Agenda item

To consider a verbal report on the progress to date with the implementation and delivery of the Health Board’s three year plan.

 

9.35 am – 10.05 am

The Betsi Cadwaladr University Health Board’s (BCUHB) Executive Director of Strategy (EDofS), Mr Geoff Lang, introduced the Three Year Plan 2015-2018. 

 

The EDofS explained to members that prior to the Health Board being put into Special Measures, discussions had taken place with the Welsh Government (WG).  During the discussions it had been agreed that the Board would not draw up a three year plan to start from 2015.  The three year plan would commence from the 2016/17 financial year onwards.  For the current year, the Board, as part of its improvement plan, would be concentrating on the following areas:

 

·       Reconnecting with the public, staff and communications

·       Mental Health improvement

·       Obstetrics and Gynaecology

·       Corporate Governance, and

·       GP Out-of-Hours services.

 

To improve communications and reconnect with staff and stakeholders, the Board had attended numerous events, during the summer months.  The events included ones arranged by the Board together with established shows and fairs which the public regularly visited.  The purpose of attending the events was to try and re-engage with people and collate their views on the Health Service in North Wales as to what had been working well and which areas required improvement.  The feedback from the events would be analysed and the main conclusions and findings would be provided at future public events to ascertain whether they resonated with the general public’s view, prior to being utilised to plan future service changes. 

 

The consultation regarding temporary changes to the obstetrics and gynaecology services was currently taking place.  Future consultations on the Mental Health Service and the GP Out-of-Hours Service would also be taking place shortly.

 

BCUHB representatives informed members of the following:

·       The Board was now in the process of developing its financial plan and priorities for 2016/17

·       Part of the planning included working with Public Health Wales (PHW) on mapping health challenges and how to improve health in general, including the work required in the region’s most deprived areas. Work would also take place with Social Services to comply with the requirements of the Social Services and Well-being (Wales) Act 2014

·       A meeting of the Board was scheduled to take place during the second week in October to discuss how to balance their priorities and the community’s priorities

·       The Board had to finalise and agree its Plan by January 2016 to enable it to enter into discussions on the priorities with the WG between January and March 2016

·       On a local Conwy and Denbighshire level, they were keen to reconnect with communities in both counties to discuss the Board and the communities’ health and social care priorities on a local level.  To facilitate this, a number of workshops were to be arranged in October 2015

·       The EDofS confirmed it had been crucial to open a two way dialogue between Health and Social Care Services to ensure the needs of the community would be met.

 

Discussion took place and responding to Members’ questions, BCUHB Officers:

 

·       Confirmed that the redevelopment of Ysbyty Glan Clwyd would be a large and complex project which had caused a lot of inconvenience for patients, staff and visitors alike.  Whilst the initial aim had been to rid the building of asbestos, the Board had utilised the project as an opportunity to upgrade the fabric of the hospital and equip it with the latest medical facilities i.e. state of the art wards, theatres, Accident and Emergency Department, Critical Care Unit etc.  The benefits of the redevelopment programme would become more visual on the opening of the new main entrance in October and when the first of the new wards were opened in November.  Staff working in the new areas had given extremely positive feedback regarding the changes

·       Agreed that the Clostridium Difficile (C-diff) outbreak had been a very difficult experience for the Board and its staff.  The redevelopment work at Ysbyty Glan Clwyd had not helped the infection control situation.  A great deal of work had been undertaken since the outbreak with respect to infection control and cross-contamination, but a lot more work would be required in order to be as good as the remainder of Wales.  The opening of the new wards, each of which would have eight single rooms to help isolate patients, would be beneficial, however, the ultimate aim would be to be as good, if not better, than the best in England.  With a view to achieving this, Professor Duerden of the National Centre for Infection Prevention and Management would return to Ysbyty Glan Clwyd within the next 3 to 6 months to monitor progress and produce a second evaluation report

·       Confirmed that there were national standards for hospital cleaning and these standards had to be met

