CEREDIGIONLOCAL HEALTH BOARD

annual report 2008|2009

Contents1 Welcome1 Mission Statement2 Who’s Who on the Board3 Committee Structure3 New GP Leaders Appointed4 Corporate Health Standard5 Continuing NHS Health Care & Continuing Health & Social Care.6 Involving the Public and Patients8-9 Listening to your Concerns and Putting Things Right10 Reporting and Responding to Incidents11 Quality Outcomes Framework (QOF)12 NHS Funded Nursing Care12 Individual Patient Commissioning (IPC)13 Promoting Equality and Diversity13 Welsh Language14 Vaccination and Immunisation15 Healthcare Associated Infections (HCAI)/1000 lives15 Freedom of Information16 Primary Care Nursing17 Clinical Governance18 Moving More Often in Ceredigion18 Managing Mouths In Ceredigion19 Ceredigion Local Public Health Team19 NHS Dental Practices in Ceredigion20 Medicines Management20 3 Counties Medicines Waste Campaign21 Investors in Carers21 Care on Call

22 Healthcare Standards for Wales22 Improving the Health of Homeless and Specifi c Vulnerable Groups23 Unscheduled Care23 Diabetes24 1000 Lives Campaign25 Ceredigion Local Public Health Team26 Stop Smoking Wales27 Integrated Community Equipment Stores Development27 Towards a Stable Life and A Brighter Future28 Primary Care Estates28 Cylch Caron30 Heart Failure Service For Ceredigion30 Emergency Planning31 Mind Your Heart Programme32 Substance Misuse32 The All Wales End of Life Care Pathway33 The National Service Framework for Older People (Ceredigion)33 The Children, Young People and Maternity Service National Service Framework34-38 Three Counties Planning Forum39 Commissioning40-45 Financial Statements46 Report of the Auditor 46 Remuneration Report47 Salary and Allowances47 Pensions Benefi ts48 Related Party Transactions

Contact usCeredigion Local Health Board, Y Bryn, North Road,Lampeter, Ceredigion, SA48 7HATel: 01570 424100, Fax: 01570 424102

Email: general.offi ce@ceredigionlhb.wales.nhs.ukEmail for complaints, compliments or comments tocomps@pembrokeshirelhb.wales.nhs.uk

www.ceredigionlhb.wales.nhs.uk From 1 October 2009, the Ceredigion LHB website will no longer exist. Please visit the website of the new organisation – Hywel Dda Health Board at: www.hywelddalhb.wales.nhs.uk

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AcknowledgementsHygiene facts from“Teach germs a lesson.”

Clean Your Hands Campaign Imagesprovided courtesy of NationalPatient Safety Agency

This report will be made available on a wide basis through health care premises, libraries, on request from the Local Health Board offi ces, through our website and will be available in hard copy, electronically on CD Rom and large print or other format. If you would like this Annual Report in large print or another format the Local Health Board will arrange for an alternative version of the Annual Report to be produced to meet your requirements.

Note. Local Health Board is referred to as LHB throughout this document. Hywel Dda Health Board is the operational name of Hywel Dda Local Health Board.

Delivering improvements to services within the resources available to us in 2008/2009 has been a challenge. We would like to pay tribute to the health professionals, managers, partner organisations and staff of the LHB and National Public Health Service and thank them for their hard work, dedication and achievements on behalf of patients and our communities during the past year.In order to make best use of the management resources available to us, we have combined senior posts in Ceredigion with Pembrokeshire LHB and have combined committee meetings and development sessions. This has enabled us to work closely with and develop already existing relationships with our colleagues in Pembrokeshire LHB, sharing good practice and expertise. We will continue to develop this model with our colleagues in Carmarthenshire LHB, laying the foundations to ensure that we have a community focus for health services when the Hywel Dda LHB is created from the existing four organisations on 1 October 2009.

We are proud to present this Annual Report in a year when, despite the challenges, we have achieved much and continued to build strong relationships with our partners in the community and at regional and national levels.

Key achievements during the year are highlighted in the main body of the report. We would like to formally acknowledge the support and assistance provided to us by a wide range of partner organisations, in particular Ceredigion County Council, Ceredigion Community Health Council, and Ceredigion Association of Voluntary Services, colleagues within Primary Care, our NHS Trusts and our community Partnerships. Together with a wide range of voluntary and community groups and organisations we are confident that we have provided a firm platform to deliver safe and sustainable services for the future in Ceredigion.

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Mission Statement Ceredigion LHB’s Mission Statement outlines how it intends to fulfil its responsibilities: ‘Ceredigion Local Health Board will work corporately to secure the most effective ways to improve the Health, Social Care and Wellbeing of the Community which we serve. This shall be achieved:

• Within available resources; • In close co-operation with the people of Ceredigion, the Local Authority, voluntary sector, other partner agencies and other Health Care agencies; • As a member of the NHS Team Wales; and • In accordance with priorities and guidance issued by the National Assembly for Wales.

Welcome to the 2008/09 Annual Report for Ceredigion Local Health Board

Who’s Who on the BoardOfficer Members Janet Hawes Chairman Bernardine Rees Chief Executive Karen Miles Deputy Chief Executive Director of Finance & Commissioning Sarah Williams Director of Primary Care & Planning Helen Williams Nurse Director Dr Stephen Griffiths Medical Director Rachel Russell Director of Local Public Health

Non-Officer Members Cllr Alun Lloyd-Jones Local Authority member (Vice-Chairman from 27 August 2008) (from 27 August 2008) Cllr Mair Morris Local Authority member (until May 2008) Cllr Paul Hinge Local Authority member from 27 August 2008) Cllr Hag Harries Local Authority member (from 27 August 2008) Parry Davies Local Authority member (from 27 August 2008) Dr Carl Langley General Medical Practitioner member Dr Dylan Williams General Practitioner Member (until 31 December 2008). Robert Hughes-Jones Pharmacist member Dr Illtyd Griffiths Dental Practitioner member (until 31 August 2008) Dr Ian Jones Dental Practitioner member (from November 2008) Robin Baker Optometrist member (from November 2008) Jason Crowl Nursing/Midwifery/Health Visitor member (until 31 December 2008) Julie Hughes Nursing/Midwifery/Health Visitor member (from 1 January 2009) Kathy Giles Therapy member Ann Walker Voluntary Sector member (Vice- Chairman from 1 April until 27 August 2008)

Mair Morris Voluntary Sector member (from July 2008) Alasdair Kenwright Community Lay member Fiona Aldred Community Lay (Carer) representative

Associate Members Lyndon Lloyd Ceredigion Community Health Council Allison Williams Ceredigion & Mid Wales NHS Trust (until May 2008) Dr Alan Axford Hywel Dda NHS Trust (from November 2008)

Co-opted Members (In attendance) Dr David Roberts Local Medical Council David Pick Pembrokeshire & Derwen NHS Trust (until December 2008) Gill Davies Hywel Dda NHS Trust (from February 2009) Emlyn Thomas Independent Chairman of the Tregaron project (from September 2008)

Board Meetings The Board meets in public every other month. Members of the public are welcome to attend and those wishing to ask questions of the Board may do so by submitting their request in writing 48 hours in advance to the Local Health Board. Details of meetings held in public are advertised in the local press and on the LHB’s website www.ceredigionlhb.wales.nhs.uk.

Declarations of Interest LHB Board members and staff are required to declare any outside interests that might influence their role. A register of those interests is maintained and is available to the public for inspection. Members of the Board must also declare any interests at Board meetings in public.

Committee Structure A review of the Committee Structure for both Ceredigion and Pembrokeshire Local Health Board’s (LHB’s) was undertaken to ascertain whether there was scope for more efficient ways of working. We had already put in place arrangements for joint meetings of the Audit and Compliments & Complaints Committees ensuring that the core business of the individual responsible bodies was protected. The joint arrangement has been successful in streamlining the work for both LHB’s and made better use of the resources available to both organisations.

As a result of the review, the joint arrangement was extended for the whole of the Committee and working group structure to support both LHB’s. The model established joint statutory/main committees which were supported by a number of sub-committees and working groups.

As a result of this new arrangement Members have benefited from sharing good practice. Organisations have benefited by being able to share information which has enabled a broader understanding of the challenges facing the NHS in delivering safe and sustainable services.

The model has been developed and used in other NHS organisations to ensure the best use is made of skills, knowledge and expertise.

The joint statutory committees and their Chairs were as follows:

• Integrated Governance Committee Chair: Cllr David Wildman (Local Authority Member)

• Audit Committee Chair: Robert Hughes-Jones (Pharmacist Member)

• Planning, Modernisation & Commissioning Committee

Chair: Mair Morris (Voluntary Sector Member)

• Remuneration Committee Chair: Janet Hawes (LHB Chairman)

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New GP Leaders AppointedIn October 2008 Dr Sue Fish, Associate Medical Director for Ceredigion LHB, was also appointed as Associate Medical Director for Primary Care with Hywel Dda NHS Trust. Between November 2008 and February 2009 she undertook project working with GPs across Ceredigion, Carmarthenshire and Pembrokeshire and hospital based consultants to identify the best way of getting GPs involved with the future planning of health care services for their patients.

In March 2009 the LHB advertised successfully for two GP locality service planning leads, one for North and one for South Ceredigion.

It is planned that they will work with consultants in Hywel Dda NHS Trust and GP colleagues from Ceredigion, Pembrokeshire and Carmarthenshire to help shape the future development of health care services across Mid and West Wales. The new GP leaders will work with GPs from across Ceredigion to keep them better informed of any changes that happen and to allow them to have a say in how services could develop.

This is the first time for a number of years that GPs and consultants will sit around the same table to advise health service managers on how health care should be developed, to provide high quality services that can be delivered closer to patients’ homes.

These GPs will also ensure that the needs of individual communities are well represented when the new Hywel Dda LHB takes over responsibility on 1 October 2009.

The GP locality service planning lead for North Ceredigion is Dr Helen Herbert, and Dr Stephen Rowlands for South Ceredigion.

Continuing NHS Health Care & Continuing Health & Social CareCeredigion LHB has a statutory duty to fund the care of individuals who are eligible for Continuing NHS Healthcare. In 2004 the Welsh Assembly Government issued new guidance relating to Continuing NHS Health Care, this required LHB’s to take the lead in the production of local implementation plans.

The LHB continues to ensure that appropriate health care packages are provided for patients within the county of Ceredigion which are responsive to clinical needs.

The LHB has also maintained an ongoing training programme providing update training to groups of professionals including community hospital staff and District nurses.

A bilingual public information leaflet has been developed entitled ‘Continuing NHS Healthcare Explained’. This can be obtained from the LHB and is available on the LHB website, www. ceredigionlhb.wales.nhs.uk.

Since January 2008 the Continuing NHS Health Care and NHS Funded Nursing Care teams across both Ceredigion and Pembrokeshire have worked together as one team with a single management structure. This has facilitated better communication and joint working between the teams with shared policy and procedure development.

Continuing NHS Health Care panel meetings are held weekly. This is where the Multi Disciplinary Team decisions in relation to eligibility to receive NHS funding is agreed and funding approved for specific care packages. Both panels have a multi agency membership which includes Local Authority and NHS Trust.

During the year, a total of 589 requests were considered by the Panel. These requests included funding for specialist equipment, nursing home care and care at home. Out of the 589 cases considered in Ceredigion, a total of 494 were approved.

A joint finance meeting is held between the LHB and the Local Authority in order to discuss financial issues or concerns. This has provided an opportunity for better communication and partnership working across agencies.

A Public Health Services Ombudsman report was published in relation to a complaint made by a Ceredigion resident, against the former Ceredigion and Mid Wales NHS Trust and the LHB.

Following this publication, the LHB has worked closely with the Trust to ensure processes are more robust and effective in relation to Continuing NHS Health Care.

Corporate Health Standard Going for Gold!Health at Work: The Corporate Standard is a national mark of quality in health promotion in the workplace. The Standard is awarded by the National Assembly for Wales to workplaces who have demonstrated a commitment to improving the health of their workforce. It is endorsed by the Health & Safety Executive, the Confederation of British Industry in Wales and the Wales Trade Unions Congress. The LHB is required, as part of the Strategic and Financial Framework (SAFF) targets, to achieve the Corporate Health Standard and a Corporate Health Standard working group has progressed achievement of the Standard.

The Standard is awarded on a grading system – Bronze, Silver and Gold, using criteria which are used to assess the quality of an organisation’s health promotion activity. The LHB achieved the Bronze level in September 2007 and since this time the Corporate Health Standard working group has been busy working towards achieving the Gold level.

On 19 December 2008 the LHB was formally assessed for Gold and the assessors were of the unanimous opinion that the Ceredigion LHB be awarded the Standard Gold Award.

During the assessment process, and in discussion with the Senior Management and the Corporate Health

Standard Working Group members, the assessors were of the opinion that the Health at Work philosophy was embraced at all levels of staff and was reflected in the everyday working culture of the organisation. Assessors were impressed with the hands on approach and how ‘in touch’ both the Chairman and Chief Executive were with the running of all parts of the organisation and their enthusiasm for ‘achieving’ came shining through.

The assessors noted that the LHB was again facing a period of change and uncertainty with the impending reorganisation of NHS in Wales. Despite this they noted that they had witnessed a very relaxed, informal atmosphere and community spirit amongst staff, which was emphasised and reinforced in their handling of the recent flood which put their headquarters out of commission for 4/5 months and which necessitated the decanting of personnel to other locations.

The assessors thanked the staff of the LHB for the warm welcome extended to them, and for the informal and honest way in which the discussions were conducted.

Since the introduction of the Corporate Health Standard, the staff have benefited from a variety of initiatives including:

ÿ Reduced price swimming

ÿ Alcohol and substance misuse awareness training

ÿ Food and mood training

ÿ Reduced price bicycle purchase

ÿ Weight management support

ÿ Individual stress support

ÿ Health check from Cardiac nurse

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Ceredigion LHB completed 4 retrospective reviews in accordance with Welsh Assembly Government policy and guidelines and there are a few cases still being reviewed. This process ensures that patients placed within care homes are receiving appropriate and safe care.

The Review Officer was able to develop and improve systems and processes around the retrospective review process.

Louise O’Connor, joined the NHS in 1992 and has worked for the LHB since its inception in 2003. Louise has responsibility for the business and operations management within the organisation, including areas such as corporate governance, claims and complaints and legal services. Louise also provides support to the LHB Board and enjoys the varied responsibilities of the role.

Involving the Publicand PatientsCeredigion LHB is committed to creating a culture where patient and public involvement is a central part of the way we work, ensuring that it is essential to LHB planning, delivery and reviewing of our local health services. The LHB is also very committed to working in partnership with local organisations.

Involving and consulting with the public and patients of Ceredigion requires ongoing development, and is an important aspect of clinical governance, and how we meet our quality standards.

The ways we have involved and informed the public and patients of Ceredigion during 2008/09 are as follows:

Citizens’ PanelCeredigion Citizens’ Panel was established during this year. Ceredigion LHB is one of the key partners along with Dyfed Powys Police, Ceredigion County Council and the Countryside Council for Wales. The Panel is made up of people who volunteer to be on the Panel. They need to be resident within the county. Recruitment to the Panel took place during Summer/Autumn 2008 and the fi rst survey was sent to 555 people. There is an ongoing recruitment campaign in order to reach the preferred total of 800 people, including information with council tax letters. There were two surveys circulated this year, the fi rst was in November 2008 and the second was sent out in February 2009. The health service questions asked in the surveys included asking if and how members would prefer to give feedback on their experiences as a patient; their interest

in volunteering in the health service; and commenting on a “Choose Well” thermometer diagram aimed at helping people make a decision on which service to use when they need urgent health care. The aim is for Ceredigion residents to participate in a survey 3 times a year; with the results acted upon by the organisations to improve your services.

