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Written Statement - Together for Health: Update

Mark Drakeford, Minister for Health and Social Services

This is the fourth progress update on the delivery of Together for Health, our five year vision for the NHS in Wales, first published in November 2011.  This statement concentrates on developments that have taken place during the last six months.

Together for Health makes it clear that this Government’s overall aim is to improve the health of everyone in Wales whilst paying particular attention to reducing inequalities.  It also makes clear this Government’s commitment to supporting a modern NHS which consistently delivers high quality care whilst also meeting the considerable challenges it faces with confidence.  As a Government we recognise that the financial climate, coupled with the demands of an increasingly ageing population and greater expectations as a result of advances in treatment means the NHS faces significant challenges. We understand the need for NHS bodies to continue to take rapid and radical action to deliver the vision set out in Together for Health and the underpinning rationale for the necessary actions are clearly set out in Together for Health.

We are now half way through the five year programme.  Whilst there is still much to do, a significant amount has been achieved already. The fact that we have delivered on many of the commitments we made in 2011 during such a challenging period means that we should have confidence that we can continue to make the improvements necessary to deliver a safe and sustainable health service in Wales.  

This Statement is a summary of the progress we have since I last provided an update to the Assembly in May 2013.

Improving Health for all and Addressing Health Inequalities  

Efforts to improve health of the whole population and address health inequalities remain central to our work, and are reflected across a full range of our programmes and initiatives. At a strategic level, during the last six months work has continued to implement the broad range of actions in Fairer Health Outcomes for All , our national action plan for reducing health inequalities.

We have also concentrated on ensuring that the NHS and social services contribute fully to the Welsh Government’s Tackling Poverty and Early Years and Child Care Plans.  During the last six months, in addition to  the good progress we have made in the delivery of specific actions, such as the development of the over 50s health check, we have also moved forward on a number of other initiatives. This includes the Inverse Care Law Programme where two lead Local Health Boards now have specific targets relating to their local initiatives. Alongside this all LHBs will be using their own needs analysis to work with their locality clusters to review how the allocation of resources can better support the aim of reducing the health inequalities that exist.  

During the last six months we have given further consideration to the potential of legislation which could help us improve the health outcomes of the poorest and most disadvantaged individuals in our communities.  These considerations are being fed into the development work for the Public Health White Paper and the Future Generations Bill.

We are also establishing local poverty milestones and targets which will form part of our work on a new NHS Delivery Framework for the NHS to be introduced in April 2014.  This will be the mechanism to ensure that Local Health Boards set clear targets for reducing health inequalities and report on progress as a mainstream activity.

In June, we published our ‘ Delivering Local Health Care - Accelerating the Pace of Change ’. In addition to requiring Local Health Boards to produce robust assessment of local health needs, we are also reinforcing the message that primary and community care have a vital role to play in improving health and wellbeing amongst our most disadvantaged individuals and communities. Added to this, supporting individuals to take greater responsibility for their own health and wellbeing has also moved forward and on 20 November we held a national event to mark Self Care week.  

Hospitals for the 21st Century

While prevention, health protection and primary care services are crucial to improving health and reducing inequalities, it is vital also to have sustainable, high quality hospital based services for those who need them.  In this area too there has been considerable progress during the previous six months.  

The first phase of plans for North Wales is now being implemented, following agreement between the Health Board and Community Health Council. The capital schemes included in the reconfiguration plans have been reviewed and where agreed, plans are in place.   These are now being given priority in terms of funding support from the future health capital budget.  The First Minister issued a statement in Plenary on 12 November accepting the Royal College of Paediatrics and Child Health’s proposed model for the delivery of neonatal services in the north in the longer term, with the development of a sub-regional neonatal intensive care centre.  

Following the recommendations of the independent scrutiny panel, I announced my determination of changes to services in the Hywel Dda area in September.  I have decided that the model of emergency care at Prince Philip Hospital will be clinically led by doctors and delivered in conjunction with emergency nurse practitioners.  I also confirmed my support for the development of a Level 2 neonatal unit at Glangwili, but asked for a further of piece of work to be done, to clarify obstetric and midwifery services in the area. This information has now been received and the clinically led scrutiny panel is being reconvened to provide its final advice and recommendations to me on this matter.  I intend to  announce my final determination to the National Assembly on 21 January 2014.

