croeso a throsolwg o’r diwrnod welcome & overview of the day · 2013. 7. 30. · trosolwg o’r...

Geoff LangDirprwy Brif Weithredwr

Deputy Chief Executive

Croeso a Throsolwg o’r diwrnod

Welcome & Overview of the Day

Trosolwg o’r diwrnod /

Overview of Day

• Agenda:

• Adborth o Weithdy 2

• Briffiad o’r sefyllfa bresennol

• Trafodaethau gyda rhanddeiliaid ar y materion o bwys hanfodol

• Y broses o hyn ymlaen

• Agenda:

• Feedback from workshop 2

• Briefing on current position

• Discussions with stakeholders on crunch issues

• Process from here

26/07/2013 2

Dr Martin DuerdenCyfarwyddwr Meddygol Dros Dro

Acting Medical Director

Adborth o Weithdy 2

Feedback from Workshop 2

Proses

Process

• Datblygu ein strategaeth ar gyfer prif wasanaethau ysbyty

• Gweithdy 3

• Gwaith cymhleth a phwysig

• Angen amser i ystyried y prif faterion ymhellach, a sicrhau eu bod yn gywir

• Development of our strategy for major hospital services

• 3rd workshop

• Complex and important work.

• Need time to consider key issues further, to get it right.

26/07/2013 4

Adborth o Weithdy 1


• Adroddiad ar y canlyniadau

• Cefnogi’r angen am newid

• Angen modelau gwasanaeth gwahanol

• Angen symud at fanylion

• Cydweithio

• Ystyried effaith

• Outcome report

• Supports Case for Change

• Need for different service models.

• Need to move to detail

• Joint working

• Consider impact

26/07/2013 5

Themâu Allweddol a’r Achos Dros NewidKey Themes & Case for Change

• Achieving and maintaining clinical standards.

• Improving patient outcomes

• Sustainable Medical Workforce

• Deanery, training & recruitment

• Sustainable clinical services

• Providing outpatient services close to home.

• Developing networked services.

• Working towards excellence.

• Providing better opportunities for staff.

• Cyflawni a chynnal safonau clinigol.

• Gwella canlyniadau i gleifion

• Gweithlu meddygol cynaliadwy

• Y Ddeoniaeth, hyfforddiant a recriwtio

• Gwasanaethau clinigol cynaliadwy

• Darparu gwasanaethau cleifion allanol yn agosach i’r cartref.

• Datblygu gwasanaethau a rwydweithwyd.

• Gweithio tuag at ragoriaeth.

• Darparu gwell cyfleoedd ar gyfer staff.

Adborth o Weithdy 2


• Adroddiad ar y canlyniadau

• Modelau clinigol eang

• Llawer o gefnogaeth i gynnal 3 UA a 3 gwasanaeth meddygol dwys.

• Derbyn rhwydweithio fel egwyddor.

• Angen ystyried effeithiau’n llawnach.

• Ystyried modelau mwy “radical”hefyd.

• Outcome Report

• Broad clinical models.

• Strong support for 3 ED’s 3 acute medicine services

• Networking accepted as a principle

• Need to consider impacts more fully

• Consider more “radical” models too.

26/07/2013 7

Beth rydym yn ei wybod 1

What we know 1

- Achos Dros Newid wedi’i ddiweddaru.

- 3 UA & 3 uned feddygol dwys.

- Rhwydwaith o wasanaethau llym eraill.

– Llawfeddygaeth Gyffredinol

– Paediatreg & Newydd-anedig

– Mamolaeth & Gynecoleg

– Iechyd Meddwl

– Gofal arbenigol (Fasgwlaidd, Canser, Pen a Gwddf)

• Updated Case for Change

• 3 ED’s & 3 acute medicine

• Network of other acute

services

– General Surgery

– Paediatrics & Neonatal

– Maternity & Gynaecology

– Mental Health

– Specialist care (Vascular, Cancer, Head & Neck)

26/07/2013 8

Beth rydym yn ei wybod 2What we know 2

• Newidiadau tebyg ar draws y

DU.