Board MeetingsWe encourage and welcome the general public to attend our Board Meetings, which are all held in public and advertised beforehand in the local press. We feel that you should be fully aware of all decisions that are made that could aff ect your services, so the Board papers are also published on our website:www.ceredigionlhb.wales.nhs.uk

Cylch Caron ProjectThe Local Service Board, Ceredigion LHB and Hywel Dda NHS Trust are working together on a multi agency project to consider the provision of services in Tregaron. The Cylch Caron Project Board, which meets regularly, has an independent chair and includes the local county councillor, a local member of the Community Health Council and Communities First. It is a Multi-Agency Board to consider development of a multi-agency hub in Tregaron which will enable shared and better access to key services on a local basis. This includes the development of an integrated Health and Social Care facility

There is a group considering engagement and communication with the community on this multi-agency project. A presentation was given to the Tregaron and Uplands Communities First Partnership on 23 February 2009 on this project. A press release about the project was issued in February 2009 to provide information to everyone on progress on the project.

Cardigan Project As part of the development of joint health and social care services in Cardigan, a Project Board has been established which includes representatives from the Community Health Council, elected representatives from the Local Authority and the Hospital League of Friends. The Project Board provides overall direction and management of the project in development of the new integrated health and social care centre in Cardigan.

The Project Board has identifi ed the need for a work stream dedicated to public engagement and communication and work is currently under way to develop this.

LHB Website From 1 October 2009, the Ceredigion LHB website will no longer exist. Please visit the website of the new organisation – Hywel Dda Health Board atwww.hywelddalhb.wales.nhs.uk

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Ceredigion Community Engagement Framework for2008-2010A multi-agency “Ceredigion Community Engagement Framework for 2008-2010” has been written and agreed. The purpose of this document is to provide a framework for eff ective community engagement and consultation activity within Ceredigion. The document includes a number of aims and specifi c objectives that will be delivered jointly by the Ceredigion Local Service Board, which includes Ceredigion LHB. The Local Service Board is a local leadership team which pulls together all the public services bodies to review the way in which they are working collaboratively and to agree and deliver joint action to achieve better outcomes for citizens where this requires working across organisational boundaries.

The Framework was launched during an ‘Intergenerational Conference’ held on 5 March 2009 in Pontrhydfendigaid which was attended by a wide cross section of organisations and people including the Deputy Minister Gwenda Thomas, the Commissioner for Older People Ruth Marks, and a message of support was sent by the Commissioner for Young People which was presented by Mark Williams, MP for Ceredigion.

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Principle 1 Getting it Right Whilst we strive to get things right first time around, if a mistake does happen, the important thing is to put it right, and to use the experience for further learning and the continuous improvement of services. In short, we see each concern raised by you as an opportunity to make things better and to produce a reasonable and fair remedy for your concern.

Principle 2 Being Customer Focused LHB staff will try to understand your concerns, explain the complaints management process, and keep you up to date with developments as required. Any information you provide will be kept in the strictest confidence, and only shared with those who really need to know with your permission/consent.

Principle 3 Being Open and Accountable The LHB provides reporting of its concerns and compliments throughout the year, which includes information on the remedies and outcomes applied. The department is accountable to the Compliments, Complaints and Incidents Committee which provides a level of scrutiny before reporting directly to the Public Board. All Board papers are available on the LHB website for review.

One case this year was referred to the Public Services Ombudsman for Wales and a Public Interest Report (no 200701470) can be accessed from the LHB office or by

accessing www.ceredigionlhb.wales.nhs.uk. An Action Plan was produced as a result of the Ombudsman’s Report and many of the actions have already been achieved.

Community Health Council The CHC provides a free complaints advocacy and support service to you if you have any problems with, or complaints about NHS services.

The CHC also: • ensures that your views and needs influence the policies and plans put in place by health providers in your area • monitor the quality of NHS services from your point of view • give you information about access to the NHS

The CHC can be contacted on (01970) 624760 or 08456 650763 (advocacy line).

Dental Services There were 16 dental concerns received this year – 3 related to practice administration such as appointment systems, 10 related to clinical/treatment issues such as treatment planning, procedures undertaken and the fitting of dentures, and 3 related to dental access.

The LHB also received a total of 9 orthodontic complaints this year, primarily regarding concerns over waiting times to begin treatment. Considerable work has been undertaken so far this year to establish robust services for the County.

GP Services We received 2 complaints about GP services regarding prescribing and a delay in referral.

Out of Hours – Care on Call We received 6 complaints about the service. Concerns related to advice given by a health professional and time waiting to see a GP.

Commissioning 5 general commissioning complaints were received. These covered a range of issues associated with counselling services for children, dermatology and rural health access.

Principle 4 Acting fairly and proportionately The LHB will strive to deal with complaints and concerns consistently, and will treat you without bias or prejudice. If you feel that you have not been treated fairly or your complaint has not been dealt with professionally then you will have the opportunity to take your complaint to the next stage of independent review to the Independent Complaints Secretariat or the Public Services Ombudsman for Wales.

Principle 5 Putting things right The LHB will ensure that any complainant/patient who has suffered any hardship as a result of maladministration will receive a full apology and explanation of any resulting remedial action.

Managing Complaints The Government sets response targets for acknowledging your concerns. This year, we achieved 97% acknowledgement response target (within 2 working days), and were able to respond to 72% within target (20 working days) for a full response.

This year we have adopted a new joint working Complaints Policy and Procedure with Pembrokeshire LHB with a central team co-ordinating complaints for both counties. This year there will be a focus on training and information for primary care practices on effective local resolution of and learning from your concerns.

This will be further improved next year, with the reorganisation of the health service, when a single point of contact will be created for all healthcare concerns.

Listening to your concerns and putting things rightIn March 2008, the Public Services Ombudsman for Wales published the guide entitled ‘Principles for Remedy.’ The document set out the 6 principles of good practice for the remedy of your concerns.

Principle 6 Seeking continuous improvement Lessons learnt from effective complaints handling can feed into the continuous improvement of the organisation, and play a significant part in improving service delivery. Examples of improvements made as a result of complaints handling include:

¸ The employment of a Dental Advisor who has advised and mentored a number of dental practices with regard to complaints handling and patient care

¸ The LHB has written to GP practices not automatically transferring callers to the Out of Hours Service, encouraging them to do so.

¸ New guidance has been issued regarding continuing Health Care processes and reflected in LHB policy and procedure.

¸ Palliative Care training has been undertaken.

¸ The LHB is working alongside the Hywel Dda NHS Trust to implement a number of Orthodontic initiatives including clear referral guidance for Dental Practitioners.

¸ A review of LHB documentation has been undertaken in line with our Welsh Language Policy.

¸ Pharmacies have been reminded of procedures in place in the event of unexpected closures.

LHB continues to welcome feedback and the detail of your concerns and compliments. You can contact the team on 01437 771 260/289

Set in the context of a population of approx 75,000, during the year we received 68 complaints (not including numbers of concerns raised directly with the hospital or with the Community Health Council). This number includes complaints you asked the LHB to co-ordinate (with your consent) about primary care such as your GP, Dental, Pharmacy and Optometry services.

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Quality Outcomes Framework 2008/09 (QOF)The LHB continually reviews the quality of care which GP practices provide to patients. This is part of the GP Contract and the review mechanism is known as the Quality Outcome Framework.

The annual QOF visits for all GP practices in Pembrokeshire and Ceredigion have been completed. The purpose of the visits was to monitor the records of the patients who are receiving care, especially those with long term conditions, and through discussions this can lead to possible changes or improvements in how they are treated.

Specifi c areas discussed with practices were:ÿ Audit activity, in particular National Patient Safety

Agency (NPSA) and 1000 Lives, Minor Surgery Audits and the Audit+ tool which is available to practices to enable understanding of what is happening to patients under their care.

ÿ Clinical Incidents and Signifi cant Events and reporting via the Datix Incident Reporting System and NPSA e-form;

ÿ Involvement of practice nurse and health care workers in the QOF process

ÿ Patient Safety in relation to the work currently carried out by the NPSA and the 1000 Lives Campaign.

The use of drugs or medicines in the care of patients is key to improving the long term outcome. The LHB Medicines Management Team works with practices to ensure the most appropriate use is made of medicines and this forms a basis of discussion of all aspects of care.

This monitoring process helps to ensure that all patients, especially those with the most ill health, receive the best treatment as well as ensuring money is spent appropriately.

The visits were welcomed by practices, and fulfi lled the purpose of checking clinical and non-clinical evidence, as well as providing opportunities to raise any issues and concerns they may be experiencing, so that possible solutions could be found.

The monitoring and QOF visits across both Ceredigion and Pembrokeshire has led to enhanced quality and holistic patient care.

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Reporting and Responding to IncidentsThe LHB is fully committed to reducing, as far as possible, the number of adverse incidents, hazards and near misses; to ensure that corrective action is taken; and lessons shared throughout the LHB and with Primary Care contractors in order to reduce the likelihood of recurrence.

All staff need to acknowledge that the risks within the LHB and Primary Care will be reduced if everyone adopts an attitude of openness and honesty. All necessary eff ort must be made to acknowledge incidents and mistakes, and the overall approach within the LHB and Primary Care should be one of help and support to each other, rather than recrimination and blame. The LHB Board is committed to this approach.

The Incident and Hazard Reporting Policy aims to identify and record incidents and near misses. It encourages prompt reporting by investigating and implementing appropriate corrective action to prevent recurrences. The total number of incidents reported during April 2008 - April 2009 for Pembrokeshire was 78 and 46 for Ceredigion.

Incidents fall broadly into the following categories:

ÿ Medication Error

ÿ Delay in Patient Care

ÿ Communication

ÿ Staffi ng issues

ÿ Patient Related Incidents

ÿ Confi dentiality

ÿ Equipment

ÿ Health & Safety and

ÿ Serious Untoward Incidents to the Region.

Solutions often include revising and improving procedures and protocols; ensuring more robust systems are put in place; and undertaking training in certain areas.

All incidents reported to the LHB are entered into the Datix Incident Reporting System and checked to ensure immediate actions have been undertaken to minimise any possible harm.

The Compliments, Complaints and Incidents Committee meet on a quarterly basis to go through all complaints, incidents and near misses. They decide if further investigation is required and:

• ensure all necessary immediate action was undertaken;

• agree what lessons can be learnt;

• ensure everyone who needs to know has been informed of the lessons learnt and the necessary changes made

All reported information and any identifi ed ongoing risks are reported to the LHB Board and the Clinical Governance Committee. This process ensures that everything possible is done to reduce harm that might arise from an incident and that the risk of recurrence is greatly reduced.

All untoward serious incidents are reported to the Welsh Assembly Government Regional Offi ce. The Regional Offi ce is also updated on a quarterly basis of the outcomes and progress of all these.

Sonia Luke, is our Quality Facilitator and visits GP practices to conduct QoF visits, as well as managing incidence reporting and NPSA alerts. The team also visits dental practices to review some issues pertinent to the Dental Reference Service reports.

NHS Funded Nursing CareNHS Funded Nursing Care involves providing a funding contribution for the registered nursing care provided within a care home. The rate for 2008/09 is £117.66 per week.

During the year Nurse Assessors carried out a total of 54 initial assessments and 93 annual assessments. The nursing team also developed a comprehensive nursing assessment for use on all assessments and reviews in the nursing homes.

During the year, a bilingual public information leaflet has been developed entitled ‘NHS Funded Nursing Care Explained’ This can be obtained from the LHB and is available on the LHB website. Nurse Assessors have been actively involved in the 1000 Lives campaign, in particular the Health Associated Infections group, and facilitating training in infection control for the Care Homes. Nurse Assessors are also involved in the Ceredigion Falls Prevention group and the Protection of Vulnerable Adults subgroup.

The Nursing Needs Decision Record (NNADR), a Welsh Assembly Government initiative rolled out during 2007, continues to be used by the Trust and further comprehensive training was delivered jointly by the LHB and the Trust in Bronglais General Hospital during 2008.

The Care Home Managers Forum continues to provide Care Home Managers and Nurses in Ceredigion and neighbouring counties with a forum to discuss relative issues, provide peer support and for professional development.

Individual Patient Commissioning (IPC)Individual Patient Commissioning is the process when a GP or NHS Consultant makes a request for funding for certain treatments which are not currently available locally, on an individual patient basis.

The Ceredigion and Pembrokeshire LHB Individual Patient Commissioning Panel has met bi-monthly since April 2008 and considered a range of funding requests from Ceredigion and Pembrokeshire residents to access specialist treatments/assessments. This included (but not exclusively) specialist high cost drugs, specialist equipment, and specialist treatment/surgery.

Funding decisions are made by a panel of professionals based on patient need and clinical evidence. The numbers of cases brought before the Individual Patient Commissioning (IPC) and Prior Approval (PA) panel from 1 April 2008 to 31 March 2009 are as follows:

A Three Counties IPC Policy was ratified by the Board in January 2009 and has been distributed to all appropriate clinicians in Carmarthenshire, Ceredigion and Pembrokeshire.

It is anticipated that from September 2009 the LHB will also facilitate the IPC process for Carmarthenshire.

Welsh LanguageThe LHB is committed to the principle that in the conduct of public business it will treat the English and Welsh languages on the basis of equality and this will be reflected in the way it carries out its public duties. The Revised Welsh Language Scheme for the LHB received approval by the Welsh Language Board on 31 March 2008.

To strengthen Welsh Language provision within NHS services in Wales, a Welsh Language Unit has been established to support the 7 LHBs in the Mid & West Wales Region since September 2008. The Officer and Secretary are based in the Ceredigion LHB offices in Lampeter. The Unit aims to ensure effective implementation of the Welsh Language Schemes of the LHBs, promote language awareness and bilingualism and provides a translation service.

This Welsh Language Unit, working closely with the LHB, has helped to increase support and guidance to staff about being a bilingual organisation and recognising the need of the public to express their views and needs in their preferred language. This includes providing regular guidance and newsletters to staff and the development of intranet for staff information.

Some of the work this year on developing information on bilingual services includes sending bilingual letters and offering language of choice for Nursing Care Assessments whenever possible with bilingual staff; all complaints correspondence are now available bilingually; and, following an enquiry from a member of the public, information was sought on Welsh and other languages spoken by primary care contractors, including GPs, and added to information on the LHB’s website for the public.

Over the last year Ceredigion LHB has also made progress against its own five pledges that it was asked to identify by the Welsh Language Board within the revised Welsh Language Scheme. This includes meeting with the local Menter Iaith, CERED to discuss possible joint work; providing staff guidelines on the requirements of the Welsh Language Scheme, particularly to help staff to make their e-mail signatures and out of office replies bilingual, and developing work with Human Resources Department on identifying Welsh language skills required in posts.

Further progress in the delivery of bilingual services is intended, with a planned review of the Welsh Language Scheme for the new Hywel Dda LHB.

Promoting Equality and DiversityDuring the year the focus has been on the development of a single equality scheme in response to the Equality Act 2006. Work has been undertaken on combining the work of the LHBs in the counties of Pembrokeshire, Carmarthenshire and Ceredigion and the Hywel Dda NHS Trust, which has provided an opportunity to bring together good practice from each of the organisations.

The new scheme will set out how the Health Board will continue to meet its legal duties for race, gender and disability. The scope of the scheme has also been extended to incorporate religion or belief, sexual orientation, age and human rights.

The Scheme will provide information and guidance to employees, patients, partner organisations and the general public on how the organisation will fulfil its duties under equality and human rights legislation.

All employees, agents and contractors undertaking work on behalf of the organisation will be responsible for implementing the Scheme.

The organisation is committed to the principle that all individuals from all communities and groups should have equal rights and access to health and social care when needed. The organisation is also committed to ensuring that staff will be confident in their ability to deliver the best healthcare possible within a truly supportive environment.

The draft Single Equality Scheme is available from the LHB’s website. For further information or to contribute to the scheme please contact Jackie Hooper, Equality and Diversity Advisor on 01267 227014.