The South Wales Programme undertook formal public consultation on its proposals between 23 May and 19 July. Over 60,000 responses were received with the final analysis and consultation summary published on the SWP website on 8th November. I understand that a decision will now be taken early in the New Year.


We are also working closely with the Local Health Boards, local transport authorities, bus industry and community transport sector to focus on the transport implications arising from the service changes that are implemented as part of the re-configuration programme.

There are opportunities to improve services in rural Wales through innovative solutions to planning and using technology to deliver care at or close to home. We have recently published a report by the Rural Health Implementation Group on its work, announced a new Health Technology and Telehealth Fund to support the wider take up of these new ways of working, and held a national showcase event on 18 November.

In response, I will commission work to look at service models to meet the specific pressures, challenges, and opportunities facing the delivery of services to those living in predominantly rural Mid Wales.

Aiming for Excellence

Together for Health signalled a determined effort to provide consistent, high quality care.  The Quality Delivery Plan set out how this would be done, though training, monitoring and reporting. The vast majority of the people of Wales receive good, safe care and NHS staff work are trained and motivated to deliver this.  But there are no grounds for complacency and we know that fast effective action is needed when things do go wrong.

One of the commitments in the Quality Delivery Plan is to improve transparency as a key to driving improvements.  In September, all Local Health Boards and Trusts published Annual Quality Statements for the first time.  A peer review of the Annual Quality Statements is now underway, under the leadership of Professor Rosemary Kennedy. A learning event is planned for January 2014 so that best practice can be shared and lessons learned.  

Following the Francis Report in England, we published “Delivering Safe Care, Compassionate Care”, which set out what we will do in Wales to make sure these events cannot be repeated here.  I will report on the progress we have made early in the New Year and this will also help inform the new all Wales Quality Statement that I intend to publish next year.

It is important that we also utilise information at all levels to drive improvements in the quality of care.  The work that has been put in place with HIW and the Wales Audit Office to define a clear escalation and intervention process where there are concerns will be reported to me in January 2014.  Added to this, I will shortly be announcing the details of an external review of the concerns/complaints process so that we can further build a culture and ethos of good customer service within the NHS. This will complement the progress we seeking in views and acting on patient experience and satisfaction feedback.

Condition Specific Delivery Plans

‘Together for Health’ committed us to develop and publish a range of delivery plans for major services and during the past six months we have continued to make good progress.

Following the publication of our Palliative and End of Life Care Delivery Plan, published on 16 April 2013, the Implementation Board has commissioned each LHB to produce an action plan outlining local activity.

In May we published the Heart Disease Delivery Plan with each LHB now asked to produce a Patents Needs Analysis for cardiac services in their areas.  This is due to be completed by January 2014.  September saw the publication of our Diabetes Delivery Plan where the main short term focus is now on developing a new diabetes patient information system, improving access to diabetes structured education and providing a stronger emphasis on paediatrics and related Type 1 diabetes cases.  

Also in September, the Wales Eye Health Care Delivery Plan was published which sets out a range of specific outcomes for eye care improvement by 2018 and we are currently consulting on drafts of a Respiratory and Neurological conditions Delivery Plans.

Good progress is also being made in the implementation of the delivery plans we published in 2012 including established reporting mechanisms now in place for Cancer,  Stroke,  Mental Health and the delivery of Maternity Services. We have also made progress on our National Oral Health Plan, launched in March 2013 and which requires Health Boards to produce local oral health action plans to meet their identified priorities by 31 December 2013.

Unscheduled Care

The significant pressure facing urgent and emergency care across the United Kingdom was recognised in Together for Health. In Wales, our response is being managed through the Unscheduled Care Programme which was announced on 23 April. The overall programme is made up of ten projects and remains a top priority, given the impact this has on the NHS and patients alike. There is a clear focus on achieving alignment between LHBs, local authority social services and the ambulance service as we prepare for winter resilience across the Welsh NHS.  During the last six months our Seasonal Planning Group has been planning for winter 2013/14 and following the Winter Planning Forum held in September, formal winter plans have now been received and are under review.