• Symud i’r maes cymunedol.

• Angen datrysiad gogledd

Cymru.

• Ystyried yn ofalus yr effaith

(gan gynnwys AEC) ar rwydweithio ar gleifion, staff a

gwasanaethau clinigol eraill.

• Penderfyniadau anodd –

ystod eang o farnau.

• Similar changes occurring

across UK

• Shift to community setting

• Need a N Wales solution

• Consider carefully the

impact (inc EqIA) of

networking upon patients, staff and other clinical

services.

• Difficult decisions – there

are a range of views.

26/07/2013 9

Meini Prawf Asesu

Assessment Criteria

• Adeiladu ar waith a

wnaethpwyd eisoes.

• Lefel dda o adborth.

• Pryderon dros amser/

ymarfer gosod mewn trefn.

• Ystyried yr adborth wrth

baratoi i asesu’r opsiynau.

• Am fwydo i mewn i’r AEC

ac asesiadau effeithiau eraill.

• Builds on previous work.

• Good level of feedback.

• Concerns over

time/ranking exercise.

• Feedback being

considered as we prepare

to assess options.

• Will feed into EqIA and

other impact assessments.

26/07/2013 10

Meini Prawf Asesu

Assessment Criteria

�Ansawdd gofal

�Diogelwch clinigol

• Hygyrchedd

�Cyflawnadwy

• Derbynioldeb

• Tryloywder

• Cynaladwyedd

• (Fforddiadwyedd)

�Quality of care

�Clinical safety

• Accessibility

�Deliverability

• Acceptability

• Transparency

• Sustainability

• (Affordability)

26/07/2013 11

Dr David CounsellPennaeth Staff / Chief of Staff

Sefyllfa Bresennol

Current Position

1. Diweddaru’r “Achos

Dros Newid”.

2. Ystod eang o fodelau ar

gyfer Gogledd Cymru:

- GRhG

- Gogledd Cymru

3. “Nifer o faterion o bwys hanfodol”

– effeithiau

1. Updated Case for

change

2. A range of broad

models for N Wales

– CPG

– N Wales

3. A number of crunch issues

– Impacts

26/07/2013 13

Diweddaru’r Achos Dros Newid

Updated Case for Change

• (Sut) gallwn ni gynnal

gwasanaethau

allweddol ar 3 safle, o ystyried yr heriau:

– Safonau

– Gweithlu

– Cyllid

• (How) can we sustain key

services across 3 sites,

given the challenges of

– Standards

– Workforce

– Finance

26/07/2013 14

Yr Her Fawr

The Big Challenge

• Need to provide services in a different way.

� Better, safer services that fulfil standards.

� Sustainable services

� Need to offer a wider range of services.

� Efficient, cost effective services.

� Good patient experience

� Care provided closer to home.

• Angen darparu gwasanaethau mewn ffordd wahanol.

� Gwasanaethau gwell a diogelach sy’n cyflawni safonau.

� Gwasanaethau cynaliadwy� Angen cynnig ystod

ehangach o wasanaethau.� Gwasanaethau effeithlon a

chost effeithiol.� Profiad da i’r claf� Gofal yn cael ei ddarparu’n

agosach i’r cartref.

Ein Gweledigaeth Glinigol

Our Clinical Vision

• Rhwydwaith o wasanaethau ansawdd

uchel.

• 3 prif ysbyty

• 3 UA a Meddygaeth Lem

• Gofal rheolaidd lleol (ee

cleifion allanol)

• Rhwydwaith o fynediad ar

gyfer derbyniadau a

gwasanaethau arbenigol

• A network of high quality services.