319 IPC - Pembrokeshire 147 PA - Pembrokeshire

223 IPC - Ceredigion 120 PA - Ceredigion

My Name is Helen Williams and I am Nurse Director for Ceredigion and Pembrokeshire Local Health Boards. My role involves providing nursing advice to the Boards, being responsible and accountable for Nursing and general policy decisions and having an agreed scheme of delegation. My main areas of responsibility include Primary Care Nursing, NHS Funded Long Term Care, Vulnerable Adult Protection, Immunisation and Vaccination, Learning Disabilities and Mental Health. The work is delivered by a team approach across the Directorate.

Karen Thomas, is a Registered General Nurse with 30 years experience working in the NHS. Based in South Pembrokeshire Hospital for 25 years she gained experience in Rehabilitation, Medical and Palliative Care. Following completion of her degree, Karen joined the LHB in August 2005, and is currently the Individual Patient Commissioning Co-ordinator for Pembrokeshire, Carmarthenshire and Ceredigion. Her role involves processing all Individual Patient Commissioning and Prior Approval funding requests and taking them panel. Her role is both varied and interesting.

14 15

Vaccination and ImmunisationThree Counties Vaccination and Immunisation Group In November 2008 the first meeting of an integrated 3 Counties Vaccination and Immunisation group commenced which saw the merging of key people across Ceredigion, Carmarthenshire and Pembrokeshire. This group will develop and implement a partnership programme to increase the uptake of all childhood and adult vaccine programmes across the Hywel Dda Community. This group is supported by the National Public Health Service for Wales.

Human Papilloma Vaccine (HPV) In October 2007 WAG introduced a Human Papilloma Vaccine (HPV) into the national immunisation programme. This new programme commenced in September 2008 and was offered to girls aged 12 to 13 years of age. The schedule has been delivered through a school based programme with positive uptake results:

Ceredigion Pembrokeshire HPV1 84.6% HPV1 85.3% HPV2 84.3% HPV2 84.7% HPV3 60.2% HPV3 0.0%

(COVER 90 NPHS May 2009).

An extension to the programme commenced in January 2009 to vaccinate young women born between 1 September 1990 and 31 August 1991. This programme is being delivered by GP practices. The LHB has been involved with ongoing support, education, training and advice for all practice staff.

Measles October 2008 saw a measles outbreak in South Ceredigion and this situation has progressed with outbreaks in both Pembrokeshire and Carmarthenshire. The LHB is working closely with NPHS, Hywell Dda NHS Trust and GP practices to increase uptake of the MMR vaccine. A review of national guidance implementation led to the development of the MMR action plan for Hywel Dda NHS Trust, Carmarthenshire, Ceredigion and Pembrokeshire LHB’s. An MMR media campaign was also agreed including posters and an information pack to be distributed across the communities.

Immunisation and Vaccination local Delivery Plan A plan has been developed to inform the development of a framework and strategy for Immunisations and vaccinations.

Training Annual vaccination and immunisation training continues across the three counties in accordance with and to meet the National Minimum Standards as recommended by the Health Protection Agency (2006). A rolling programme has been developed to provide equality in information and education across the three communities.

Healthcare Associated Infections (HCAI)/1000 livesHealthcare Associated Infections are one of the key content areas for the 1000 lives campaign, and continue to cause substantial patient deaths, cost to the health service and individual cost to patients.

However, there is good evidence that a proportion of these infections may be preventable through careful attention to infection control procedures.

As part of the 1000 lives campaign and in response to implementing the “Healthcare Associated Infection Community Strategy” WAG (2007), the 3 LHB’s have been working with NPHS and the Hywel Dda NHS Trust to establish local service delivery and action plans.

Achievements for 2008/09 included:• Establishment of a local HCAI multi-agency group to

address issues and develop action plans.

• The clarification of roles, responsibilities and accountability in relation to HCAI’s within community and primary care services.

• Training needs assessments undertaken across primary care and care homes.

• Infection Control training sessions delivered to primary care and care homes. National e-learning programme actively promoted with good uptake.

• Engagement with primary care practices and care homes to undertake audits and implement infection control standards using evidence based practice and tools from the NPHS.

Freedom of Information Freedom of Information (FOI) in the NHS The Freedom of Information Act 2000 gives the public a general right of access to all types of recorded information held by public authorities. The purpose of the Act is to encourage greater openness by public bodies.

Since the introduction of the FOI Act, Ceredigion LHB provided many responses to requests. Examples of the requests received include information on:

ÿ Prescribing Formulary ÿ Mental health commissioning ÿ Senior management structure & staffing structure ÿ Diabetes services ÿ Wheelchair provision ÿ Prescriptions

Between 1 April 08 and 31 March 09 we received 28 requests for information under the Act.

This scheme is available on our website at www.ceredigionlhb.wales.nhs.uk or alternatively a hard copy is available by contacting the LHB.

If you need help with your request please contact the Freedom of Information Officer, Ceredigion and Pembrokeshire LHBs, Y Bryn, North Road, Lampeter, Ceredigion. SA48 8AZ or e-mail: information request@ceredigionlhb.wales.nhs.uk and the LHB will respond promptly.

“Disposable paper towels are the best

option for drying hands because

damp towels can harbour germs”

+

16 17

There has been a good attendance at the Committee meetings with representation from a wide range of professionals which has enabled the group to maintain a broad perspective when reviewing documentation. The Committee has also gained a greater understanding of clinical issues and events which has enabled discussions around how we can engage with other organisations to fi nd solutions.

Clinical Governance NewsletterA Clinical Governance Newsletter was produced to update and inform Primary Care contractors on ways to improve patient care through good practice and disseminate lessons learnt from events. It is hoped that this will become more frequent in the future and contractors will be encouraged to contribute.

Audit of Dental Nurse Qualifi cations In August 2008 the registration of dental nurses became a mandatory requirement from the General Dental Council. In response to this an audit has commenced regarding dental nurse qualifi cations. The replies so far have confi rmed the current requirements that all dental nurses should either be qualifi ed or in training, have been met.

National Institute for Health and Clinical Excellence (NICE)The Joint NICE Advisory Group continued to meet regularly to look at the implementation of NICE Guidance. This is a joint group with members from the Hywel Dda NHS Trust, Ceredigion and Pembrokeshire LHB’s. In the future the group will be reviewed to include Carmarthenshire LHB.

Clinical Governance Toolkit The GP Clinical Governance Toolkit remains an eff ective way of helping GP surgeries assess their level of clinical governance within their practice but further work needs to be carried out to support practices in its completion.

Clinical GovernanceWhat is Clinical Governance?Clinical Governance means:

“providing the right care to patients, by the right staff , in the right way, at the right time, and always aiming to provide the best service”. (Clinical Governance in Wales – WAG Leafl et 2008)

The LHB has a duty to ensure that the quality of care received by the patient is maintained and improved upon.

The Clinical Governance CommitteeThis work is monitored by the Clinical Governance Committee, which has met 3 times over the last year. The last meeting was a joint meeting covering both Ceredigion and Pembrokeshire. The Committee initially reported direct to the Board and, from December 2008, to the Integrated Governance Committee. The standard of care is measured by the Welsh Healthcare Standards.

The Clinical Governance Committee has been asked to scrutinise reports and policies across the wide spectrum of Clinical Governance.

These included the following areas:ÿ clinical governance around consentÿ NICE guidance and medicines managementÿ infection control ÿ research approval ÿ public and patient involvementÿ prescribing and pharmaceutical auditsÿ copying of lettersÿ substance misuse and ÿ vulnerable adults

The LHB Clinical Governance Team is in place to encourage all healthcare professionals within primary care to continually examine the way they work and compare their procedures with best practice.

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Sonia Briggs, is currently seconded to the Clinical Governance Managers post having been employed by the LHB for 3 years. In addition to this role, Sonia also has delegated responsibility for Palliative Care issues and manages the Macmillan Education post; and NSF Older Person. Sonia is a Corporal within the RAF Reserve Service and has been on active deployment to Afghanistan.

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Primary Care NursingThe LHB Primary Care Nurses continue to progress the development of standards, provide on-going professional advice, training and education to Primary Care Nursing Staff . On-going achievements and developments include:

• Appraisal system for Primary Care Nursing Staff . Information from the appraisals informs the training needs assessment and future training plans, enabling the LHB to facilitate Continuing Professional Development (CPD) for the staff .

• Training that has been delivered over the year includes: Immunisation and Vaccinations, Ear Care, Infection Control, Sexual Health, Genito Urinary Medicine, Lipid Management, Heart Failure, Management of Controlled Drugs in Primary Care, Palliative Care, Cardiology, Prescribing in Respiratory Medicine and Depression.

• Phlebotomy training for Primary Care Staff continues to be delivered eff ectively in Primary Care across Ceredigion. Evaluation of the training confi rms the high standard of training delivered.

• Collaborative working with the Heart Failure Nurse and Primary Care Staff to improve the care for patients with Heart Failure.

• The delivery of an induction day for Practice Nurses across Mid West and South Wales. This successful day provided peer support, education and networking opportunities for staff new to post.

• In response to the GP’s contract, and the need for Primary Care Staff to access clinical supervision, a pilot group has been established. This peer supervision group is facilitated by the LHB and involves nurses from 5 Practices. This will be reviewedand evaluated in August.

• The 3 counties wound formulary is near completion. This has involved collaborative working between the 3 Trusts and 3 LHB’s. Training will be made available to all staff involved in wound care later in the year.

• Practice Nurse of the Year: Amanda James, Specialist Practice Nurse at Lampeter Medical Practice was runner up in the Wales Practice Nurse of the Year awards. This was for her contribution in implementing evidence-based Practice for Cardio Vascular Disease in Primary care.

• Increasing the numbers of Independent Nurse Prescribers in Primary Care is key to meeting the requirements of Welsh Assembly Government Chronic Conditions Framework and the proposed Community Nursing Strategy. We currently have two nurses who are undertaking the Independent Nurse PrescribingCourse with the University of Swansea.

WHEN SHOULD WE WASHOUR HANDS?

Everyone should wash their hands;

whenever they look dirty

after using the toilet or helping a child to use the toilet

immediately before handling any food and immediately after handling

raw food (especially poultry)

+

Julie Kilford, is the Clinical Governance Administrator and deals with much of the communication for the Clinical Governance Team including the running of the Clinical Governance Committee and the production of the Clinical Governance Newsletter. Julie is also involved in the process of approval of Research within primary care.

NHS Dental Practices in CeredigionDid you know that there are approximately 107 dental appointments per week available for unregistered Ceredigion patients who are in dental pain?

Between Monday and Friday, two dental practices offer emergency access appointments for unregistered patients in the Ceredigion area. They are Denticare, 2 The Market Place, Lampeter, tel. 01570 423630 and Denticare, 61 North Parade, Aberystwyth, tel. 01970 612266.

Managing Mouths in Ceredigion Nurse Mangers in Ceredigion recently attended an oral health training event organised by the Pembrokeshire LHB.

The Managing Mouths training consists of four modules covering

• Preventing dental decay • Looking after dentures • The aging mouth • Oral Hygiene and cleaning techniques.

20 21

Moving More Often in CeredigionMoving More Often (MMO) is a programme for those working with frailer older people who wish to promote physical activity, and is ideal for people living in residential care or who attend a day centre. The aim of MMO is to encourage the uptake of gentle exercise through the use of games and group activities. It is a British Heart Foundation scheme supported by the WAG.

Background A partnership group was formed in Ceredigion, as the County was selected to take part in a pilot of the scheme.

The MMO partnership group decided to dovetail the MMO scheme to the county’s existing Extend exercise initiative which is a more comprehensive physical activity programme involving the training of care staff.

Training was provided to: • Staff in Council residential care homes including an EMI unit, • Staff in a privately run residential care home, • Age Concern Day Centre Volunteers and • The Council Reablement service.

Funding was acquired from WAG and the Sports Council which paid for equipment and training. A DVD was produced to help with the evaluation and to promote the scheme to other homes.

Ceredigion was involved in an early pilot of the scheme and was therefore able to offer support to colleagues in Pembrokeshire and Carmarthenshire public health teams to set up their programmes.

Evaluation Developing the MMO scheme has been a positive experience for participants, care home staff, volunteers and the members of the Partnership Group, with a high level of enjoyment. Everyone involved has found it very rewarding and participants have identified benefits in terms of physical and emotional wellbeing and social interaction. The staff enjoyed the chance to interact with participants in a new and fun way. The changes noted since beginning the sessions include walking, mobility, laughing and feeling good. The scheme continues to run well, and over time, increasing numbers of participants have become involved.

If you would like to find out more about Moving More Often in Ceredigion contact Lucy Hancock 01570 423957

Patients can access emergency dental treatment on a Saturday morning with Denticare, Lampeter and on Sunday Mornings with Denticare Aberystwyth. This service also runs on Bank Holidays.

For information on how to access the weekend and bank holiday service please telephone the NHS Direct Dental Information Line on 0845 60 10 128.

If you require any help regarding an NHS dentist please contact Christine Green the LHBs Dental Services Administrator on 01437 771257 or email: christine.green@pembrokeshirelhb.wales.nhs.uk

Ceredigion Local Public Health TeamIachus Gyda’n Gilydd – Healthy Together Ceredigion

£454,802 Big Lottery Funding over 3 years for Ceredigion Local Health Board.The aim of this project, ‘Iachus Gyda’n Gilydd’, is to promote healthy eating and physical activity to address obesity prevention in children under the age of 12 in Ceredigion.

This will be achieved with active participation to develop and deliver festivals with healthy eating, physical activity and play themes in 4 areas of Ceredigion.

The target areas are Penparcau, Llangybi, Llandysul and Llanarth (including New Quay). These areas have been identified as requiring specific intervention in order to improve the health of children from the local Health Needs Assessment 2007.

This project will:

• Build capacity and support children, their families and community groups in the chosen areas.

• Explore existing perceptions of healthy lifestyles amongst the target group and support participants to make positive choices in their lives.

• Monitor and evaluate all project activities and outcomes to produce evidence on the contribution of the Healthy Places festival model to positive behavioural change.

Festivals will be held on a regular basis, some linking to existing events and assisting children, families and community groups to develop new festival ideas. These may include food festivals, inter community sports, farmers markets, games days, carnivals, community harvest festivals and feasts. Small festivals will build up to larger inter - community festivals, improving physical activity, healthy eating and community cohesion, within and between the four areas.

It is envisaged that ongoing activities will develop alongside the festivals, such as growing food, ‘come & cook’, local food tasters, snacking healthily, and family games. The project will involve whole families participating together to stage festivals and events.

The successful funding application was developed by a multi-agency group under Ceredigion’s Health and Well Being partnership. Project managed by Ceredigion Public Health Team.

The programme which aims to support care staff in providing oral health care for older people in residential care is supported by an information manual which is available in welsh and includes oral health care assessment forms which may be used in conjunction with the residents care plan.

For more information about Managing Mouths please contact the Pembrokeshire LHB 01437 771220

+ “Liquid soap is better than solid

soap because it is less likely

to become contaminated”

Medicines ManagementThe aim of the Medicines Management Team is to ensure that people within Ceredigion receive the best quality medicines management and pharmaceutical advice and care possible within the available financial resources.

Prescribing of medication is the most common approach taken when treating patients in the NHS. Effective medicines management promotes improvements in clinical outcomes and reduces risk of error.

This year, in addition to providing prescribing advice and education to GPs in the County, the Medicines Management Team has provided additional support to community pharmacists and nurses.

One example is the provision of emergency hormonal contraception (EHC) by accredited pharmacists, which is available in many pharmacies throughout the County. This service is free of charge and provides immediate assistance to the patients, and valuable advice and guidance regarding general sexual health and contraceptive options. If additional healthcare issues have been identified, or raised by the patient within the consultation, then referrals can then be made to GPs.

The Medicines Management Team continued to visit practices within Ceredigion to discuss issues which may have been highlighted from the practice prescribing information, and to discuss clinical and educational issues which affect prescribing. A set of objectives is agreed upon and progress against these is measured.

Overall, the Medicines Management Team are involved in a number of wide ranging activities helping to ensure that medicines are prescribed and used in a safe, efficient and cost effective manner.

