Oral Microbiology 0 0 0 0

Orthodontics 0.2 0 0 0

Paediatric Dentistry 0.2 0 0 0

Periodontics 0.6 0 0 0

Prosthodontics 0 0 0 0

Restorative Dentistry 0.6 0 0 0

Special Care Dentistry 0.8 0 0 0

3.6 0 0

Dental specialties

TOTAL CONSULTANT WORKFORCE

Group Specialty



Surgery (cont’d)

Other medical specialties


2) GPs and Dentists (excluding Consultants) (FTE)

These figures should include all GPs and Dentists, including those working in independent GP/dental

practices and those directly employed by the Health Board/Trust (including locums).

The only exception is for Consultants working in the Hospital Dental Service (HDS), who should be recorded in the table above.

Commissioning requirement for Dental Care Practitioners and Practice Nurses should be recorded

on pages 1-2 of this document.

Projected change

2015 2016 2017 2021

General Dental Service (GDS) Dentists 1 0 0

Community Dental Service (CDS) Dentists) 0.6 0.2 0

Other Dentists (excluding HDS Consultants) 0 0 0

3) Non-Consultant doctors (FTE) (all specialties combined)

Please give a broad overview of how your organisation’s overall non-consultant medical workforce is

likely to change in size during the next three years. It is recognised that the size of an organisation’s

training grade workforce is not entirely within its control; the forecasts provided by organisations will

therefore be triangulated against information from the Wales Deanery.

While specialty-specific information has not been requested below, please feel free to provide

additional information (e.g. if the bulk of the forecasted increases/decreases are anticipated to be in

specific specialties)

Total

2015 2016 2017 (2015-2017)

Non-Consultant Career Grade doctors 0 0 0 0

Training Grades: Foundation Grades 0 0 0 0

Training Grades: Core level

(ST1-ST2)

Training Grades: Higher level (ST3+) 0 0 0 0

0

General Practitioners (GP) tbc

Type of doctor


(Full Time Equivalent) Additional Comments

Type of doctor/dentist



0

0

0 0


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