·       Advised that difficulties in recruiting suitably qualified staff had been a cause of concern across the whole NHS and not unique to North Wales.  Nevertheless, there had been additional difficulties in recruiting staff to certain medical disciplines, or to certain grades, particularly those where the Deanery had withdrawn the hospital’s “training” status.  UK Government policies with respect to immigration and visa regulations had further compounded the problems.  The Board were, however, actively working with both Liverpool and Manchester Medical Schools with a view to getting them to place students in hospitals in North Wales during their training period.   This was due to the fact that it was widely acknowledged that medical students often preferred to stay at their training hospitals upon the completion of their training

·       There had been a shortage of nurses in many areas of the UK due to an insufficient number of nurses being trained in recent years.  Whilst the number of student nurse places at universities had been on the increase, it would take a couple of years for those nurses to complete their training and be ready to work at the hospitals.  In recent years, a number of nurses had been recruited from outside the UK, particularly Ireland and Spain.  Whilst there were clear standards of comparability between nursing qualifications in different countries, it was the nursing procedures and practices in countries which varied.  Therefore, nurses from those countries would commence six month induction training to familiarise themselves with NHS practices and procedures

·       Clarified the Deanery’s role and its view on the number of training hospitals in North Wales

·       Agreed that there had been a need to raise awareness of the Welsh language and its use throughout the Deaneries, including Liverpool and Manchester.  There was also an opportunity to use the need for Welsh speaking medical staff as a means to attract medical students from North Wales back to the area to practice

·       Work had been underway to review the type of accommodation and the availability of accommodation for junior medical staff who moved to the district general hospitals to work, as the accommodation offered could also be a factor that would shape a medical student’s choice of hospital placement

·       Discussions were continuing with a view to having a School of Medicine in North Wales in the future.  Students were now able to study for a Bachelor of Medical Science degree at Bangor, which could then be used to access a medical training course

·       Confirmed that the Health and Social Care Advisory Service (HASCAS) had been working with the Board to look at all individual alleged cases of abuse on Tawelfan Ward.  A number of staff members were currently suspended pending the conclusion of the investigations and, if appropriate, disciplinary proceedings would be invoked

·       In the past the Health Service had operated on a “sickness/intervention” model, the aspiration for the future was to work on a “proactive/well-being” model.  This would see Health working with partner organisations to address issues such as deprivation, regeneration and not in education, employment or training (NEET) with a view to improving health and well-being outcomes throughout an individual’s lifetime.  This work would be progressed through the TRAC project

·       Informed members that work was currently underway via the Local Development Plan (LDP) Leads and WG Group as to how the Health Service could improve its service planning to accommodate population changes and demands following the adoption of Local Authority LDPs across North Wales.  Whilst population growths were a challenge throughout all sectors of the health service, it was anticipated that the greatest challenge would be faced by the primary care sector as they did not have surplus capacity to accommodate large population growths.

 

At the conclusion of the discussion BCUHB Officers undertook to explore the following matters and report back to members:

 

·       Concerns raised regarding the staffing numbers at the new Critical Care Unit and whether it had a full complement of appropriately qualified staff at all times

·       The number of mixed wards and mixed bays at Ysbyty Glan Clwyd and the Board’s policy on mixed wards and bays (apart from in the Intensive Care and Critical Care Units and on the Acute Medical wards)

·       The Board’s Policy regarding the wearing of uniforms whilst not on duty (and the number of staff disciplined for non-compliance with the Policy).  Committee members were advised that members of the public were within their rights to report staff who were observed wearing their uniforms whilst off duty

·       PHW’s work relating to health inequalities

·       Concerns raised regarding certain consultants not commencing clinics on time and, consequently, their patients not being afforded the full time entitlement for their consultation, and

·       To report the concerns raised by the Committee to the Health Board in due course.

 

The Committee expressed their gratitude to the Executive Director of Strategy for attending and it was:

 

RESOLVED  that subject to the provision of the above information, the Partnerships Scrutiny Committee received the progress report.