1000 Lives Plus Programme Board

Wednesday 22 December 2010

Notes of the Meeting, Key Points and Actions

Attendees: / Prof Sir Mansel Aylward CB, Chair Public Health Wales/Director Centre for Psychosocial & Disability Research/Joint Chair 1000 Lives Plus (co-chair)
Dr Chris Jones, Medical Director NHS Wales/Deputy Chief Medical Officer (co-chair)
Dr Alan Willson, Director of Research & Development National Leadership & Innovation Agency for Healthcare/ Director 1000 Lives Plus
Jan Davies, Head of CGSDU, Specialist Advisor Welsh Assembly Government/1000 Lives Plus Director
Felicity Barclay, 1000 Lives Plus Programme Manager, Public Health Wales
Andrew Cooper, 1000 Lives Plus Communications Officer, Public Health Wales
Dr Jean White, Chief Nursing Officer/ Nurse Director NHS Wales, Welsh Assembly Government
Andrew Evans, Assistant Director, Governance/1000 Lives Plus Key Contact for Abertawe Bro Morgannwg University Health Board
Rachel Fletcher, Quality & Patient Safety Improvement Manager/1000 Lives Plus Key Contact for Aneurin Bevan Health Board
Joy Whitlock, Quality & Safety Improvement Manager /1000 Lives Plus Key Contact for Cardiff & Vale University Health Board
Carol Tofts, 1000 Lives Plus Programme Manager / Key Contact representative, Hywel Dda Health Board
Dr Howard Cooper, Head of Clinical Governance /1000 Lives Plus Key Contact for Powys Teaching Local Health Board
Bob Hudson, CEO Public Health Wales, Key Contact representative
Andrew Jenkins, Asst. Clinical Director/Consultant Paramedic / 1000 Lives Plus Key Contact Representative,Welsh Ambulance Service NHS Trust
Katie Norton, Director of Primary, Community and Mental Health Services, Cardiff & Vale University Health Board
Jan Smith, Executive Director of Therapies and Health Science, Aneurin Bevan Health Board
John Palmer, Director, Public Service Improvement, Welsh Assembly Government
Jeremy Stephens, Head of Performance & Strategic Projects, Swansea Council
Prof Stephen Palmer, Cochrane Chair in Epidemiology and Public Health, Cardiff University
Mollie Roach, Community Health Council Representative
Prof Ceri Phillips, Professor of Health Economics and Deputy Head of School (Research), Swansea University
Dr Paul Myres, Chair of the Primary Care Quality Forum, Public Health Wales
Richard Bowen, Director of Operations, Health & Social Services Directorate General, Welsh Assembly Government / (MA)
(CJ)
(AW)
(JD)
(FB)
(AC)
(JW)
(AE)
(RF)
(JW)
(CT)
(HC)
(BH)
(AJ)
(KN)
(JS)
(JP)
(JS)
(SP)
(MR)
(CP)
(PM)
(RB)
Apologies: / Helen Simpson, Finance Director, Betsi Cadwaladr University Health Board
Prof Peter Barrett-Lee, Medical Director, Velindre NHS Trust
Ruth Walker, Executive Director of Nursing, Cardiff and Vale University Health Board
Hugh Ross, Director, NHS Wales Health Strategy Support Unit, WAG
Dr Chris Potter, Director of Public Health, Powys Teaching Local Health Board
Kellie-Jenkins Forrester, Clinical Governance Manager, 1000 Lives Plus Key Contact for Cwm Taf Heath Board
Anwen Crawford, Key Contact representative, Betsi Cadwaladr University Health Board
Lisa Miller, Director of Operations/1000 Lives Plus Key Contact for Velindre NHS Trust
Debbie Morgan, Director of Workforce and Organisation Development, Abertawe Bro Morgannwg University Health Board
  1. Welcome and introductions
  • MA welcomed the group to the first meeting of the Programme Board and outlined the morning ahead.
  • Attendees introduced themselves and apologies were noted.
  • MA presented an overview of the 1000 Lives Campaign (see presentation 1) and highlighted several key points regarding the Campaign:
  • It has received national and international recognition.
  • Its achievements were due to management buy-in and frontline engagement working together.
  • Measurement for improvement and adopting best practice using small tests of change were fundamental.
  • In addition to the content areas, it provided a focus on dignity, respect and courtesy through patient stories.
  1. Overview and context of 1000 Lives Plus

