Achievements of the Mid Wales Healthcare Collaborative (Mwhc) - Year 2

ACHIEVEMENTS OF THE MID WALES HEALTHCARE COLLABORATIVE (MWHC) - YEAR 2

(APRIL 2016 – MARCH 2017)

1. Introduction

The following report summarises the achievements attained by the Mid Wales Healthcare Collaborative (MWHC) for its second year - April 2016 to March 2017.

This information is intended to provide an update on the progress of the work of the MWHC and to provide some detail into ongoing projects and the direction that the work is taking.

2.Background

In January 2014 the Welsh Government commissioned the Welsh Institute for Health and Social Care (WIHSC) to explore the options for the provision of high quality and sustainable healthcare service in mid Wales. The different needs of rural communities, and the cross-boundary challenges of this region, suggested the need for a review of the system.

The Mid Wales Healthcare Study, which was published in October 2014, highlighted a number of issues and twelve recommendations were made to ensure healthcare services in mid Wales are effective for the population. The first of the recommendations made is that a joint governance mechanism, ‘The Mid Wales Healthcare Collaborative (MWHC)’, should be established in order to implement the eleven other recommendations made in the report.

The objectives of the MWHC are to:

• Deliver a single integrated change programme, with full public and professional participation, which addresses the delivery of social care, primary care and specialist care as an integrated continuum, provided as close to home as possible
• Address prevention as well as treatment, and promote prudent healthcare
• Deliver a regional plan for Mid Wales. The definition of Mid Wales varies depending on what element of Health and Social Care is being addressed due to how people are currently receiving care but it is roughly the area within the circle below and for community and primary care includes Ceredigion, North Powys and South Gwynedd.

3.Achievements for April 2016 to March 2017

The MWHC was established in 2015 and this report summarises the achievements of the Collaborative during Year 2 for the period April 2016 to March 2017.

Recommendation 1 – The Mid Wales Healthcare Collaborative
The three Health Boards should establish a joint governance mechanism (working title: The Mid Wales Healthcare Collaborative) as described in the report, in order to implement many of the recommendations below.

The MWHC was launched on the 12th March 2015 by the Welsh Government Minister for Health and Social Care, Professor Mark Drakeford at the Mid Wales Rural Healthcare Conference. The MWHC is led by two independent co-chairs Dr Ruth Hall and Mr Jack Evershed and is accountable to the Welsh Government, to the three Health Boards, WAST and to the scrutiny mechanisms for local government. The MWHC governance structure was established in 2015 and includes the following groups:

• MWHC Board

A joint Committee comprising the Chair and Chief-Executive of Betsi Cadwaladr University Health Board (BCUHB), Hywel Dda University Health Board (HDUHB), Powys Teaching Health Board (PTHB) and the Welsh Ambulance Services Trust (WAST) and the Leader and Chief Executive of Ceredigion County Council, Gwynedd County Council and Powys County Council. During 2016/17 the MWHC Board has met/will meet on the following dates:

- Council Chambers, Ceredigion County Council Headquarters, Aberaeron, Ceredigion - 5th September 2016

- Council Chambers, Powys County Council Headquarters, Llandrindod Wells, Powys - 9th December 2016

- Neuadd Pendre Social Centre, Tywyn, Gwynedd - 24th March 2017

• MWHC Planning & Co-ordination group

This group co-ordinates the work of the Innovation sub-groups and is chaired by a Chief Executive (currently from HDdUHB).

• Innovation sub-groups

Eight Innovation sub-groups who are responsible for the delivery of their plans. Each health organisation is responsible for two of the eight sub-groups which draw their membership from each of the seven organisations that make up the MWHC Board.

• Centre for Excellence in Rural Health & Social Care

The sub-committee oversees the establishment of the Centre for Excellence in Rural Health and Social Care (Rural Health and Care Wales).

Recommendation 2 - Improved Public Engagement
Public engagement in Mid Wales should be established on a new basis, and coordinated by The Mid Wales Healthcare Collaborative.

Engagement events

The Collaborative continued its public engagement programme in Year 2, similar to the format of those held in Year 1. This saw a 2nd and 3rd round of events in which learning from the previous round was incorporated and used to shape a more focused approach for the events in 2016.