3 Counties Medicines Waste CampaignAcross Ceredigion, Pembrokeshire and Carmarthenshire unused/returned prescription medicines are costing approximately £1.5 million a year – equivalent to the cost of employing 30 more community nurses or performing 1,609 cataract operations. Ceredigion LHB Medicines Management Team worked collaboratively with Pembrokeshire and Ceredigion LHB’s to focus on this issue and in March 2009 the Medicines Waste Campaign was successfully launched across the three counties.

The launch events were covered by national television networks and local press highlighting the potential savings that could be made if only medicines that were needed were obtained. The campaign was embraced by community pharmacy and by medical practices throughout the area and feedback from the contractors was very positive, both on the quality of the campaign material and its content. The key messages of the campaign were clear and simple:

• Only order what you need • Wasted medicines waste money • Unused medicines cannot be recycledPosters and leaflets were distributed to all community pharmacies and GP practices, with the addition of bottle shaped reminders which were placed inside each prescription bag given to patients.

Community pharmacy continues to be involved in health promotion campaigns throughout the year and feedback following each campaign helps to inform and guide the LHB with regard to future initiatives.

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Investors in Carers The Ceredigion Investors in Carers (CiiC) scheme is an accredited award framework for GP practices. The scheme measures the standards of good practice and ways of working, to support Carers within the practices and the county.

The scheme was designed by a team from Ceredigion LHB, the Carers Development Lead from the Local Authority Social Services Department, and the British Red Cross Carers Fieldworker project from the Voluntary Sector. The team’s aim was to look at Carers and their Primary Care issues.

There are many benefits for both GP practices and carers that are achieved from the scheme ensuring all Carers get help and support in their caring role and with their own health.

Fourteen GP Practices in Ceredigion originally achieved the Bronze Award and the Ceredigion Investors in Carers (CiiC) scheme has won national awards for its innovation and joint working.

In order to provide further information on carers and support for GP practices in Ceredigion, a Workshop was held on 25 February in Lampeter. The Workshop included sharing best practice from a report carried out by the Princess Royal Trust for Carers and Royal College of General Practitioners. A valuable presentation on recognising, identifying and understanding support to Young Carers in Primary Care settings was received, including hearing from a Young Carer about her personal experience which had a powerful impact. The session also provided an opportunity to reflect and exchange with other practices their achievements in respect of the help and support for carers.

The CiiC project has been successful in obtaining a small grant from the Ceredigion Well Being Activity Programme 2009 which will help make possible further work to develop the scheme and to support GP practices.

The Investors in Carers toolkit of information to run the scheme has been copyrighted by Ceredigion LHB and six toolkits have been purchased to date by organisations across both Wales and England. This includes Pembrokeshire and Carmarthenshire, the neighbouring counties which will make up the future Hywel Dda LHB, who have already or are currently running pilot schemes with some of the GP practices in their counties.

The money received from other areas purchasing the scheme is reinvested in the Ceredigion Investors in Carers Scheme which this year has included purchasing additional time from the Red Cross Carers Fieldworker Project to work with GP practices and the funding was also used for the Workshop with GP practices.

Care on CallCare on Call, the GP Out of Hours service in Pembrokeshire, is now in its 5th year of operation.

The service managed:

ÿ approximately 39,000 calls last year ÿ resulting in 14,000 patients being seen at treatment

centres across Pembrokeshire and Ceredigion, ÿ 5,000 patients being seen in their own homes. ÿ In addition, a total of 8,000 calls were resolved with

telephone advice by a Registered GP or a qualified practitioner, and

ÿ 9,000 calls resolved by advice from a trained nurse.

Work is continuing on the Unscheduled Care Project, with several staff being involved in drawing services together. It is planned to integrate the 3 Out of Hours Services of Carmarthenshire, Ceredigion and Pembrokeshire from October 2009. This will give opportunities to work across boundaries, improving access to care for all patients within the Hywel Dda community.

On Line Clinician (OLC) was introduced successfully into the treatment centres during Autumn 2008. OLC is an electronic system that enables the clinicians to enter consultation data directly onto the Out Of Hours computer system rather than writing the notes onto paper call sheets. Concerns had been raised by GP practices that the hand-written call sheets were sometimes difficult to read and the printed call sheets generated by OLC have alleviated this problem for treatment centre consultations.

Other benefits have included:ÿ consolidating the information produced (and used) by

the service into a single record of care, ÿ greater clarity of notekeeping and ÿ improved transmission of patient information to

surgeries the following day.

Medicines Waste Information Campaign A Medicines Waste campaign was launched on 6 March 2009 across Ceredigion, Pembrokeshire and Carmarthenshire. Its aims were to raise awareness with the public and health professionals of the significant amount of returned and unused medicines by highlighting the patient safety, clinical effectiveness and cost issues. The campaign attracted media attention and included roadshows at pharmacies where the public could ask for more information and there were inserts included with prescriptions with the main messages to help people think about their use of medicines.

THINK BEFORE YOU ORDERAsk in your pharmacy or GP

surgery for further information

HELP US MAKE MORE OF YOUR LOCAL NHS

Wasted medicines waste money

Repeat Prescription?

ONLY ORDER

WHAT YOU NEED

Healthcare Standardsfor WalesThe Healthcare Standards for Wales set out the Welsh Assembly Government’s common framework to support the NHS and its partners in providing eff ective, timely and quality services across all healthcare settings.

The Healthcare Standards are used by Healthcare Inspectorate Wales as part of their processes for assessing the quality, safety and eff ectiveness of healthcare providers and commissioners across Wales.

There are 32 Healthcare Standards covering 4 domainswhich are:

ÿ Patient Experience

ÿ Clinical Outcomes

ÿ Healthcare Governance and

ÿ Public Health

All healthcare providers are assessed against the standards. Progress against the quality and patient safety improvement areas was regularly monitored throughout the year. All reports relating to the self assessment can be found on our website.

Improving the Health of Homeless and Specifi c Vulnerable groupsThe Health and Homelessness Standards are the Welsh Assembly Governments next step towards improving and addressing the health needs of all ages of homeless people and specifi c vulnerable groups.

In this context, the specifi c vulnerable groups include people who are homeless, asylum seekers and refugees, gypsy-travellers and migrant workers.

The approach to meeting their health needs will involve:

• Improving service delivery

• Improving strategic direction within the health service.

The LHB is the lead agency for the Standards, however crucial to the delivery will be good partnership working across the NHS, Local Authority and the voluntary sector.

In Ceredigion, a multi-agency group is being set up to collate the views of those who are homeless and specifi c vulnerable individuals. It is hoped that this work will inform and support the development of service provision for homeless and specifi c vulnerable groups.

24 25

DiabetesBringing together the former Local Diabetes Services Advisory Groups from Ceredigion, Carmarthenshire and Pembrokeshire the new Hywel Dda Diabetes Clinical Network was formed. The network has an agreed structure, terms of reference and has identifi ed priority work areas to progress the Diabetes agenda, share best practice and develop future services.

The network comprises of a wide range of health professionals from both primary and secondary care, together with managerial staff , Diabetes UK, and patient representatives whose valued input ensures the voice of the patient is heard and provides a two way communication link to the Diabetes Patient Reference Groups.

The Network has also established links to associated bodies such as the Diabetic Retinopathy Screening Services for Wales, Education and the Welsh Assembly Government.

The development of the Network has strengthened the Diabetes Service and profi led it as forward thinking and dynamic in its approach.

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Unscheduled CareUnscheduled Care is the delivery of emergency and urgent Health and Social Care on a 24 hours a day, seven days a week basis. It involves all Health and Social Care partners, including Primary and Community Care, Mental Health, Local Authority, Social Care and Voluntary Agencies in partnership with the users of services.

A Local Delivery Plan (2009-2011) has been approved to deliver Unscheduled Care within the 3 counties of the new Hywel Dda Health Board. To serve the population of West Wales, there will be:

Three Emergency and Urgent Care Centres in:ÿ Bronglais Hospital in Aberystwyth,

ÿ Withybush Hospital in Haverfordwest and

ÿ West Wales Hospital in Carmarthen

Three Urgent Care Centres in:ÿ Llandysul,

ÿ South Pembrokeshire Hospital, Tenby and

ÿ Llanelli

Unscheduled Care is not simply ‘an out of hours activity’; it involves ‘in hours services’ providing access for urgent care from 8.00 am until 6.30 pm Monday to Friday. GP services and Social Care Services will have to develop systems for improving access to routine and urgent care ‘in hours’ to ensure that patients get urgent care continuously throughout the working week.Services at West Wales and Bronglais General Hospitals are being redesigned with new buildings and staffi ng arrangements to support Unscheduled Care.Unscheduled Care will bring together services to provide better local Emergency and Urgent Care, with senior staff diagnosing and treating the sickest patients fi rst in the minimum time and ensuring if they cannot be managed in their local hospital, that they are transferred to specialist care as rapidly as possible.Improving Unscheduled Care meets the nationally set policy objectives and will allow better use of staffi ng, resources and tax payer funds and result in improvements in the delivery of scheduled, planned and routine care.New services will be supported by the Individual Health Record from mid 2010 which enables clinicians to access the health record of each patient with their consent, to improve the eff ectiveness and safety of care.

A major public engagement and information campaign will support the changes in care delivery across the 3 counties.

Basic Hygiene PrecautionsWe can all take basic hygiene precautions to minimise the spread of germs. This includes:-• Covering your nose and mouth when coughing or sneezing, using a tissue when possible.• Disposing of dirty tissues promptly and carefully.• Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people.• Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product.• Helping your children follow this advice

Dr Iain Robertson-Steel fi rst came to Pembrokeshire in 1979 as an RAF Medical Offi cer. Iain and his family moved to live in Solva permanently 3 years ago. Iain has extensive previous experience as a GP and Consultant with an interest in Immediate and Emergency Care. Iain is the Associate Medical Director for the Out of Hours and Unscheduled Care and is working with the NHS and Social Care teams to deliver safe and eff ective services for the population in the future.

Ceredigion Local Public Health TeamThe Ceredigion Local Public Health Team (LPHT) is based in Lampeter as part of the Local Health Board, but is employed by the National Public Health Service (NPHS) for Wales, Velindre NHS Trust.

The team works under the leadership of Rachel Russell (Local Public Health Director) to improve the health of the population of Ceredigion in partnership with local public sector, private sector and voluntary sector organizations. The team has been delivering specialist public health advice and services at county level since their establishment in 2003/4.

Some of the activity of the team in 2008/09 is detailed below.

ÿ Bywyd Dda – Health, Social Care and Wellbeing Strategy for Ceredigion The first year of the implementation plan has seen the actions to address the priorities of reducing inequalities, making better connections, early intervention and health improvement and improving quality and integration of services being progressed.

ÿ Mental Health An Open Space Technology workshop held in October started the process of developing an Emotional and Mental Health Promotion Action Plan for Ceredigion. A draft for consultation is due out in summer 2009.

ÿ Substance Misuse Following two successful Open Space Technology workshops, one with young people and the other with professional stakeholders, the priorities and ideas generated will be fed into the development of a Substance Misuse Prevention Plan.

ÿ Accident Prevention Child Safety Accident Prevention training was provided to volunteers and professionals. Mapping of existing work in this area was also carried out.

ÿ Healthy Food and Physical Activity The Healthy Food and Physical Activity Action Groups have now been combined and a joint draft action plan will be out for consultation in the summer 2009.

ÿ Sexual Health 189 young people accessed the “C” condom card scheme between February & April 2009.

ÿ Healthy Schools • 6 primary schools yet to join (target 100% by 2010) • 7 out of the 7 secondary schools are now part of the scheme • Teaching Learning Centres (all 3 sites) are members • Five School Nutrition Action Groups (SNAGs) have been formed in secondary schools. • Consultations have been held with all secondary schools (apart from Tregaron which is arranged for June), on Sex and Relationships Education (SRE) provision within secondary schools. A report, which will include recommendations on enhancing the delivery of SRE within schools in Ceredigion, will be presented to the Local Education Authority by mid June.

ÿ Keep Well This Winter Campaign• Led the local implementation of the

Keep Well this Winter campaign, during the 2008/2009 campaign this included arranging ‘Making Homes Warmer and Healthier to Live in’ training workshops for frontline workers and volunteers

• Developed Keep Well this Winter Calendar and Keeping Warm in Ceredigion booklet.

ÿ Measles outbreak –Newcastle Emlyn October 2008 A response was co-ordinated by the Health Protection Team of the NPHS, supported by the Local Public Health Team.

ÿ Pandemic Influenza Planning Local Public Health Team supported a multi agency pandemic influenza planning group in preparing the Ceredigion Pandemic Plan.

1000 Lives CampaignThe 1000 Lives campaign was launched in April 2008 involving the Welsh Assembly Government, the Wales Centre for Health, the National Leadership and Innovations Agency for Healthcare, the National Public Health Service and the National Patient Safety Agency. It takes forward a number of actions from the Healthcare Quality Improvement Plan: Designed to Deliver 2006 (QuIP) and presents an opportunity to involve front-line staff in the quality and safety agenda.

The aim is to save 1000 lives and to avoid up to 50,000 episodes of harm in Welsh healthcare in 2 years from the launch date in April 2008.

The Campaign will build on the excellent work already underway in Wales and accelerate these efforts around patient safety and quality of healthcare.

Ceredigion LHB along with all LHBs in Wales signed up to the campaign. The medicines management teams within Ceredigion and Pembrokeshire LHB’s have been working together on the evidence-based content areas, which have been developed by clinicians working together in Wales, in the following areas:

• Improving Leadership for Quality – Enhancing and promoting quality and patient safety across the whole health community. One example of a practical way this

can be achieved is through visits or ‘walkarounds’ to GP practices, care homes and hospitals where senior managers, together with non-officer Board members engage staff in a two-way exchange of communication. Issues raised can be addressed quickly and efficiently.

• Reducing Health Care Associated Infections – focusing on practical ways to reduce infections, for example implementing good hand hygiene procedures for staff and patients.

• Improving Medicines Management – focussing firmly on medicines and how they are managed in all situations across the healthcare community, such as how medication is prescribed and dispensed and how the patient is monitored and assisted with taking the medication to achieve the best health outcomes

• Improving General Medical and Surgical Care – looking at how long term chronic conditions such as heart failure, are managed and monitored.

For the duration of the Campaign, Trust and LHBs will have the responsibility of ensuring that best practice is shared, that the impact of any changes is monitored and information shared with other healthcare organisations.

Further details Visit the Campaign website at: www.1000livescampaign.wales.nhs.uk today or email 1000LivesCampaign@wch.wales.nhs.uk

It is important that the improvements we will see reflect all of the local and national initiatives, and the 1000 Lives Campaign will bring together these current and proposed initiatives; add value to them and ensure all healthcare organisations are working closely together.

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Ceredigion Local Public Health Team (LPHT) is based in Lampeter as part of the Local Health Board, but is employed by National Public Health Service (NPHS) for Wales. The team are:

Rachel Russell - Local Public Health Director

Helen Jones - Principal Public Health Specialist

Geinor Jones - Senior Public Health Specialist

Cerys Humphreys - Senior Public Health Practitioner, Healthy Schools

Lucy Hancock - Health Promotion Practitioner

The team are supported by a part-time Senior Clerical Officer - Angela Payne and a part-time administrive officer - Sian Jones.

We aim to improve the health of the population of Ceredigion in partnership with local public sector, private sector and voluntary sector organizations. We promote health and well-being following the principals of the Ottawa Charter (WHO 1986) by, building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and re-orientating health services.

Integrated Community Equipment Stores DevelopmentAs part of the Continuing NHS Health Care process, Ceredigion LHB funds items of specialist equipment for patients in the community. Equipment is provided for sole long term use and is used to address the heath needs of the individual. This equipment is delivered, installed and then collected by the current Joint Equipment Store, based in Felinfach. The store has state of the art repair and decontamination facilities.

In 2002 the Audit Commission report “Fully Equipped” described the problems experienced by patients and service users getting access to clean, maintained and appropriate equipment in a timely way. Following this report the document “Designed for Life”, the National Service Frameworks for Children and for Older People built on the recommendations for appropriate provision of equipment.