CJ presented to the group on the first six months of 1000 Lives Plus (see presentation 2) and referenced the following key points:

  • Becoming a national programme will help mainstream the work as the engine for change to improve the experience of patients in Wales.
  • Building on the foundations of the Campaign, it will become broader than patient safety and address patient experience across services.
  • There is a need to align with the other national programmes as 1000 Lives Plus will have an interest in all their work.
  • There is a need to engage in a transformation of care with pre-emptive care earlier in the patient journey and less focus on acute care.
  • Services need to put the patient back at the centre of care, becoming patient-centred and providing every patient with the care they need.
  • It is a supportive and enabling process that provides tools and techniques to improve care.
  • New areas of evidence-based practice will need to be identified for future implementation.
  • There are legacy achievements expected to be part of the core outcomes for all organisations, existing areas and new areas of work.

The group discussed the focus of 1000 Lives Plus and the following observations were made:

  • The life-long patient journey should be addressed as opposed to a discrete patient pathway.
  • As the programme encompasses broader areas of work, broader language will need to be used, moving from ‘the patient’ to ‘people’.
  • The change in language should reflect a greater change in focus, working on areas before a person is within the system, stopping people passing through thresholds.
  • The programme is held up as best practice for Wales as it brings together outcomes for people, real workforce motivation and engagement, and cost benefit.
  • The issue of benefits realisation is key.
  • The methodology can be used across all services, based on the learning that improvement has to come from within communities for better health outcomes e.g. the work on reducing domestic abuse.
  • There is danger that the programme will become diluted if the areas of work are spread too wide or the brand is adopted by other improvement initiatives.
  • It can address economic issues in a way traditionally seen as paradoxical – care can be improved and cost reduced.

ACTIONS:

  1. JP to provide an update on the domestic abuse work at the next Programme Board meeting.
  1. Programme Structure and linkages with other programmes and groups
  • JD informed the group that 1000 Lives Plus became a national programme following discussions between Paul Williams and Trust and Health Board CEOs.
  • She explained the programme structure and that through the regular Programme Director meetings better alignment across the work of all programmes should be possible.The scope of many of the programmes are outside of NHS boundaries so this is likely to take the 1000 Lives Plus way of working into new areas and help address thefocus on ‘people’ rather than patients.
  • The approach used by 1000 Lives Plus – the methodology, evidence-based interventions and measurement for improvement – were commended at the recent Programme Directors meeting and the progress of all the programmes will be discussed at their next meeting.
  • It is anticipated that 1000 Lives Plus will align and influence the other national programmes to ensure the method and using measures underpin all the programmes.
  1. Programme PID
  • AW took the group through the document, focusing on the seven workstreams and key deliverables.
  • AW noted that the programme is trying to support the skill and infrastructure to work in a reliable and predictable way. It is about supporting and empowering Health Boards and Trusts in a catalytic way rather than a centralised approach.
  • JD provided a summary of the method used to retain innovation whilst also embedding improvements: maintenance areas linked to the AOF, new areas tracked through process measures and areas for potential development, ensuring a rolling programme of testing, embedding and spreading.
  • AW suggested potential workstream leads and the group agreed these as follows:
  • Ensure improvement is integral to clinical practice in Wales: Dr AlanWillson, 1000 Lives Plus Director, and Debbie Morgan, Director of Workforce and Organisation Development, ABMU Health Board
  • Ensure care is based on best evidence: Public Health Wales
  • Ensure a focus on improved outcomes: ProfStephen Palmer, Cochrane Chair in Epidemiology and Public Health, Cardiff University
  • Increase value: invest in improvement:Prof Ceri Phillips, Professor of Health Economics and Deputy Head of School (Research), Swansea University and Helen Simpson, Finance Director, BCU Health Board
  • Ensure the people of Wales are at the centre of all care delivered: Nursing lead Denise Richards, Nursing Officer – Patient Experience, and Mollie Roach, Community Health Councils Representative
  • Ensure sustained improvement through the future workforce: Stephen Griffiths, Director of Workforce Development, NLIAH and Prof John Bligh, Dean of Medical Education, Cardiff University
  • Create a shared will for excellence: Andrew Cooper, 1000 Lives Plus Communications Officer, and Karen Newman, Head of Communications, Aneurin Bevan Health Board

The group provided the following comments on the PID:

  • The balance between bureaucracy and local implementation needs to be maintained.
  • Public Health Wales should support the development of the evidence-base for potential future work, using the proposed approach.
  • The balance between focused areas of work and improving the whole patient experience across services must be considered. Potential areas of work are wider than the NHS but the ‘width and depth’ of the interventions needs to be right so that their impact in reducing harm can be measured.
  • Transparency of outcomes and consistency of approach and evaluation in the workstreams is required.
  • Getting cultural behaviour right in the workforce is key to improvement, balanced with rewarding staff and enabling innovation within the workforce.
  • Sustainability regarding environmental impact is a cross-cutting theme.