The locations and dates were as follows:

Summer 2016 – 2nd Round

1. Aberdyfi, Dyfi Hall, Gwynedd – 21st June 2016
2. Felinfach, Memorial Hall, Ceredigion - 27th June 2016
3. Llanwrtyd Wells, Victoria Hall, Powys – 4th July 2016

Winter 2016 – 3rd Round

1. Aberystwyth, Morlan Centre, Ceredigion – Friday 11th November 2016
2. Dolgellau, Glan Wnion Leisure Centre, Gwynedd – Thursday 17th November 2016
3. Newtown, Elephant and Castle Hotel, Powys – Tuesday 22nd November 2016

For the third round of events, the Innovation sub-group members were more empowered and fully consulted with regards to choosing locations, topics for focus that were relevant to the area in which they were held and how to advertise these events effectively. It must be noted that the group assisted with advertising for rounds 1 and 2 also. Full commitment was offered to help distribute the posters well in advance of the events and speak to relevant groups of the community to ensure their involvement and offer them the opportunity to hear about the work of the Collaborative.

Despite these concerted efforts, the attendance at all three locations were low. However, the conversations that were held were of great importance and benefit to the work of the Collaborative.

It was always the intention to structure the three rounds of the events in the manner of:

• Round 1 – was to hear what the public felt about the Study and the recommendations that it had made and how they felt best to move forward. This information would help to inform the groups as to how they were to proceed.
• Round 2 – was to test with the public the ‘work in progress’ of the Innovation Groups to see if they agreed that these ideas would work within their communities and suit their needs, and
• Round 3 – was to share what had been implemented or what was to be developed within the Innovation Groups and focus on what was to be delivered in theses focus areas.

The achievement around public involvement and engagement has been significant when compared to the public unrest and lack of confidence in the ability for health service providers to engage and work together at the inception of the Mid Wales Healthcare Collaborative. The low turnout at public at events in Rounds two and three could be interpreted as such that confidence is beginning to be restored but assumptions aside, the Collaborative has provided an opportunity for the public to express their views and be a part of the work going forward in a new and innovative way that has not been approached before in the Mid Wales region.

It must be realised that the gathering of 4 organisations (on many occasions 5 or more as Local Authority, CHC and third sector providers were present) around one table to discuss an agreed focus is in itself an achievement and true Collaboration in progress.

Engagement and involvement at MWHC Board meetings

The MWHC Board have continued with the question and answer sessions during their meetings, ‘Listening to You’, in order to allow members of the public the opportunity to provide feedback and ask questions about presentations/papers provided to the Board. In addition we have continued to set aside time before and after each Board meeting to allow the public to meet with MWHC colleagues to allow the public to share issues of importance to them and to discuss how to continue to communicate with local communities.

During the last year, two of the MWHC Board meetings have been broadcast live over the internet. This was a new innovation aimed at making Collaborative meetings more accessible to the public.

Local group and health forums

The Independent co-chairs have actively engaged with local communities, through local groups and health forums, and individuals.

Social media

As well as public events and engagement with local groups, the MWHC have endeavoured to embrace social media via Twitter, LinkedIn and Facebook.

Other communication methods

The MWHC has continued to develop its own dedicated website and produced quarterly newsletters.

Recommendation 3 - Local Action on Primary Care
The three Health Boards should re-double their efforts to address the pressures facing local primary care, developing complementary services, creating new models, sharing functions and providing business support, looking at new organisational models for general practice, and where possible providing targeted financial support. There is traction to be gained by the Boards coordinating their efforts to meet the specific circumstances of Mid Wales, and considering shared solutions where appropriate.

Up-skill the primary care workforce

Previously planned work with Public Health Wales, to scope out upskilling the workforce, did not proceed as intended but contact has now been made with the City of Birmingham University. A delegation from the Powys Teaching Health Board (PTHB) area visited the University in December 2016. A positive outcome to the meeting was reported to the group and it was concluded that the University had training courses available that would suit the needs of practice nurses in Powys and beyond potentially.

Physician Associates (PA)

There are currently four students supported with bursaries via the MWHC and a further one directly by Powys THB. A further two are to be supported in South Powys by Powys THB working in collaboration with the South Powys GP Cluster. These have been identified and undertake their first clinical placements in South Powys in August 2017. The first PA student supported with a bursary qualified in early 2017; and has been offered a contact of employment by Hywel Dda University Health Board (HDUHB) to undertake the first year of her internship in general practice and Bronglais General Hospital. A Second student, who qualifies in summer 2017, will be offered a fixed term contract of employment by PTHB and the third will be offered a fixed term contract to work in Bronglais General Hospital.

Virtual Ward

The extension of the Virtual Ward work in Powys across Mid Wales into the other Health Board areas has been put on hold pending a review of the Virtual Ward approach in Powys. Early indications are the Virtual Ward work in North Powys is leading to a reduction in unplanned hospital admissions in England.

Dental Services

There has been an agreement reached between Powys THB and Hywel Dda UHB for up to 100 patients to receive care involving sedation at the Powys THB dental facility in Newtown. The first referrals have now been received. This will remove the need for Hywel Dda UHB patients to travel to South Wales.