In 2006/7 Ceredigion received a Capital Grant allocation of £488k from the Welsh Assembly Government to develop an Integrated Community Equipment Service (ICES).

A Project Board with representation from the 3 partners (Ceredigion LHB, Ceredigion and Mid Wales NHS Trust and Ceredigion LA) was established and a pooled budget arrangement established between the agencies.

It is expected that the service will be fully operational by the end of September 2009. There will be public information and assessment areas on site, training facilities, warehousing and decontamination facilities and an electronic stock control system. Links are being established with Pembrokeshire and Carmarthen ICES services to develop common areas of practice and protocols.

Stop Smoking WalesStop-Smoking Clinics Stop Smoking Wales has been busy in Ceredigion, providing free, friendly support to adult smokers who are ready to stop smoking. Trained specialists provide weekly sessions which are held across the County in various local community and healthcare venues on weekday mornings, afternoons and evenings. The specialists help people to plan and prepare for their quit date and then offer professional support to individuals and groups throughout the duration of the six week smoking cessation programme. To arrange an appointment, contact the freephone telephone number: 0800 085 2219.

Development of the Stop Smoking Wales Service A Public Health Practitioner has been appointed to develop and promote Stop Smoking Wales locally and increase the numbers of smokers accessing specialist support. Based with Local Public Health Team, the practitioner for Ceredigion is Vikki Wood: 01570 423957.

Pre-Operative Smoking Cessation Stop Smoking Wales continues to work in partnership with NHS Trusts to promote smoking cessation support for patients awaiting elective surgery. The service is developing a referral mechanism throughout all appropriate hospital departments, and offers training for healthcare staff to enable them to encourage and refer patients to quit smoking before their operation. Pre-operative smoking cessation will continue to be a high priority for the service in 2009/2010.

Brief Intervention Training A free, accredited one-day training course has been developed for anyone working in health or community settings who would like to learn positive and effective ways of encouraging smokers to quit. The first course will run in Ceredigion in July and is already fully booked. A further date is being arranged for December 2009. For further details please contact Vikki Wood: 01570 423957.

Ceredigion Tobacco Control Forum The Ceredigion Tobacco Control Forum meets regularly throughout the year. Members representing a wide variety of local organisations have developed an action plan, including measures to address smoking prevention, cessation, and protection from environmental tobacco smoke. The Forum was involved in a number of initiatives to promote No Smoking Day in March. For more information about the Forum, please contact Naomi McDonagh, Environmental Health Officer: 01545 572105 ext 4133.

Smoke Bugs A Smokebugs event for Primary schools was held in March 2009 in Bwlch Nant yr Arian, in partnership with Forest Enterprise and the Fire Service. All schools who attended received mini window box gardening kits. Smoke Bugs is part of a smoking prevention programme co-ordinated by the Ceredigion Healthy Schools Scheme. For further information please contact Amy Jones: 07790 023997.

Vikki Wood. As one of ten Public Health Practitioners for Stop Smoking Wales, Vikki’s role is to develop and promote the stop smoking service locally and nationally. She does this by working with partners such as the Ceredigion Public Health Team and Tobacco Control Forum, to provide training for professionals, and increase awareness and use of the service in the community.

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“Towards A Stable Life and A Brighter Future” WAG (2007)The publication of “Towards A Stable Life and A Brighter Future” WAG (2007) provides Guidance and Regulations to strengthen arrangements for the:

1. Placement, health, education and well-being of looked after children and young people; and

2. Responsible Commissioner for secondary health care for vulnerable children placed away from home.

The LHB has been working with the LA and NHS Trust to implement the guidance and regulations.

A Multi-Agency Placement Panel has been established to:• determine that there is no placement in the area

capable of meeting the child’s needs, or that an out of area placement is more consistent with the child’s welfare;

• satisfy themselves that the child’s health and educational needs will be met in the proposed placement;

• agree arrangements for meeting the child’s health and educational needs; and

• agree funding for the placement.

The LHB has also developed local implementation procedures to ensure the regulations in regard to health assessments, commissioning arrangements and information sharing and transfer of records for this group of vulnerable children/young people are met.

Primary Care EstatesThe Primary Care Resource Centre in Aberaeron continues to be developed. The new premises will house the services currently provided at Aberaeron Hospital along with the Oxford Street GP Practice. A site for the development has been identified and a partnership group has been working to develop plans for the premises. A public consultation exercise will shortly follow to ask the public for views on the proposed development.

A new Primary Care Resource Centre in Aberystwyth is planned which will house the GP practice (Padarn Surgery) along with a pharmacy, University Medical Centre and Créche. Rooms will also be provided for health visiting and district nursing in the new premises. A site has been secured and plans were prepared in line with national guidance.

A new Community Hospital/Primary Care Resource Centre is planned in Cardigan which will house the GP practice (currently based in Cardigan Health Centre) along with Cardigan Hospital which includes inpatient services, a minor injury unit, outpatient department, X-ray department, physiotherapy, occupational therapy, speech and language therapy, podiatry and community dental, together with office space for social services and a base for the integrated health and social care team. A site has been identified for the new development on the Bath House Farm development on the edge of town.

Tregaron to house a new multi-agency Resource Centre: the Cylch Caron project aims to develop integrated new premises in Tregaron which will house the GP practice along with the community hospital together with social services, police and housing.

Cylch CaronThe aim of the Cylch Caron Project is to improve access to services for the citizens in the Tregaron and Upland Villages area.

The project aims to develop a multi-agency facility in Tregaron, providing a range of services locally. From the Cylch Caron Centre, there will be an opportunity to provide high quality care accommodation and day care facilities for older people who have a need for assistance, care and support in order to sustain independent living in a community setting. The values of this integrated service to the citizen include choice, independence, dignity, privacy, rights and fulfilment.

One of the main benefits of developing an integrated centre is ensuring economies of scale and developing shared services on one site.

The major elements of this Centre will be the provision of health services, which will include:

• GP Practice • Day Hospital/Rehabilitation Service • Minor Injury Unit • Outpatient Department • X-Ray • Community Dental provision • Therapies • Telemedicine • Inpatient beds

The opportunities of an ‘integrated facility’ include the following:• It will enable Home Care staff to be based on-site

with health/surgery staff allowing for improved communication and an integration of Care Management arrangements that will better respond to the Unified Assessment Process.

• It will enable better access to weekend and late night nursing services on the occasions where this may be necessary and in the provision of palliative care services.

30 31

• Co-location of community nursing and home care staff will enable the implementation of the Community Services Change Programme.

• The provision of day centre facilities will enable opportunities for use by the community in the evenings.

This model of working will also support the extra care housing scheme, where older people are able to live in their own self-contained accommodation, with the availability of health and social care support when needed. The aim of such development is to facilitate independence and choice within a supportive environment. A 30-40 bedded unit is proposed.

The Centre will also offer a wide range of services for the local community:• The County Council is proposing to provide a central

public service point, to provide a customer service base in the town.

• The Council also proposes to provide a registrar service, for births and deaths at the Centre.

• The Centre would also be a location for a tourist information point linking the Tregaron and Upland Villages with the Cambrian Mountains Initiative.

• A Children’s Information Service will also be available at the Centre.

• Dyfed Powys Police also see the potential of maintaining Neighbourhood Team presence, based at the Centre.

• The potential of offering outreach services provided by voluntary groups are also being explored. Examples include:

- Ceredigion Age Concern - Aberystwyth Women’s Aid - Epilepsy Wales - Leonard Cheshire Disability - Mudiad Ysgol Feithrin - Aberystwyth Citizens’ Advice Bureau - MIND Aberystwyth - Ceredigion Association of Voluntary Organisation

It is critical that the Cylch Caron Centre is seen as a community resource. Facilities will be available to the community in the evenings for activities, meetings, clubs etc. In addition, it is proposed that community facilities such as a café would be available.

In order to ensure community involvement in the Cylch Caron Project, an Engagement and Communications Work plan is to be developed. This will ensure that all key stakeholders, including local citizens, are involved in the development and the delivery of the Project, and that community needs are identified throughout the development. The Communities First Partnership and the structures it has will be key to this work. The Ceredigion 2020 Community Engagement Framework will also be used as a key resource.

The projected outcomes of the Project include:• Opening of an integrated, multi-agency Centre in

Tregaron

• An integrated health and social care team for the locality

• Effective use of resources

• Greater communication between partner and local citizens

• Improved access to services for citizens

Emma Cadman, Health Planning Manager - has worked for the LHB since 2004. She works with a range of agencies to prepare bids to the Welsh Assembly to develop new GP premises for the County or develop existing GP practice premises. She finds working with GP practices very rewarding.

+ +

+

Heart Failure Service for CeredigionFollowing a successful joint initiative in Spring 2008, Ceredigion LHB was awarded funding for three years from the British Heart Foundation to provide a Heart Failure Nurse for Ceredigion.

To date over 150 patients have been referred to, and seen by, the Heart Failure Nurse all requiring varying degrees of support and medical management. In the coming months the service will be audited to ensure that the service provided is effective in improving the management of patients with heart failure.

Heart failure is a common condition which effects 2-3% of the population increasing to 10-20% in the over 75’s. It often greatly affects patients’ quality of life with many patients experiencing life limiting symptoms and frequent extended hospital re-admissions.

The Nurse appointed in June 2008 works with Primary and Secondary care to ensure the best possible treatment and outcomes for patients with heart failure. The nurse works closely with local GP’s, Practice and District Nurses as well as with the Consultant Cardiologist at Bronglais Hospital.

Referrals are made when the patient is discharged from hospital and each patient and spouse/carer is contacted within two weeks of arriving home. A visit is organised by the Nurse either in an outpatient clinic or, if necessary, in the patients home.

In this first visit the diagnosis of Heart failure is explained to the patient, with specific attention given to advice on self monitoring and a plan of what action to take if symptoms were to deteriorate. Medical treatment for heart failure is complex requiring close monitoring during a staged optimisation of treatment following agreed protocols. This often happens over a period of months where the patient is seen regularly. However in some cases keeping the patient comfortable is the most important goal involving palliative care teams as necessary.

Outpatient clinics have been developed across the county in several towns and in a variety of venue’s making the service as accessible as possible for the patient.

The service is also set to continue developing, with education of other health professionals being a priority for the coming year.

Mind Your Heart programmeMind Your Heart works to improve the physical health of people with severe and enduring mental health problems in Ceredigion. It supports organisations to help people live healthier lives by eating better, taking more exercise and other activities good for their health.

At the beginning of the financial year we carried out a full evaluation of the first three years of the programme. The resulting report was distributed widely and copies are available by contacting us.

As a result we have consolidated our engagement with voluntary organisations this year and have continued to raise awareness of the importance of good physical health to people with severe and enduring mental health problems. This has included promoting the ‘Healthier Lifestyles for Workers in Mental Health’ Toolkit, published in 2008, giving presentations and running workshops for health professionals and those in mental health services.

In March 2009 we published ‘The Ceredigion Recovery Book’. This is a new version of the original Recovery Book written for Norwich Mind, revised and updated for Ceredigion with local contacts and resources. It has been distributed to all key organisations in Ceredigion.

The book was launched at the National Library of Wales in Aberystwyth by Elin Jones AM followed by a opportunity to talk to a ‘human library’ which allowed people to find out more about the contents of the book.

Finally, we also launched the Mind Your Heart website in March http://www.mindyourheart.org.uk/. Here you can find out about the programme, download our publications and link to other websites concerned with the benefits of looking after the body for those with mental health problems.

“I liked the positive outlook”

“I did come to the training feeling a little negative but the explanation and positive manner I encountered completely changed my view”

“Excellent course, content and involvement”

“It made me aware that you can learn from your own experience and apply it to work”

Jan Batty, Development Worker, Mind Your Heart Jan works on the Mind Your Heart programme, a health promotion initiative to improve the physical health of people with severe and enduring mental health problems. Through training of staff in mental health services, providing support for new activities, information and advice, the programme supports individuals and organisations to choose healthier options.

Emergency Planning As we move towards the new Hywel Dda Local Health Board, Emergency Planning arrangements have been reviewed and strengthened in a number of ways:

• An Emergency Planning Lead has been appointed to cover the Hywel Dda health community.

• Business Continuity Plans have been reviewed and strengthened.

• Major Incident Plans are under review to reflect new structures.

• Pandemic Influenza Planning has progressed significantly as the move was made from pre-pandemic into declared pandemic phase. Existing pandemic plans have been activated and developed according to local need.

• Multi-agency working has been essential in responding to the pandemic - and relationships, plans and processes greatly strengthened as a result.

• Training and exercises have been undertaken on a range of emergency scenarios, with health participating as a key partner.

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Substance MisuseThe Welsh Assembly Government has empowered Community Safety Partnerships (CSP) to manage substance misuse on a local level and support these with substantial increases in funding to commission services and respond to local problems. Ceredigion LHB, along with other partners on the CSP, is committed to addressing the root causes of substance misuse and to providing treatment and support to those who most need it

Ceredigion Substance Misuse Joint Commissioning Group provide a mechanism through which service provision can be researched, developed, purchased and monitored for Ceredigion. The group makes recommendations on the commissioning of substance misuse services to the CSP and the LHB based on evidence and best practice.

Investment into managing substance misuse has increased across Wales, and funding has been invested in Ceredigion in a huge range of services provided locally including education and prevention projects, community based interventions, inpatient detoxifications and residential rehabilitation as well as Specialist Young Persons Drinking and Drugs Services.

A Substance Misuse Commissioning Strategy has been produced which involves undertaking a market, resource and gap analysis and, as a result, priority areas have been identified. Following this, commissioners have produced a 3 year action plan to address areas of need.

The Commissioning Strategy identified a gap in the access to services in the South of the County. As a result of this, Ceredigion LHB in partnership with the CSP invested in the Specialist Prescribing Scheme in Ceredigion enabling the widening of the service to include clinical sessions in the mid and south of the County. In addition to this, capital investment from Welsh Assembly Government has enabled Cyswllt Contact to open premises in Cardigan with structured day care and family services funded via the Ceredigion Joint Commissioning Group.

Ceredigion LHB supports the Criminal Justice Substance Misuse Services specifically for those clients who have Drug Rehabilitation Requirements imposed upon them through the Criminal Justice System. This is in line with the Government’s strategy for tackling drugs and reducing crime and links to the Drug Interventions Programme which aims to get adult drug-misusing offenders out of crime and into treatment.

The National Service Framework for Older People (Ceredigion)National Service Frameworks are designed to improve standards and equity of access to health and social services across the country. The NSF for Older people addresses the health and social care needs of people from the age of 50 onwards, recognising that preparation for a healthy, active and independent old age needs to start early and that the transition into ‘old age’ needs consideration and management. This NSF was developed and presented following the Strategy for Older People in Wales, launched in 2003.

The NSF for Older people was subsequently launched in May 2006, setting out a 5-10 year programme to bring all services up to a minimum good standard in the shorter term, and to share and spread good practice to continuously improve services and strive towards excellence. The NSF details a total of ten standards which set out the rationale and evidence base, followed by the key actions required.

The monitoring of the NSF is managed within each county via a Self Assessment Tool that is completed on a three monthly basis and submitted to the regional office for scrutiny and further discussion. Completion of the SAAT is managed on a partnership basis and includes social care, local authority members, health (acute and community/primary care) and the voluntary sector. The Local Authority is responsible for overseeing the NSF however there are identified leads within each discipline within health and social care.

The end of year report for Ceredigion, in relation to the NSF was fair with progress made on the 2007/08 report. The scores were agreed at 4.88 with the Welsh Median being 5.37. The forthcoming year will present significant challenges within Ceredigion to ensure that the work defined within the standards of the NSF is demonstrated via the monitoring process.

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The Children, Young People and Maternity Services National Service FrameworkIn Ceredigion the LHB has worked in partnership with children, young people, families and service providers from a number of organisations both voluntary and statutory to develop the First Ceredigion Children’s and Young Peoples Plan (CYPP).