The following amendments to the document were suggested:

  • To pick up the key messages about Welsh health and the social determinants of health from CMO’s report.
  • To amend the language to reflect ‘people’ rather than patients.
  • To ensure clarity of aims and the contribution by all services is clearly outlined in the stakeholder piece.
  • To be clear on the risks and impact of the national programme.
  • To include the strength of leadership in the programme at the beginning of the PID, balanced with the focus of frontline engagement and a bottom-up approach.
  • To include supporting staff within workstream 7.
  • To rename workstream 4 ‘Increasing value -Investing in Improvement’.

ACTIONS:

  1. MA to liaise with Public Health Wales to nominate a lead for workstream 2.
  2. The central 1000 Lives Plus team to coordinate a workshop with Public Health Wales.
  3. The central 1000 Lives Plus team to send invitations to workstream leads on behalf of the Board.
  4. FB to make the above amendments to the PID.
  5. The central 1000 Lives Plus team to develop a briefing paperfocusing on the methodology and integration of top-down leadership and frontline engagement and ownership of changes and key messages from the board meeting.
  6. The central 1000 Lives Plus team to present on the methodology at the next meeting.

5. Developing the evidence-base for future work and a process for selection

AW presented to the group on the status of the areas of work within the programme, highlighting that areas of work are selected from a clear prioritised evidence-base and made appropriate for implementation in a welsh context using a standardised methodology (see presentation 3).

The group discussed the presentation and made the following observations:

  • An intervention relating to the third sector and social care would be valuable in integrating the work across services.
  • There is a need to be mindful of the capacity to make tangible changes.
  • A map of the variation in practice across Wales linked to economics would be useful, similar to the Atlas of Variation produced by NHS England.
  • The areas of work need to be evidence-based but this should not restrict innovation locally or nationally.
  • New areas of work need to be driven by population need, not just availability of evidence.
  • A new area could bring together evidence from different sectors into a new bundle to create a new cross-service approach.
  • The work will need to link with academic R&D e.g. Academic health science collaborative.
  • The criteria was agreed as framework to take the work forward, subject to some amendments.

ACTIONS:

  1. FB to amend the selection criteria to include ‘health and healthcare outcomes’ and an additional point – ‘What is the scale of the problem?’
  2. The central 1000 Lives Plus team to provide more clarity around potential areas of work at the next meeting.
  3. The central 1000 Lives Plus team to present on the joint working with the Primary Care Assurance Board at the next meeting.

6. A.O.B

No additional business or points were raised by the group.

7. Date and frequency of next meetings

  • Thursday 3rd March, 9.30 – 12.00
  • Thursday 14th July, 9.30 – 12.00
  • Monday 17th October, 13.00 – 15.30

Actions Log

No / Action / Who / Deadline / Status
1 / Provide an update on the campaign on Domestic Violence at the next Programme Board meeting. / JP / 24.02.11
2 / Liaise with Public Health Wales to nominate a lead for workstream 2. / MA / 21.01.11
3 / Coordinate a workshop with Public Health Wales. / Central team / 29.02.11
4 / Send invitations to workstream leads on behalf of the Board. / Central team / 21.01.11
5 / Make amendments to PID / FB / 21.01.11
6 / Develop a briefing paper for members to relay to their organisations describing the 1000 Lives Plus programme and Board. / Central team / 21.01.11
7 / Present on the methodology at the next meeting. / Central team / 24.02.11
8 / Amend the selection criteria to include ‘health and healthcare outcomes’and an additional point – ‘What is the scale of the problem?’ / FB / 21.01.11
9 / Provide more clarity around potential areas of work at the next meeting. / Central team / 24.02.11
10 / Present on the joint working with the Primary Care Assurance Board at the next meeting. / Central team / 24.02.11
Version: 01 / Date: 23/12/2010 / Status: Final
Author: FB / Page: 1 of 6