Aligned with the programme on urgent and emergency care is the work to implement the recommendations of the McClelland Review of ambulance services which was published earlier this year. This work is progressing according to the agreed timetable with implementation of the future organisation planned for April 2014.

Building on the planning process developed in relation to unscheduled care, I announced new arrangements for improved planning of elective care in a statement to the Assembly on 10 December.

Transparency on Performance

We remain committed to delivering a step change in the availability of data to patients on the performance of their local health services. Earlier this year Local Health Boards published mortality rates and information about health care acquired infections.

In October 2013, we launched ‘My Local Health Service’ which provides important information about the performance of local services. My Local Health Service website is a novel approach to improve transparency across NHS Wales. This website will enable patients to find information quickly, complementing those operated by the NHS and Welsh Government.


A New Partnership with the Public

In 2012 we published a consultation paper on issues relating to developing a new partnership with the public and the matter was also at the core of the consultation on the possibility of issuing a new Public Health Bill.  Since then there have been a number of initiatives on shared decision making techniques and training clinicians on working better with the public. We have also sought to increase information for the public and the consultations around service change have been among the most open and innovative ever in Wales.   All this amounts to a greater attention to collecting and considering patient views than ever before.

Making Every Penny Count

‘Together for Health’ also committed us to put in place a new financial regime to improve the planning and utilisation of financial resources in line with clinical priorities.   Central to delivering this is a move to a more flexible financial regime underpinned by a legal financial duty for Local Health Boards to break even over a rolling 3 financial years as opposed to annually. To support this we moved quickly to introduce new legislation through the NHS Wales (Finance) Bill which was passed by the National Assembly on 3 December with Royal Assent expected in late January 2014.  

We have also recently announced an additional £570m over the next three years to ensure the NHS in Wales is able to maintain delivery of services based around the core principles of safety and quality.

Alongside the additional resources and new financial flexibility, we have strengthened the planning system across NHS Wales. The NHS Wales Planning Framework, published in November clarifies the respective planning roles and responsibilities of the Welsh Government and NHS bodies.  This includes setting out the shared expectations of the Welsh Government and NHS Wales for Integrated Medium Term Plans; defining the planning cycle and key scrutiny and assurance mechanisms; and outlining the support that is available, or being developed, across the system to support the development of an effective planning system.  Local Health Boards are currently developing their 2014/15 Medium Term Plans.

We have also moved to strengthen the performance system to achieve a greater focus on patient outcomes and during the previous six months we have engaged with members of the public as well as clinicians and other partners to discuss how we should measure the performance of the NHS.

Legislation

Progress on our Legislative programme has continued in the last six months with key pieces of legislation being taken forward which play a part in supporting the Together for Health commitments. In addition to the NHS Wales (Finance) Bill mentioned previously, the Human Transplantation Act 2013 was passed by the National Assembly in July. Implementation is in on track with the initiation of a two year information campaign which will culminate in full implementation by 1 December 2015. On 20 November the Asbestos Bill was passed by the National Assembly and is currently in its four week intimation period.  The Counsel General informed the National Assembly in a statement on 11 December of his decision to refer the Bill to the Supreme Court, together with his reasons for doing so. Regulations to implement and operate a statutory food hygiene rating scheme in Wales as required by the Food Hygiene Rating Act 2013 were approved by the Assembly on 12 November.  The Act and Food Hygiene Rating (Wales) Regulations 2013 came into force on 28 November.

Conclusion

Taken together, this update demonstrates continued progress across the key health policy commitments contained in ‘Together for Health’.  These interlocking reforms are essential to improving quality of life for all and making the NHS in Wales consistently safe and effective, more integrated, sustainable and resilient.  Progress to date has only come thanks to the strong commitment of staff across the service, our partners and the public and I remain grateful for that. I am also confident that we will be able to build on this as we collectively take forward our agenda.