Building on good practice, the CYPP focus is on jointly agreed priorities to deliver modern, innovative and effective services across the county, with work progressing on the following key areas;

• The Children and Adolescent Mental Health Services (CAMHS) has continued to focus on continuity of services provided and ensuring that all needs are met for young people moving from children’s services to adult service’s.

All achievements are reported to the Welsh Assembly on an annual basis and the findings of the current NSF review being undertaken will be published in the near future.

The All Wales End of Life Care PathwayThe Pembrokeshire Care Home Project is a three year project which commenced in September 2007 and is funded by Macmillan Cancer Support with additional monies from a Welsh Assembly Government Grant, which enabled the inclusion of domiciliary care agency staff.

The overall aim of the project is to ‘improve the quality of care for patients with cancer and other life limiting diseases through the development and implementation of palliative care educational programmes (incorporating the Care Pathway for the Last Days of Life) for providers of care within Care Homes and Domiciliary Care Agencies’.

Within Pembrokeshire, education and training had already been conducted within the hospital setting and district nursing. Additional work was conducted with Pembrokeshire GP’s, with all but one practice now using the Care Pathways.

The Care Home Project has ensured training for qualified nurses and health and social care workers within nursing homes, over a two day period, looking at areas such as principles of palliative care; palliative care emergencies; communication; team working; cultural and religious issues; pain and symptom management; drug conversions and the grieving process.

To enable and promote the training process, the project nurse has been supported by the nurses within the Pembrokeshire Macmillan Team.

The project is supported by a steering group with representatives from Social Care, Macmillan Cancer Support, Consultant in Palliative Medicine, Care Homes, Voluntary Sector, Out of Hours GP, Care & Social Services Inspectorate Wales.

The project, to date, has been very successful within the nursing homes and domiciliary care agencies. The feedback from participants has been extremely positive

With approximately 18 months of the project time left, the steering group has agreed that work can be

conducted across border into Ceredigion. Initial discussions are underway with relevant

personnel in the Trust.

Three Counties Planning Forum1. Remit The Planning Forum is established to consider and bring forward proposals on the service model needed to support services and hospital configuration for the 3 counties. The Forum continues to meet bi-monthly and has wide stake-holder involvement.

2. Service Groups From February 2007 to date, a total of 20 Service Groups have been set up for individual clinical specialty areas, with the over-riding aim to develop plans for integrated services across Carmarthenshire, Ceredigion and Pembrokeshire. The Service Planning Groups include:

• Breast care • Cardiology • Chronic Pain • Community Services • Critical Care • Dementia • Dermatology • Diabetes • ENT • Mental health Unscheduled Care

• Ophthalmology • Orthodontics • Out of Hours Primary Care • Palliative Care • Stroke care • Substance Misuse • Transport • Unscheduled care • Upper GI Surgery • Workforce Planning

All Service Groups are at varying levels of development and all have presented progress/proposals for consideration to the Planning Forum. A number of these ‘task and finish’ groups have made their recommendations as to the most appropriate service model for the three counties and have now been disbanded. This work is being taken forward within the Trust.

3. Key Achievements Examples of key achievements are:

3.1 Ophthalmology The Planning Forum endorsed the business case for a ‘Wet’ Age-related Macular Service within the 3 Counties. This involved a staged approach to setting up the service, firstly at Amman Valley Hospital in June 2008 and in February 2009 within Aberystwyth. This approach has ensured

Marilyn Wilkinson, has held the post of Project Manager for the Three Counties Planning Forum since September 2007. She moved to this position following many years in Directorate Management positions within Medicine, Women and Children and Mental Health Services within Bro Morgannwg Trust. This enables her to bring to the post an indepth background knowledge and experience in service development within a variety of clinical specialties. Marilyn has also significant experience in Human Resource Management.

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services are now accessible to patients in all parts of the 3 counties with a view to setting up a Pembrokeshire service if there is the appropriate demand.

Age-related Macular Degeneration causes severe visual loss and is the commonest form of blindness in persons over 50 years of age.

The service in Aberystwyth is expanding; there are now over 90 patients within the service with 16-18 patients receiving injections each.

In Amman Valley Hospital there are over 130 patients from Pembrokeshire and Carmarthenshire being treated within 2 lucentis clinics per week.

There has been an extremely positive response from patients and quotes include:

‘It is wonderful to have my sight restored’

‘I can now see to read’

‘I can see the clock on the mantelpiece’

‘Thank you for giving me my eyesight back’

‘I will now be able to do my Christmas shopping

‘You must be very proud to have achieved an award and have photographs of your team displayed in the Carmarthen Journal’

‘My vision is improving’

‘At least my vision is stable and no worse now’

‘The injection looks like colourful metallic paint swirling down at me’

‘Since having the injections my hallucinations have disappeared’

As part of the Trust Staff Award Scheme, the project has received the Chief Executive’s Award for Outstanding Service Innovation and Excellence in Improving Patient Care.

3.2 Mental Health Unscheduled Care To ensure patients suffering with Mental Health problems receive the highest quality treatment when accessing emergency services, a rapid assessment tool has been developed by the Service Group for use by all staff providing A+E and Unscheduled Services across the 3 counties.

A continuous training programme is being provided to all staff on this newly developed rapid assessment tool ensuring assessment processes are consistent with all staff asking the same questions. There has been improved engagement with ‘Out of hours’ GPs and there has also been significant developments regarding the electronic patient record for this service ensuring patient details are shared.

The training programme has now been further enhanced and a training dvd and package has been produced and launched. The dvd has now been made available to all staff working within:

• Ambulance Service

• GP ‘Out of Hours’

• Accident and Emergency

The dvd was produced from within existing budget making the most efficient use of resources by using staff as the actors. This package is currently being evaluated.

3.3 Diabetes Following on from the Diabetes Service Group recommendations, 5 main areas are being progressed by the Diabetes Clinical Network:

Patient Sub-group• Patient reference groups for each county are well

established and are represented on the Network, in an attempt at capturing the needs, problems and opinions of people with diabetes in one group.

• A Tele-health project is planned looking at the health care professionals’ time saving and patient satisfaction outcome in a group of diabetic patients who will regularly transmit their blood glucose readings to the HCP’s computer via a modem phone connection.

“Thorough washing with liquid soap

and running water removes most germs

from our hands”+

As part of the Trust Staff Award Scheme, the Wet Age-related Macular Service has received the Chief Executive’s Award for Outstanding Service Innovation and Excellence in Improving Patient Care.

Information Sub-group• Existing diabetes website for Carmarthenshire will be

expanded and updated for the 3 counties.

• The Network is working with Informing Healthcare to select an all Wales 2y care system which links with GP and district Pharmacy systems and could also incorporate renal and cardiovascular requirements. It is hoped that Withybush and Bronglais Hospitals will be pilot sites for this all Wales Diabetes EPR.

Patient Education As part of an education programme for people to manage their diabetes, structured group education courses for type 1 diabetes (DAFYDD)(4 days) and type 2 diabetes (XPERT)(3 days), are being delivered by dieticians and diabetes nurses. So far, <5% of eligible patients have done these courses.

Professional Training Training of Primary Care staff is an essential pre-requisite for the net movement of chronic disease care from hospitals to the community. Training plans include the following:

• GPs and practice nurses from Pembrokeshire are now attending the Swansea University Masters level diabetes course locally and there are plans to run a similar course next year in Aberystwyth.

• The 4th annual Carmarthenshire Diabetes Update Day for primary care was held in the Halliwell Centre on 18 June with over 100 attendance for all over West Wales.

• The Carmarthenshire Local Enhanced Service in Diabetes required completion of a basic diabetes course by a GP and a practice nurse from each Practice. As a result, all but 2 of the Carmarthenshire practices now provide the diabetes care for all uncomplicated Type 2 diabetics on diet/oral medication.

Specialist Services Developments will be required to be undertaken for the following specialist services:

• Paediatric and young people’s diabetes services • Diabetic foot and vascular services • Renal and diabetic retinopathy services • Diabetic pregnancy

3.4 Palliative care A multi-disciplinary Service Planning Group for Palliative Care is established. To set the scene, a Palliative Care Services Workshop was held on the 12 December 2008, as a first step to take services forward with an integrated approach within Hywel Dda. Baroness Professor Finlay presented the recommendations within the ‘Sugar’ report and outlined the ‘blueprint’ for the planning of future services.

The Group is working collaboratively to ensure the delivery of an equitable palliative care service across the health community. There are a number of work-streams taking work forward which will include:

• 24 hour consultant cover in the region

• The development of a robust Communication Policy

• 7 day working/access to clinical nursing services within Hywel Dda Health Community.

• Funding for Allied Health Professionals to support primary health care

• Rapid Discharge Policy

To reduce duplication, at the last Palliative Care Coalition Group meeting it was agreed that both the Coalition Group and the Planning Group would merge as the intended aims for both were for the development of services in palliative care.

3.5 Community Services - Rehabilitation/ Intermediate Care Rehabilitation/Intermediate Care Service Development is being taken forward by one of the sub-groups of the Community Services Planning Group. A multi-agency ‘Minding the Gap’ workshop was held in April 2009 with over 50 operational staff and managers. There was extremely positive feedback following this workshop with joint principles and future development issues agreed.

Building on the work from this workshop, a Rehabilitation Strategy is in the process of being developed and a further workshop is planned for 24 September 2009, to take forward the key issues.

3.6 Critical Care The overall aim of the 3 counties group is to determine a clear framework of future delivery of critical care services to the residents of the 3 counties and to identify developments in line with Quality Requirements for Adult Critical Care in Wales. The following progress has been made:

• An action plan has been formulated to address shortfalls against quality standards, however, there is a significant funding deficit.

• A regional sub-group is taking forward transport development for critically ill patients.

• The most pressing issue is currently planning for the potential spread of pandemic flu which includes doubling capacity for the critically ill patients.

• A regional sub-group is taking forward questionnaire design to ensure appropriate and consistent feedback from patients and relatives.

• An Information Sub-Group is analysing all existing data collection method, IT databases, format and the timeliness of data reporting.

• The shape of future services is dependant on the outcome of key decisions re trauma and major surgery provision within the Trust. Options are currently being discussed.

3.7 Chronic Pain Within the Planning Group, services within the 3 counties are being assessed against the WAG ‘Designed for Pain’ document principles which include:

• Encouragement of patient self-help initiatives.

• Utilisation of a wide variety of currently available facilities outside the NHS, especially those of Local Authority Leisure Centres.

• The employment of triage techniques once NHS services are sought, to identify those people requiring specific management, for example because of acute medical problems or adverse psycho-social factors. This ensures that resources, including those of the GPs, are efficiently utilised.

• Provision of services, as far as possible, within the community rather than hospital.

• Establishment of management programs based on cognitive-behavioural techniques (CBT).

All Wales Map of Medicine pathways are now drafted, and the Planning Group are contributing to this development. Engagement with primary care colleagues continues to be undertaken.

During September 2009, WAG is to undertake a service audit and the work completed on the above analysis will enable the Trust to respond in a robust fashion.

The over-riding aim is the Devolution of Pain Management Services from secondary care into the Community. The Group is to apply for a funding award from NAPP Pharmaceuticals to pump prime this transition.

Welsh Pain Advisory Board Guidance is awaited, which will continue to inform the Development Plan. The successful outcome of the bidding process will assist in expediating developments, however, the devolution to Community Services will still be perceived as a key service priority.

The next stage is for the group to appraise the service options for the establishment of an integrated service model for Chronic Non-malignant Pain, establishing the logistical and financial obstacles and recommend the service model for Hywel Dda Health Community.

3.8 Cardiology The Service Group has delivered a Strategy (adhering to NSF CHD Quality Requirements and National Standards) for a clinically networked Cardiology service operating across 4 hospitals within the 3 counties. A ‘hub and spoke’ service model is proposed, the hub to be based in West Wales General Hospital (WWGH), Carmarthen with local general hospitals providing core services. There will be timely access to core and specialised clinical services and a large part of care is to be closer to patients’ homes.

Local hospital service will include:

• Rapid in-patient assessment and stabilisation

• Work effectively with tertiary centre

• All have a Critical Care Unit

• Provide Core Diagnostic services

• New and follow-up OP services

• Develop primary care referral pathways

Enhanced services at West Wales General will include:

• A Cardiac Catheter Laboratory

• Enhanced Diagnostic (stress echo, perfusion imaging)

• Permanent Pacing

Tertiary services will continue to be provided with ABMU

NHS Trust and include:

• Angioplasty

• Cardiac Surgery

• A ‘Treat and Return’ process

38 39

3.9 Transport The Planning Group has a new Service Lead and membership. Tangible objectives have been agreed as follows:

To plan an improved quality and whole systems non-emergency Transport Service for patients, through the integration of Trust, Local Authority and Voluntary transport service provision.

Data is in the process of being collected and collated from all Health, Social Care and Voluntary providers of non-emergency transport services within the 3 counties.

This data includes:• vehicles

• staff

• resources

• expenditure

• type and scope of services

• patients/clients

This information will form the baseline for further work with the over-riding aim of establishing an integrated non-emergency transport service. The Norfolk service will be benchmarked.

A Sustainable Travel Plan is being pulled together for the Trust for submission to WAG.

The Forum constitution has proved to be task and relationship orientated and has enabled a very positive partnership and wide ranging engagement. The Forum has ensured a dynamic process, creating an agenda for change focusing on best practice and innovation addressing the complex task of achieving the right balance of services provided on a local/centralised basis.

This collaborative and reflective process provides a firm platform for both future service development and engagement process with local communities and partner organisations. Service development has needed to be incremental in its approach and the Forum has not underestimated the time that is required to achieve service change.

Arrangements for managing the future work of the Planning Forum are being reviewed in the light of the establishment and emerging structures of the new Hywel Dda LHB. It is imperative work is taken forward through the Trust Clinical Services Strategy within a financial framework with links into tertiary service requirements and the development plans of ABM and other neighbouring Trusts. This would provide the opportunity for the Health Board to ensure a whole systems approach to planning and service development.

40 41

CommissioningDuring 2008/09 the LHB’s guiding principles for the commissioning and delivery of patient services were as follows:-

ÿ To develop a multi-agency Modernisation & Innovations Register and Local Delivery Plans; supporting partner organisations and existing Service Development Plans;

ÿ To support and prioritise key modernisation and service improvements by utilising service reviews outcomes and public and patient involvement;

ÿ To direct and monitor the commissioning agenda on a regional level for secondary care services and a local level for primary care services;

ÿ To develop the strategic framework and direction of commissioning across all sectors of the LHB’s, in line with the Health Social Care and Wellbeing Strategies;

ÿ To oversee the preparation of the LHB’s Annual Operating Framework and to ensure robust performance monitoring was implemented.

The focus for 2008/09 was the achievement of waiting times targets, commissioning and service modernisation, which are set out in ‘LHB’s Annual Operating Framework’. As part of delivering the above, the LHB has taken the following actions:

ÿ Across the 3 Counties there has been a review of Primary Care Enhanced Services to ensure that there is uniformity in the delivery of care pathways across the 3 Counties.

ÿ Ceredigion LHB has agreed to work with partner organisations in developing an Integrated Services Model in Tregaron. The Hywel Dda NHS Trust is currently preparing a Strategic Outline Programme for community hospitals and community services in Ceredigion and the development of an integrated facility for primary and community health services in Tregaron will be a key feature.

ÿ The LHB jointly funded a business case for the provision of Wet Aged Macular Degeneration Service from the Hywel Dda NHS Trust. Wet Aged Macular Degeneration represents the most common cause of blindness in the UK and the benefits of the service are the maintenance or improvement of vision for patients with this condition. The service is currently provided from two treatment centres, namely Bronglais Hospital (in Ceredigion) and Amman Valley Hospital (in Carmarthenshire).

ÿ The LHB and Hywel Dda NHS Trust jointly funded a 4th Ear Nose & Throat (ENT) Consultant in order to ensure that the shared ENT service between Carmarthenshire and Ceredigion is sustainable.