Discharge from Bronglais Hospital

The Assessing Alternative to Admissions team (AA2A) been in place since May 2016. This service is embedded alongside the discharge liaison service and links closely with health and social care community teams. The recording and monitoring systems are being established and will link in to the County Performance Management systems.

Complex discharge pathways have been rolled out on the wards in Bronglais General Hospital. This will improve patient flow and will improve engagement with families/carers in relation to safe timely discharge. Appointment has now been made jointly by Hywel Dda UHB and Powys THB to the post of Care Transfer Coordinator which has strengthened the discharge process.

Recommendation 4 - National Primary Care Plan
The Welsh Government national Primary Care Plan should address the many common and systemic challenges facing primary care, which lie beyond the scope of the Health Boards.

There are many challenges facing the current model of general practice in North Ceredigion which include the recruitment and retention of GPs and practice nurses, the changing nature of delivering medical care, an aging frail population with multiple chronic conditions and the current financial pressures facing public sector organisation in Wales. The seven GP practices that are part of the North Ceredigion GP Cluster are exploring the opportunities that working jointly would bring to create a strengthened primary care medical service in rural Mid Wales which would be more cost effective and meets the needs of the rural population. By developing different ways of working together and delivering services jointly, patients will be able to see a greater number of different health care professionals in their local surgery with appropriate skills rather than having to visit the acute hospital. This will provide an improved quality of care for patients and allow some services to be delivered in primary care and the community that are currently provided in secondary care.

The seven GP practices are keen to support each other and work with other partners in the North Ceredigion GP cluster to develop innovative ways of working which are appropriate for a rural area. They are also keen to work with the Mid Wales Healthcare Collaborative to include their patients in helping co-design future services. The options appraisal has been completed to agree the preferred model for federation of the seven practices. It is anticipated that the business plans for the federation will be completed during the spring 2017 with the new federation going live on 1st May 2017.

Recommendation 5 - Bronglais General Hospital
Hywel Dda University Health Board, supported by the other two Boards, should confirm publicly its vision of the future strategic role of Bronglais General Hospital and the strategic direction which it intends to pursue. The Health Board’s submission to this study provides a good basis for such a vision. It will require subsequent detailed consideration of pathway and service options, but should be sufficiently specific to reassure potential and current staff and the public that the hospital will remain an acute centre, and that urgent and non-urgent provision will address the challenges of remoteness. It should state explicitly the criteria which must be met, based on the Six Key Service Criteria set out in the report.
Recommendation 6 – Clinical Engagement
Clinical staff in all the specialties should now be actively engaged in clinical discussions with their colleagues about how services should develop. This process will require active leadership and facilitation by the Hywel Dda University Health Board, working on behalf of the Mid Wales Healthcare Collaborative. It must address the difficulties in the relationships between the hospitals, and should include representatives from primary care, the Royal Colleges, the Deanery and service providers from Scotland and elsewhere who have successfully addressed some aspects of rural acute care provision. This process, including reviews by professional bodies, should address the specialty-specific issues (see below), but also their interdependencies, and the linkages with pre-hospital care and between hospitals, along the patient pathways. It is important that the medical Royal Colleges are all engaged in this work, along with the learned bodies drawn from the other professions.
Recommendation 7 – Bronglais General Hospital Cardiology Services
A further examination of the options for providing cardiology services in Bronglais General Hospital should now be started, which takes full account of the broad range of presenting conditions at this hospital, and evaluates alternative ways of constructing the sort of clinical network support that is needed. This should build upon the initial discussions held as part of this study, and the submission to this study from the Royal College of Physicians, both of which offer some grounds for optimism that alternative solutions are worth exploring.
Recommendation 8 – Bronglais General Hospital General Surgery and Obstetrics and Gynaecology Services
A similar process should take place in relation to general surgery, building on the discussions initiated by this Study and scheduled for October 2014, and for Maternity and Obstetric services in Bronglais General Hospital.

Bronglais and Mid Wales Vision

Work has been progressed to develop an outline of how services might be provided to the residents of Mid Wales. This has involved extensive engagement with staff –clinical and non-clinical. A detailed report ‘A sustainable future for healthcare in Mid Wales: Access, People and Technology’ presents a broad vision of how healthcare could be delivered to the population of Mid Wales in the near future with Bronglais General Hospital as a significant hub. The report builds on the work which was started by Dr Brian Campbell, the previous Chair of the Bronglais General Hospital Innovation sub-group. It outlines how services could be provided through networks crossing organisational boundaries, through better use of new staff groups and through using technology enabled healthcare. The report recognises Bronglais General Hospital’s as an important part of networked services providing care for the people of Mid Wales with partners in Betsi Cadwaladr University Health Board, Hywel Dda University Health Board, Powys Teaching Health Board and English providers.