• 3 major hospitals

• 3 ED’s & Acute Medicine

• Local routine care (eg outpatients)

• Network of access for

admissions & specialist services

26/07/2013 16

Rhwydweithiau

Networks

• Cynnal mynediad i wasanaethau dros 3 ysbyty.

• Darparu rhai gwasanaethau o lai na 3 ysbyty o fewn rhwydwaith glinigol gref.

• Nifer mewn bodolaeth eisoes.

• Tystiolaeth fod canoli timau clinigol o fewn rhwydwaith gref yn gallu gwella canlyniadau a chynaladwyedd

• Maintains access to services across three hospitals.

• Some services delivered from fewer than 3 hospitals within a strong clinical network.

• We have a number in place already.

• Evidence that consolidating clinical teams within a strong network can improve outcomes and sustainability.

26/07/2013 17

Modelau eang

Broad models

• 3 Safle – gwasanaethau a ddosbarthwyd

• 3 safle – gwasanaethau a rwydweithiwyd (gwahanol

ddewisiadau)– Adran Achosion Brys

– Meddygaeth


– Mamolaeth & Gynaecoleg

– Newydd-anedig

– Pediatreg

– Iechyd Meddwl

– Gwasanaethau eraill

• 3 Sites – distributed services

• 3 sites – networked services (different

options)– ED

– Medicine

– General Surgery

– Maternity & gynaecology

– Neonatal

– Paediatrics

– Mental Health

– Other services

26/07/2013 18

Dr Tony ShambrookPennaeth Staff / Chief of Staff

Llawfeddygaeth Gyffredinol Annewisol “NEGS”

Non-elective General Surgery “NEGS”

Pam mae angen newid?

Why do we need to change?

• Safonau a

chanlyniadau

• Recriwtio.

• Arbenigedd

• Hyfforddiant ac

amselenni gwaith.

• Cyllid

• Standards &

Outcomes

• Recruitment

• Specialisation

• Training & Rotas

• Finance

26/07/2013 20

Modelau

Models

• 3 safle/ 2 safle hyfforddi

- Cynaladwyedd

- Recriwtio

• “Rhwydwaith NEGS”

(gwahanol fodelau)

• Rhaid i wasanaeth y dyfodol

gynnal 3 UA/ meddygaeth llym.

• 3 sites/2 training sites

– Sustainability

– Recruitment

• “Networked NEGS”

(different models)

• Future service must

sustain 3 ED’s/acute medicine.

26/07/2013 21

Y materion blaenaf

Crunch Issues

• Perthynas rhwng

Rhwydwaith NEGS ac

UA, meddygaeth (gan

gynnwys hyfforddeion)

a gwasanaeth trawma.

• Cefnogaeth i

wasanaethau heb fod

yn lawfeddygol eraill.

• Relationship between

networked NEGS and

ED’s, medicine (inc

trainees) and trauma

service.

• Support to other non-

surgical services.

26/07/2013 22

Dr Brendan HarringtonPennaeth Staff / Chief of Staff

Gofal Paediatrig a Newydd-anedig

Paediatric & Neonatal care



• Safonau a

chanlyniadau

• Recriwtio

• Gwytnwch

• Hyfforddiant ac

amserlenni gwaith.

• Cyllid

• Standards &

Outcomes

• Recruitment

• Resilience


• Finance

26/07/2013 24

• Symud tuag at wasanaethau wedi’u darparu gan ymgynghorwyr gyda chefnogaeth uwch ymarferwyr

• Ymyriad cynnar / rhwystro / gwasanaeth cymunedol

• 3 gwasanaeth cleifion mewnol gyda 2 safle hyfforddi.

• Rhwydwaith paediatrig?

- Anodd

• Move towards more consultant delivered care with advanced practitioner support.

• Early intervention/ prevention/community service

• 3 inpatient services with 2 training sites.

• Networked Paeds?