2008/2009 Achievements in Patient Numbers and Waiting Times The diagram below sets out the number of appointments/procedures that have been delivered for Ceredigion residents across Hywel Dda, Swansea and Cardiff & Vale NHS Trusts.

In terms of patient care delivered to Ceredigion residents, our 3 main NHS Trust providers are:

ü Hywel Dda NHS Trust - 95% of all procedures/ appointments;

ü Swansea NHS Trust - 4% of all procedures/appointments

ü Cardiff & Vale NHS Trust - 1% of all procedures/appointments

In order to ensure that waiting time targets were achieved during 2008/09 the LHB purchased extra Orthodontic and Oral Surgery and second offer spinal orthopaedic services for Ceredigion residents waiting at Cardiff & Vale NHS Trust.

24,000 Outpatient A

ppoi

ntm

ents

10,000 Inpatie

nt P

roce

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s

7,000 Day Case P

roce

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s

OurMainNHSTrusts*

3

The table below shows the LHB’s achievements in waiting times for Hywel Dda NHS Trust over the last year; with the latest waiting times target of 10 weeks for outpatient appointments and 14 weeks for inpatient and daycase treatments.

WAITING TIMES

Total0-10weeks

0-14weeks

0-22weeks

InpatientAt 31/03/2009 N/A 438 438

At 31/03/2008 N/A N/A 520 520

DaycaseAt 31/03/2009 N/A 660 660

At 31/03/2008 N/A N/A 697 697

OutpatientAt 31/03/2009 2,178 N/A 2,178

At 31/03/2008 N/A N/A 2,920 2,920

Operating Cost Statement for the year ended 31st March 2009 and Achievement of Operational Financial Balance

2008-09£(000)

2007-08£(000)

Primary Health Care 38,219 36,844

Secondary and Community Healthcare 76,026 72,250

Other Programme Expenditure 931 890

Administration Costs 1,385 1,517

Total Expenditure 116,561 111,501

Miscellaneous Income (2,161) (1,598)

Net Operating Costs 114,400 109,903

Less: Non Discretionary Expenditure (1,985) (1,846)

Net Operating Costs less NonDiscretionary Expenditure

116,385 111,749

Revenue Resource Limit 116,412 111,825

Operational Financial Balance 27 76

Balance Sheet as at 31st March 2009

2009£(000)

2008£(000)

Fixed Assets 0 0

Current Assets

Debtors 502 456

Cash at Bank and in Hand 124 28

Total Current Assets 626 484

Creditors: Amounts falling due withinone year

7,511 7,433

Net Current Assets/Liabilities (6,885) (6,949)

Creditors: Amounts falling due after more than one year

0 0

Total Net Assets (6,885) (6,949)

FINANCED BY

General Fund and Revaluation Reserve (6,885) (6,949)

Cash Flow Statement for the Year Ended 31st March 2009

2009£(000)

2008£(000)

Net Operating Costs (114,400) (109,903)

Adjustment for Non cash Transactions (242) (220)

Adjustments for movements inWorking Capital other than cash

32 1,343

Utilisation of provisions 0 0

Net cash Outflow from operating activities

(114,610) (108,780)

Capital Expenditure andFinancial Investment

0 0

Net cash inflow/(outflow) beforefinancing

(114,610) (108,780)

Financing:

Assembly Revenue Funding 114,706 108,771

Repayment of Welsh Assembly Government Loan

0 0

Net cash inflow/(outflow) from financing

114,706 108,771

Increase/(decrease) in cash 96 (9)

This additional income does not form part of the normal recurring income that the Hywel Dda Trust can expect from the Local Health Boards in the Health Community.

The LHB’s Statement of Recognised Gains and Losses shows a nil return.

Local Health Board £m

Carmarthenshire LHB 2.1

Ceredigion LHB 0.8

Pembrokeshire LHB 9.1

Total 12.0

IntroductionCeredigion LHB is required, and indeed has met, the two key statutory financial targets in the financial year 2008/09, which are:

• Not to exceed the LHB’s notified resource limit ; and • Not to exceed the LHB’s cash limit.

An abridged set of accounts for the LHB is set out below. Full copies of the LHB’s annual accounts can be obtained from Louise O’Connor on 01437 771220.

Summary Financial Statements

The LHB’s accounts are prepared using Government Resource Accounting principles as stipulated by Welsh Assembly Government in the ‘LHB Manual for Accounts 2008-09’.

The LHB receives over 98% of its income from Welsh Assembly Government in the form of a resource limit amounting to £116.412m.

The LHB received £0.640m of resource in the current financial year that had been brokered forward from the 2007/08 Financial Year by Welsh Assembly Government.

In March 2009 the Local Health Boards in the Hywel Dda Health Community received an additional non recurring resource allocation of £12.0m from Welsh Assembly Government on behalf of the Hywel Dda NHS Trust, which they paid over to the Trust as part of the Trust’s Long Term Agreement income. The amount received by each Local Health Board is set out in the table opposite.

Financial StatementsCeredigion LHB Annual Accounts 2008/09

42 43

NHS Managers Pay The LHB can confirm that pay rises for NHS senior managers in 2008/09 did not exceed 2.75%.

Pensions Details of the LHB’s pension costs can be found in Note 4.7 of the LHB’s Annual Accounts.

External Audit The LHB’s external auditor is the Wales Audit Office. The auditor was remunerated £66,000 for the statutory audit work, including Value for Money audits, carried out during the year.

Public Sector Payment Policy – Measure of Compliance Welsh Assembly Government requires the LHB to pay non–NHS trade creditors in accordance with the CBI prompt payment code and NHS bodies in accordance with Government Accounting rules. The target is to pay 95% of creditors within 30 days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed with the supplier. No amounts have been included in the accounts arising from claims made by small businesses under the Late Payments of Debts Commercial (Interest) Act 1998.

Public Sector Payment Policy2008-09 2008-09 2007-08 2007-08

Number of Invoices

Value of Invoices £(000)

Number of Invoices

Value of Invoices £(000)

Non-NHSTotal bills paid 2008-09 28,936 15,737 29,514 13,596

Total bills paid within target

28,780 15,369 29,452 13,575

Percentage of bills paidwithin target

99.5% 97.7% 99.8% 99.8%

NHSTotal bills paid 2008-09 739 68,321 701 66,116

Total bills paid within target

714 68,221 680 65,965

Percentage of bills paidwithin target

96.6% 99.9% 97.0% 99.8%

TotalTotal bills paid 2008-09 29,675 84,058 30,215 79,712

Total bills paid within target

29,494 83,590 30,132 79,540

Percentage of bills paidwithin target

99.4% 99.4% 99.7% 99.8%

Financial Position for 2008/09Expenditure During the year the LHB spent £116.6m on services. Of this £76.0m was spent on secondary and community care, such as hospital services, community services, continuing care and the voluntary sector. £38.2m was spent on primary care services such as GP’s, dentists, opticians and pharmacists. £0.9m was spent on other programme expenditure including £0.488m on buying public health and health promotion services from the National Public Health Service. £1.4m was spent on administrative costs including £0.528m which was used to buy services from the NHS Business Services Centre Wales. This is shown in the pie chart below:

Primary Care Primary Care Expenditure includes payments for the cost of drugs, General Medical Services (GMS), Pharmaceutical services, Out of Hours GP cover, General Ophthalmic Services (GOS), General Dental Services and other expenditure.

Included in Other Expenditure are payments for the primary care mental health team, and Clinical Governance in Primary Care.

A pie chart showing the LHB’s investment in the primary care sector is set out below. As can be seen, just under half the LHB’s expenditure in this area relates to drugs prescribed by Ceredigion GPs as follows:

£38,219,000 Primary Care

£76,026,000 Secondary & Community Health Care

£931,000 Other Programme Expenditure

£1,385,000 Administration Expenditure

£14,636,000 GMS

£784,000 Pharmaceutical

£4,537,000 GDS

£609,000 GOS

£1,252,000 Other

£16,401,000 Drugs

£61,115,000 Hywel Dda NHS Trust

£8,371,000 Continuing Healthcare

£675,000 NHS Funded Nursing Care

£5,865,000 Other

Making the ConnectionEfficiency Gains

2008/09

Cash Releasing

£(000)

Non Cash Releasing

£(000)

Investment

£(000)

Net Savings

£(000)

Procurement 0 100 100 0

Support Services 0 528 528 0

Reshaping/reconfigurationof services

0 559 559 0

Better use of staff 0 671 671 0

Total 0 1,858 1,858 0

Secondary Care A pie chart showing the LHB’s investment in the secondary and community care sector is set out below. It is worth noting that expenditure in this area accounts for over 70% of the LHB’s expenditure.

The LHB commissions Secondary & Community services for Ceredigion residents from all Trusts to the value of £65.6m. Within this, the value of the Hywel Dda NHS Trust contract is £61.1m. This is the LHB’s main provider of health care, and this contract amounts to 52% of the LHB’s total expenditure and 80% of its expenditure on secondary and community care.

The LHB’s other two main providers of secondary care are the ABMU NHS Trust, and the Robert Jones & Agnes Hunt NHS Trust.

The LHB spent £9.0m on the provision of Continuing Care and NHS Funded Nursing Care in Ceredigion, an increase of £1.4m compared to 2007/08.

Other expenditure includes the commissioning of healthcare from voluntary organisations, Local Authorities, and the private sector.

Making the Connections Making the Connections is a Welsh Assembly Government sponsored initiative which looks to all organisations in the public sector in Wales to eradicate duplication; dovetail service delivery and either increase productivity or make savings through working together.

The scope which the Ceredigion LHB has for implementing the above initiative needs to be viewed in the context of the fact that two thirds of the entire budget is utilised in the commissioning of secondary care services as previously mentioned. These services are already subject to national ministerial targets for increased productivity set within the Annual Operating Framework, as well as cash releasing savings within the inflationary uplift that is the National Finance Agreement.

Ceredigion LHB, in common with other LHBs in Wales, procures its support services from the NHS Wales Business Services Centre on a shared services basis. By this means the LHB can demonstrate that it has streamlined the provision of support services for Human Resources, Finance, Information Management Technology and Primary Care Contractor Services. Similarly, the LHB also procures Public Health and Health Promotion services on an All-Wales shared basis from the National Public Health Service.

The LHB is currently forecasting that it made productivity gains of £1.858m in 2008/09 for an investment of £1.858m. The LHB’s achievements under the Making the Connections initiative are summarised in the table below:

44 45

Statement of Internal Control1. Scope of responsibility The Board is accountable for internal control. As Accountable Officer and Chief Executive for this Board, I have the responsibility for maintaining a sound system of internal control that supports achievement of the organisation’s policies, aims and objectives, whilst safeguarding the public funds and this organisation’s assets for which I am personally responsible, in accordance with the responsibilities assigned by the Accounting Officer of NHS Wales.

Overall accountability and responsibility for risk management, including controls assurance, lies with the Board and Chief Executive. The Board is responsible for the LHB’s system of internal control, including risk management. It is therefore the Board’s responsibility to ensure that there are proper and independent assurances given on the soundnesss and effectiveness of the systems & processes in place for meeting the LHB’s objectives which are derived from the Welsh Assembly Government’s (WAG) Annual Operating Framework, and delivering appropriate outcomes.

Following the introduction of the Joint Management Structure with Pembrokeshire the previous financial year, during 2008/09 a joint review of the committee structure was undertaken in order to ensure that the reporting structures at the LHB were capable of providing a robust scrutiny process during a time of substantial change in light of the pending NHS Reorganisation in Wales. Integral to this process are the Audit Committee and the Joint Integrated Governance Committee. Under the LHB’s Standing Orders specific responsibilities have been devolved to the Audit Committee, from which the Board receives regular reports. The Joint Integrated Governance Committee has delegated authority from the Board to adopt all policies, procedures etc., relating to clinical standards, risk management, complaints and performance management. This committee reports both directly to the Board and in retrospect to the Audit Committee, in order for the Audit Committee to fulfil its overall role for scrutiny on behalf of the Board.

The responsibilities and accountabilities of each committee are specified within the individual Terms of Reference and are also included in the Risk Management Strategy & Policy. The LHB’s Risk Management Strategy & Policy include principles derived from the Treasury’s Risk Management Framework and from the Welsh Risk Pool on behalf of WAG.

The Welsh Assembly Government is kept fully informed on the risk management processes in place within the organization through the Annual Operating Framework and Service and Financial Framework where significant risks are noted. In addition, financial risks are highlighted within the monthly financial monitoring returns submitted to the Welsh Assembly Government and at regular review meetings.

2. The purpose of the system of internal control The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of organisational policies, aims and objectives, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in the organisation for the year ended 31 March 2009 and up to the date of approval of the annual report and accounts, and accords with Welsh Assembly Government guidance.

3. Capacity to handle risk The Board has in place a robust system of Internal Control with committee structures in place to support the Board and its activities in ensuring Corporate Governance. The organization’s Risk Management Policy & Strategy defines the structures for the management and ownership of risk and also includes the delegation of certain responsibilities and accountabilities with regard to risk, to specific committees and individuals. These include the Audit Committee and the Joint Integrated Governance Committee together with some of the working groups and sub committees, such as the Risk Working Group, Joint Clinical Governance Committee, and Compliments, Complaints and Incidents Committee, which underpin the main Committees of the Board.

The LHB recognizes that embedding risk management into its core business processes, i.e. creating a culture where effective risk management is an integral and natural part of the way most people work, is a key objective for the organization. The Risk Management Policy & Strategy which has been approved by the Board therefore reflects these principles. It includes both individual & corporate responsibilities surrounding effective decision and policy making and the ability to manage risks inherent with the successful delivery of policies and initiatives. It also recognizes that services and projects are increasingly being delivered through or in conjunction with partner organizations, and that good risk management is integral to delivering successful partnerships.

The Risk Management Policy & Strategy is supported by a detailed Risk Management Procedure and Desk Top Procedure for Risk Management. The desk top procedure for identifying risks and preparing action plans for inclusion on the risk register also accommodates both amendment to and removal of risks from the register, leaving a clear audit trail for each risk identified. All staff are made aware of the availability of these documents and are also informed of any updates. Both the Integrated Governance Committee & Board receive

periodical updates on the risk profile of the organization and staff are also informed of these updates. These factors combined have contributed to a risk based approach to the achievement of the LHB’s objectives during the year. The Welsh Risk Pool has highlighted the LHB’s Desk Top Procedure as an example of best practice which has been shared across Wales.

Executive Directors & Senior Managers are also responsible for ensuring that staff understand and apply the LHB policy and strategy in relation to risk management. This is further reiterated in the job descriptions of all staff which makes reference to the individual’s responsibility in having a proactive role in the management of risk. The induction programme for all new staff includes the individual’s responsibility towards risk management with an information sheet included in the Induction Packs. During the year, training sessions were delivered on Financial Governance, Risk Management and Counter Fraud in order to provide regular updates on the subject to all staff. The sessions were designed to ensure that all staff are aware of the importance of financial governance, to ensure risk register awareness & the risk management process, incident & hazard reporting, and counter fraud processes. Further to Board approval to a revision of delegated financial limits, the Scheme of Delegation and authorized signatories list was disseminated to all staff, thus ensuring that all staff are equipped to manage risk in a way appropriate to their authority & duties.

4. The risk and control framework The LHB’s Policy Statement on Risk Management is driven by the recognition that effective risk management is a key component of corporate and clinical governance & is integral to the delivery of its objectives in service provision. The risk management strategy has been developed & implemented to adapt to the changing regulatory environment, including the introduction of Healthcare Standards and to ensure that the principles derived from the Treasury’s Risk Management Framework and the Welsh Risk Pool’s Risk Management Toolkit are incorporated. These factors combined, ensure that an integrated approach to risk management is embedded into the activities of the organisation. The risk management strategy recognizes that risk is inherent in all the organisation’s activities and that it is imperative that responsibilities and accountabilities are clearly defined. The strategy outlines responsibilities for managing risk from the Board down to individual staff, and identifies the corporate accountability arrangements within the LHB towards managing risk. These responsibilities include managing risks associated with the development and delivery of new services/activities and those associated with working with partners/stakeholders.