– Difficult

26/07/2013 25

Modelau

Models

Y materion blaenaf

Crunch Issues

• Lleoliad safle/oedd

hyfforddi paediatig, Uned

Newydd-Anedig Leol a chysylltiadau gyda’r

gwasanethau Mamolaeth

• Location of paediatric

training site/s, Local

Neonatal Unit and links with Maternity services

26/07/2013 26

Dr Glynne RobertsPennaeth Staff Cysylltiol / Associate Chief of Staff

Gwasanaethau Merched

Women’s Services



• Safonau a

chanlyniadau

• Recriwtio.

• Hyfforddiant ac

amserlenni gwaith.

• Gwytnwch

• Galw

• Cyllid

• Standards &

Outcomes

• Recruitment


• Resilience

• Demand

• Finance

26/07/2013 28

• 3 uned obstetrig ymgynghorwyr gyda 3 uned dan arweiniad bydwragedd .

– -2 niferoedd uwch/ 1 llai

– Posibilrwydd o haenu risg ar draws safleoedd

• 2 uned obstetrig ymgynghorwyr gydag unedau dan arweiniad bydwragedd wrth law, ac 1 uned dan arweiniad bydwragedd unigol.

• Gynaecoleg – llawdriniaethau mawr ochr yn ochr â hyfforddiant/ obstetrig/ llawdriniaethau gyffredinol.

• 3 consultant obstetric units with 3 midwifery led units(MLU)

– 2 higher/1 lower volume

– Possible stratified risk across sites

• 2 consultant obstetric units with alongside MLUs and 1 standalone MLU.

• Gynaecology – major surgery aligned with training/obstetrics/general surgery.

26/07/2013 29

Modelau

Models

Y materion blaenaf

Crunch Issues

• Fel gwasanaethau plant

– lleoliad yr UNAL/

hyfforddiant/ safleoedd mamolaeth.

• Niferoedd a enir a

phroffil risg

• As per Paediatrics –

location of

LNU/training/

maternity sites

• Delivery numbers &

risk profile

26/07/2013 30

Dr Olwen WilliamsPennaeth Staff / Chief of Staff

Meddygaeth Cychwynnol, Cymunedol ac Arbenigol

Primary, Community & Specialist Medicine



• Safonau a chanlyniadau

• Demograffiaeth

• Recriwtio

• Hyfforddiant ac

amserlenni gwaith

• Cyllid

• Newidiadau drwy’r DU

- “Haenau” UA

• Standards &

Outcomes

• Demography

• Recruitment


• Finance

• UK wide changes

– ED “tiers”

26/07/2013 32

• 3 UA

• 3 gwasanaeth

meddygol llym

• Rhwydweithio

gwasanaethau

meddygol arbenigol.

• Rhwydweithio

gwasanaethau llai llym.

• Safle dim-hyfforddiant?

• 3 EDs

• 3 Acute medicine

services.

• Networking of

specialist medicine

services.

• Networking of less

acute services.

• Non-training site?

26/07/2013 33

Modelau

Models

Y materion blaenaf

Crunch Issues

• Recriwtio cynaladwy.

• Effaith rhwydweithio

llawdriniaethau yn UA,

meddygaeth lem a gwasanaethau trawma.

• Effaith rhwydweithio

llawdriniaethau ar hyfforddeion meddygol

• Sustainable recruitment

• Impact of networking surgery on ED, acute

medicine & trauma

services.

• Impact of networking surgery on medical

trainees.

26/07/2013 34

Dr David CounsellPennaeth Staff / Chief of Staff

Modelau Gogledd Cymru

North Wales Models

• Beth mae hyn yn ei olygu ar

raddfa Gogledd Cymru?

• Eisoes wedi rhannu

modelau cyffredinol.

• Angen amser i ystyried y materion allweddol

ymhellach, i’w cael yn gywir

• Mae dynodi safleoedd yn

unol â gwaith GRhG. (Angen mwy o waith)

• So what does this mean

on a N Wales basis?

• Already shared broad

models.

• Need time to consider key issues further, to

get it right.

• Site identifications are

as per CPG work. (Further work needed.)

26/07/2013 36

26/07/2013 37

Sesiwn Trafod 1

Plenary Session 1

Adborth / Y materion blaenaf

Feedback / Crunch Issues

• Trafodaeth agored

• 45-60 munud

• Meic symudol

• Cofnodi adborth a’r

ystod o agweddau

• Panel i ateb os yn

addas

• Cymraeg neu

Saesneg

• Open plenary

• 45-60 mins

• Roving mic

• Record feedback

and range of views.

• Panel to answer if

appropriate

• English or Welsh

26/07/2013 39

Y materion blaenaf

Crunch Issues

1. Recriwtio a hyfforddiant

2. Cyswllt rhwng rhwydweithio

llawdriniaethau a’r effaith ar feddygaeth lem / UA

3. Cyswllt rhwng safleoedd newydd-anedig, paediatreg

a hyfforddi.

4. Newidiadau anodd –

adeiladu’r gefnogaeth

1. Recruitment & training

2. Links between

networking surgery & impact upon acute

medicine / ED

3. Links between neonatal, paediatrics

and & training sites

4. Difficult changes –

building the will.

26/07/2013 40

Mr Ian HowardCyfarwyddwr Cynorthwyol Cynllunio

Assistant Director of Planning

Rhaglen waith y dyfodol

Future Work Programme

Meysydd rydym yn canolbwyntio arnynt/Areas we are focusing on

• Sut fydd pob un o’r safleoedd llym yn

gweithredu fel uned cydlynol o fewn

rhwydwaith o

wasanaethau

• O fewn y cyd-destun o 3 prif ysbyty llym, sut dylid

darparu’r elfen o ofal heb ei gynllunio o fewn

ysbyty?

• How each of the Acute sites will function as a

coherent unit within a

network of services

• Within the context of three major acute

hospitals, how should the hospital element of

unscheduled care be delivered?

26/07/2013 42

• Prif wasanaethau argyfwng neu annewisol


– Meddygaeth

– Trawma

– Paediatreg gan gynnwys

Newydd-anedig ar lefelau 1 a 2

– Mamolaeth a gynaecoleg

– Iechyd Meddwl

• Canlyniadau uniongyrchol unrhyw newidiadau

• Key emergency or non-elective services

– General Surgery

– Medicine

– Trauma

– Paediatrics, including neonatal

care at levels 1 and 2

– Maternity and Gynaecology

– Mental Health

• The direct consequences of any changes

26/07/2013 43

Heriau / Challenges

• Y cyd-destun polisi

• Cymhlethdod y modelau

gofal

• Adolygiad

Gwasanaethau Newydd-anedig

• The Policy Context

• The Complexity of the

Models of Care

• The review of Neonatal

Services

26/07/2013 44

Proses

Process

• Datblygu modelau gwasanaeth arbenigol ac integredig.

• Profi yn erbyn meini prawf ac asesu’r effaith (AEC ayb)

• Gweithdai i adolygu modelau datblygol – ?Awst & ?Medi

• Develop specialty and integrated service models

• Test against criteria & impact assess (EQIA etc)

• Workshops to review developing models –?August & ?September

26/07/2013 45

Sesiwn Trafod 2

Plenary Session 2

Rhaglen waith y dyfodol

Future Work Programme

Sylwadau Cloi

Closing Remarks

Adborth pellach

Further feedback

• Further events &

engagement.

• Planning Dept, Ysbyty

Glan Clwyd

[email protected]

26/07/2013 48

• Digwyddiadau pellach

ac ymgysylltiad

• Adran Gynllunio,

Ysbyty Glan Clwyd

[email protected]

croeso a throsolwg o’r diwrnod welcome & overview of the day · 2013. 7. 30. · trosolwg o’r...

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