A documented framework exists which prioritizes risks according to their impact and probability and this is supported by an organisational risk register developed by analyzing the LHB’s corporate and departmental objectives.

The introduction of healthcare standards reflects a performance approach to risk management and assessment of the adequacy of the actual processes in place at the LHB. During 2008/09 the LHB has continued with its consistent and systematic application of the standards throughout the organisation. This has included cross referencing Committee & Board papers, SaFF, Annual Operating Framework & Risk Register reporting requirements to the appropriate Healthcare Standard. This ensures that due diligence is therefore given to the healthcare standards across the whole of the organisation’s activities.

In assessing the Healthcare Standards submission for 2007-08, HIW were specifically looking at whether improvements had been made for those 22 Standards where the LHB were assessed as being Aware or Responding at one or more of the three levels of assessment in 2006-07. It was concluded that although the LHB had made some progress in improving its maturity in respect of 4 the Standards which were assessed at Developing, the others remained at either Aware or Responding and the LHB needed to focus on these during 2008-09. With specific reference to those Standards that underpin the management of risk, whereas the LHB had assessed itself as Practising at all three levels for Standard 16 neither Internal Audit nor HIW concurred with this, resulting in an overall Responding level. A similar position applied to Standard 28, with HIW concluding with Developing at Corporate level and Responding at both Operational and User Experience levels whereas the LHB had considered itself again as Practising. One of the main criticisms was the lack of current & appropriate evidence to support the narrative in the responses and evidence of practical application & evaluation was not apparent. Although from the LHBs perspective the overall HIW conclusion was disappointing, it was encouraging in that it also concluded that the LHB had taken progressive steps to embed the Healthcare Standards into the organisation’s governance processes and had demonstrated commitment to the Healthcare Standards agenda & assessment process.

Further to the 2007/08 self assessment and the HIW verification of performance, the Board approved a Healthcare Standards Improvement Plan, which was also agreed by the Regional Office of WAG. Following the assessment, HIW participated in a workshop and have been working with the LHB in order to improve its maturity in those 18 areas which required strengthening. The Board is presented with regular updates of progress against the improvement plan by means of a traffic light status report and a Healthcare Standards Improvement Plan Progress Report is also submitted to Regional Office on a quarterly basis . Both show significant progress made against all the 18 areas requiring improvement.

The LHB has completed its self-assessment against the healthcare standards for 2008/09 which will be reviewed by Health Inspectorate Wales at a later date. This has been a process which has seen significant Board engagement and staff involvement. In order to ensure that the healthcare

46 47

standards are embedded in the culture of the organization, all staff were issued with a pro forma containing all 32 Standards and were asked either individually or as a team, to indicate where & how elements of the individual/team role contributed to the Standards. A team of Lead Officers, in conjunction with the relevant Executive & Officer input were then assigned to complete the Standards, a process which has involved to some extent all staff within the organisation.

The Board agreed to a scrutiny process which has involved each Non Officer Member being given responsibility for 2/3 standards. Any scrutiny comments received from the Non Officer Members have been fed back to the Leads Officers for further action. Final scrutiny, in the form of a workshop, was placed with the Joint Integrated Governance Committee on behalf of the Board, prior to sign off.

The LHB’s Internal Auditors have also been involved in the scrutiny process, working to an All Wales minimum programme of work as agreed with HIW. An Internal Audit review has been undertaken on a sample of Standards in order to ensure that the evidence adequately supports the responses and that the self assessed score is appropriate in consideration of the maturity matrix requirements. The sample included Standards 14, 16, 27 & 28 which underpin this Statement of Internal Control. The Internal Audit review also considered whether the Board was appropriately engaged and the level of scrutiny involved in the process, both of which were deemed to be effective.

In completing the self assessment for 2008/09, progress made against the HCSIP, as reported quarterly to Regional Office, has enabled the LHB to assess itself as either Responding or Developing in those areas previously deemed weak. With reference to the standards integral to the SIC, the position has either been maintained or improved from the previous verified position. Performance against these 4 Standards has been assessed as follows:

14 - Level 4, Practising 16 - Level 3, Developing 27 - Level 4, Practising 28 - Level 4, Practising As Accountable Officer, I am reassured by the positive feedback that all the necessary processes, together with the action plans are now in place and provide sufficient evidence that the LHB is doing its reasonable best to manage itself against risks of all kinds, and therefore meets all the requirements of acceptable internal control.

5. Review of effectiveness As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive officers within the organisation who have responsibility for the development and maintenance of the internal control

framework, and comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the Audit Committee, Integrated Governance and Clinical Governance Committees and a plan to address weaknesses and ensure continuous improvement of the system is in place.

As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.

In order to reflect the joint management structure with Pembrokeshire LHB, a further review of the committee structure was undertaken during 2008/09, concluding in a Joint Committee Structure with clear Leads & Support assigned to deliver the LHBs objectives. This Board approved revised structure provides the necessary assurances regarding the system of internal control.

The Risk Management Policy & Strategy has also been revised and approved by the Integrated Governance Committee on behalf of Board to accommodate the changes necessitated by the review of Committee Structure and to ensure that it remains appropriate & current. The Risk Working Group during the course of the year has ensured that the Board is kept informed of the risks facing the organisation and the action plans to control such risk. Clinical Governance principles, processes and systems are monitored by the Joint Clinical Governance Committee and encompassed within the Healthcare Standards Improvement Plan. The LHB employs a Clinical Governance Officer whose remit encompasses all clinical risks facing the organization, whilst the Finance Manager is the designated Risk Co-coordinator.

The Audit Committee has played a significant role in approving and monitoring the action arising out of the significant control problems relating to dental contracts which were identified in the 2007-08 SIC.

The LHB receives Internal Audit Services via a Service Level Agreement with the Internal Audit Agency managed by Hywel Dda NHS Trust and has been actively involved in the assessment of the Healthcare Standards self assessment submission.

Signed: B.Rees Date: 10th June 2009 Chief Executive (on behalf of the Board)

Report of the Auditor General for Wales to the National Assembly for Wales on the Summary Financial StatementsI have examined the summary financial statements of Ceredigion LHB’s statutory financial statements set out on pages 40 to 45.

Respective responsibilities of the Board and auditor The Accounting Officer is responsible for preparing the Annual Report. My responsibility is to report my opinion on the consistency of the summary financial statements with the statutory financial statements. I also read the other information contained in the Annual Report and consider the implications for my report if I become aware of any misstatements or material inconsistencies with the summary financial statements.

Basis of opinion I conducted my work in accordance with Bulletin 1999/6 ‘The auditor’s statement on the summary financial statements’ issued by the Auditing Practices Board for use in the United Kingdom.

Opinion In my opinion the summary financial statements are consistent with the statutory financial statements of Ceredigion LHB for the year ended 31 March 2009 on which I have issued an unqualified opinion.

Jeremy Colman Auditor General for Wales 15th June 2009

Wales Audit Office 24 Cathedral Road Cardiff CF11 9LJ

Service Contracts of Non Executive Directors Non officer members are appointed for a term of between 3 and 5 years, the term is staggered to ensure consistency in LHB Board decision-making. Non officer members are required to sign an accountability agreement, which is the agreed contract between the Board and its members for the purposes of their employment.

Remuneration Report Remuneration and Terms of Service Committee In 2008/09 Ceredigion Local Health Board operated a joint Remuneration Committee with Pembrokeshire Local health Board. The members of the LHB’s Remuneration and Terms of Service Committee from Ceredigion LHB were as follows:

Mrs Janet Hawes, Chairman Mr Bob Hughes-Jones, Non-Executive Director

Dr Illtyd Griffiths, Non-Executive Director (until 31 Aug 2008)

Dr Dylan Williams, Non-Executive Director (Until 25 Nov 2008)

Mrs Ann Walker, Non-Executive Director (until 25 Nov 2008)

Cllr Alun Lloyd Jones, Non-Executive Director (from 26 Nov 2008 )

Mrs Bernardine Rees, Chief Executive, was a member of the Remuneration Committee except for matters relating to her own remuneration and terms and conditions.

Policy for the Remuneration of Senior managers From October 2004, the NHS Agenda for Change process was introduced to achieve consistency in contracts and terms and conditions across NHS Wales. New contracts are currently being drafted.

Executive Directors are not part of this process and a review is being undertaken on the possibility of aligning these posts with the Agenda for Change process. Senior managers are currently paid on a local senior management pay scale, any cost of living increases are subject to ratification by the Remuneration Committee as well as any additional remuneration changes.

Executive Directors are on standard contracts with pay bandings based on guidance issued by Welsh Assembly Government for the remuneration of LHB Executive Directors. Any uplifts or awards to Executive Directors are also subject to ratification by the Remuneration Committee.

Notice periods fluctuate depending on the type of contract from one month to three months. Very senior manager’s have to provide 3 months notice.

No termination payments were made during the year 2008/09.

As previously reported, pay rises for NHS senior managers in 2008/09 did not exceed 2.75%. In addition, no directors waived their right to remuneration during the year and no directors were paid allowances in lieu of remuneration. No directors received performance related bonuses during the year.

48 49

2008-09 2007-08

Name and Title

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Executive DirectorsMrs Bernardine Rees - Chief Executive 40-45 0 15 40-45 0 0

Mrs Karen Miles - Director of Finance & Commissioning 35-39 0 0 15-20 0 0

Dr Stephen Griffiths - Medical Director 35-40 0 0 35-40 0 0

Ms Sarah Williams - Director of Community & Primary Care 35-40 0 0 0 0 0

Mrs S. Hurds - Director of Corporate Strategy 20-25 0 0 40-45 23 0

Mrs Helen Williams - Nursing Director 20-25 0 0 30-35 40 0

Mr Mike Powell - Acting Primary Care Director 0 0 0 20-25 0 0

Mr Ceri Lewis - Acting Director of Finance 0 0 0 16-20 0 0

Mr Stuart Moncur - Associate Director 25-30 0 0 0 0 0

Non Officer MembersMrs J Hawes - Chair 20-25 0 0 25-30 0 0

Dr Dylan Williams - GP Member 0-5 0 0 5-10 0 0

Dr Carl Langley - GP Member 5-10 0 0 5-10 0 0

Mr Robert Hughes-Jones - Pharmacist Member 5-10 0 0 5-10 0 0

Dr Illtyd Griffiths – Dental Member 0-5 0 0 5-10 0 0

Ms Ann Walker – Voluntary Sector 5-10 0 0 5-10 0 0

Mr Alasdair Kenwright – Lay Member 5-10 0 0 5-10 0 0

Ms Juliet Regan – Carer Member 0-5 0 0 5-10 0 0

Ms Fiona Aldred – Carer Member 5-10 0 0 0 0 0

Ms S Morris – Voluntary Member 0-5 0 0 0 0 0

Mrs J Hughes - Nursing Member 0-5 0 0 0 0 0

Mr R Baker - Optometrist Member 0-5 0 0 0 0 0

Mr I Jones - Dental Member 0-5 0 0 0 0 0

Cllr Alun Lloyd Jones - Ceredigion County Council 0 0 0 0 0 0

Cllr Paul Hinge - Ceredigion County Council 0 0 0 0 0 0

Cllr Hag Harries - Ceredigion County Council 0 0 0 0 0 0

Mr Parry Davies - Ceredigion County Council 0 0 0 0 0 0

Mrs Kathy Giles – Hywel Dda NHS Trust 0 0 0 0 0 0

Mr Lyndon Lloyd 0 0 0 0 0 0

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£000 £000 £000 £000 £000 £000 £000 £00

Joint Appointments with Pembrokeshire & Carmarthenshire LHBs

Bernardine Rees 2.5-5.0 7.5-10.0 40-45 130-135 976 684 192 0

Joint Appointments with Pembrokeshire LHB

Karen Miles 2.5-5.0 10.0-12.5 20-25 65-70 356 237 79 0

Sarah Williams 2.5-5.0 7.5-10.0 5-10 25-30 194 96 67 0

Helen Williams 7.5-10.0 25.0-27.5 20-25 65-70 343 226 78 0

Susan Hurds (2.5)-0 (2.5)-0 20-25 60-65 394 305 56 0

Ceredigion LHB Appointments

Stuart Moncur 0-2.5 0-2.5 20-25 70-75 488 341 68 0

Pensions Benefits

Salary and Allowances

Dr S Griffiths the Medical Director at Ceredigion LHB does not pay any pensions contributions.

50

Name Details Interests

Cllr A. Lloyd-Jones Non-Executive Director Member of Ceredigion County Council. Member of the Assoc of the British Pharmaceutical Industry. Pensions received from two Pharmaceutical Companies. Member of Llanfarian Community Council. Member of Dyfed-Powys Police Authority. Chair of Ymlaen Ceredigion.Cwmni Iaith CYF. CAB.

Cllr Paul Hinge Non-Executive Director Management Board Member of Tai Cartref. Ceredigion County Councillor.Executive Member of Royal Welsh Fusiliers Comrades Association.

Cllr Hag Harries Non-Executive Director Member of Ceredigion County Council, Lampeter Town Council & Wales Sports Council.

Parry Davies Non-Executive Director Officer of Ceredigion County Council.

Dr D. Williams Non-Executive Director(1.4.08-31.12.08)

In General Medical Practice within Ceredigion and receives remuneration from the LHB in accordance with the Statement of Fees and Allowances under the terms of the GMS Contract.

Dr C. Langley Non-Executive Director In General Medical Practice within Ceredigion and receives remuneration from the LHB in accordance with the Statement of Fees and Allowances under the terms of the GMS Contract.

Kathy Giles Non-Executive Director Therapist Representative, employed by Hywel Dda NHS Trust.

Robert Hughes-Jones Non-Executive Director Locum Pharmacist in Ceredigion.Receives a pension from a company which has a Pharmaceutical contract in Ceredigion.

Mrs M. Morris Non-Executive Director Member of Cardigan Town Council. Member of Cardigan Hospital League of Friends.Age Concern Ceredigion Advisory Committee Member. Member Cardigan 50+ Forum.

Dr Illtyd Griffiths Non-Executive Director(1.4.08-31.8.08)

Dental Practice representative. Part Owner of Dental Premises in Aberystwyth.

Ann Walker Non-Executive Director Trustee of a Voluntary Sector Body.

Alasdair Kenwright Non-Executive Director Vice-Chair Police Authorities Wales. Chair of Dyfed Powys Police Authority.

Robin Baker Non-Executive Director(1.11.08 - present)

Treasurer South West Wales Region. Optometric Committee. Treasurer Optometry Wales Committee. Non executive director of Pembrokeshire LHB.

Ian Jones Non-Executive Director(1.11.08 - present)

Organiser of Dental Services for Crisis Christmas in London. Secretary of Dyfed-Powys Local Dental Committee. Non-executive director of Pembrokeshire LHB.

Julie Hughes Non-Executive Director(1.1.09 - present)

Non-executive director of Pembrokeshire LHB.

Fiona Aldred Carer Representative CEO of a Voluntary Sector Body that receives a grant from the LHB.

Lyndon Lloyd Associate Member Vice-Chair of Ceredigion Community Health Council. Vice President of Age Concern Ceredigion.Member of Ceredigion County Council. Member of Beulah Community Council.

Dr Alan Axford Trust Representative Employee of Hywel Dda NHS Trust.

Emlyn Thomas Co-opted Member Aberaeron Town Council. Cars for Carers. Social Services Voluntary driver.

Gill Davies Co-opted Member(24.2.09 - present)

Employee of Hywel Dda NHS Trust.

Dr David Roberts Co-opted Member In General Medical Practice within Ceredigion and receives renumeration from the LHB in accordance with the Statement of Fees and Allowances under the terms of the GMS Contract. LMC Chairman.

David Pick Co-opted Member(1.4.08 - 30.11.08)

Employee of Hywel Dda NHS Trust.

Related Party transactionsA number of the LHB’s Board members have interests in related parties as follows:

Signed: B.ReesDate:10th June 2009

Chief Executive(on behalf of the Board)