Geoff LangCyfarwyddwr Gweithredol Gofal Cychwynnol, Cymuned a Gwasanaethau Iechyd

Meddwl / Executive Director of Primary, Community & Mental Health

Pwyllgor Craffu Wrecsam / Wrexham Scrutiny Committee

Dydd Mercher 12 Hydref 2011 / Wednesday 12 October 2011

Cynllun 5 Mlynedd / 5 Year Plan

Ein Nod / Our Aim

To provide a “world class” health service in North Wales that:

• Improves the health and wellbeing of the population

• Provides an excellent experience no matter who, or where, or what language

• Reduces the cost of health provision per capita

The ‘Triple Aim’

Darparu gwasanaeth iechyd o’r radd flaenaf yng ngogledd Cymru sy’n:

• Gwella iechyd a lles y boblogaeth

• Darparu profiad ardderchog i bawb, waeth pwy bynnag ydynt, yn lle bynnag maent ac ym mha bynnag iaith

• Lleihau cost darpariaeth iechyd y pen

Y ‘Nod Triphlyg’

Sefydliad sy’n Ymarfer Iechyd Cyhoeddus /

A Public Health Practicing Organisation

• Focused upon improving population health outcomes

• Services are designed to meet need

• Support citizens and communities to focus on health and well-being rather than illness

• Canolbwyntio ar wella canlyniadau iechyd y boblogaeth

• Cynlluniwyd gwasanaethau i gwrdd ag anghenion

• Cefnogi dinasyddion a chymunedau i ganolbwyntio ar iechyd a lles yn hytrach na salwch

Golyga hyn / This means

• Continuous quality improvement, reduction in waste, harm and variation

• More care provided outside of an acute hospital setting through primary and community health and social services

• Emphasis on independence and supported living at home or in communities

• Complex care delivered in centres of excellence

• No longer will healthcare be measured in terms of beds and buildings but rather services and health outcomes

• Gwella ansawdd, lleihau gwastraff, niwed ac amrywiadau parhaus

• Darparu mwy o ofal y tu allan i leoliad ysbyty llym drwy iechyd cychwynnol a chymuned a’r gwasanaethau cymdeithasol

• Pwyslais ar fyw annibynnol a chyda chefnogaeth yn y cartref neu mewn cymunedau

• Darparu gofal gymhleth mewn canolfannau rhagoriaeth

• Ni chaiff gofal iechyd ei fesur bellach o ran niferoedd y gwelyau ac adeiladau, ond yn hytrach drwy wasanaethau a chanlyniadau iechyd

Gyrwyr a galluogwyr newid / Drivers and enablers for change

• The health of our population

• Our workforce• The money available• The need to deliver

• Iechyd ein poblogaeth• Ein gweithlu• Yr arian sydd ar gael• Yr angen i ddarparu

Iechyd ein poblogaeth / The health of our

population• Current causes of

mortality• Variation in

outcome• Demographic

changes• Life style choices• Emergency services• The cycle of life

• Achosion marwolaeth presennol

• Amrywiaethau mewn canlyniadau

• Newidiadau mewn demograffeg

• Dewisiadau ffordd o fyw

• Gwasanaethau brys• Cylch Bywyd

Ein gweithlu – heriau / Our workforce -

challenges• An ageing and

changing workforce• Reduction in junior

medical staff and distribution of training places

• EWTD compliance • Recruitment

• Gweithlu sy’n heneiddio ac yn newid

• Lleihad mewn staff meddygol iau a dosbarthiad lleoedd hyfforddi

• Cydymffurfiad â CAGE• Recriwtio

Rhagolygon Ariannol /Financial outlook• Expected no increase in

Health Board allocations per year

• Continuing pay and non-pay pressures increasing the real terms effect

• Impact of medical advances, high cost drugs & technology

• Forecast demographic and demand pressures

• Estimated gap to 2014/15 of £200million

• Savings target 6.1% for this year

• Disgwyl dim cynnydd yn nyraniad blynyddol y Bwrdd Iechyd

• Pwysau cyflogau a materion eraill parhaus yn cynyddu’r effeithiau termau real

• Effaith datblygiadau meddygol, cyffuriau a thechnoleg drud

• Pwysau rhagolygon demograffeg a galw

• Amcangyfrifir bwlch hyd 2014/15 o £200 miliwn

• Targed arbedion o 6.1% ar gyfer eleni

Ein hymateb – Fframwaith Strategol / Our response - Strategic Framework

Collaboration• With partners to integrate

delivery and meet shared outcomes

• Aligned budgets; joint working• With higher and further

education to embed research, teaching, learning and evaluation

Enablers• Shared services and integrated

procurement and asset base (public service agenda)

• Focused investment to maximise service benefit

• Sustainable assets with a targeted reduction in carbon footprint

• Sound governance and values

Cydweithrediad• Gyda phartneriaid i integreiddio

darpariaeth a chwrdd â chanlyniadau a rennir

• Cyllidebau aliniedig; cydweithio• Gydag addysg uwch a phellach i

fewnosod ymchwil, dysgu, addysgu a gwerthuso

Galluogwyr• Gwasanaethau a rennir a

phryniadau integredig a sail asedau (agenda gwasanaeth cyhoeddus)

• Buddsoddiad canolbwyntiedig i fwyafu buddion gwasanaeth

• Asedau cynaliadwy gyda tharged i leihau ôl troed carbon

• Llywodraethu a gwerthoedd cadarn

Ein hymateb – Fframwaith Strategol / Our response - Strategic Framework

Ansawdd • Diogelwch ac ansawdd yn gyntaf –

lleihau niwed, gwastraff ac amrywiaeth

• Gwasanaeth a arweinir a’i ddarparu’n glinigol

• Rhwystriad targededig i’r mannau bydd fwyaf effeithiol

• Gofal hunan-reoledig yn canoli ar y claf

• Gwell perfformiad i ddarparu canlyniadau cyson

• Symudiad adnoddau i’r gymuned targededig

Gweithlu• Adolygu ac ailgynllunio• Cyflogwr o ddewis • Enghraifft dda am hyfforddi

Quality• Safety and quality first -

reducing harm, waste and variation

• Clinically led and delivered service

• Targeted prevention to where it will be most effective

• Patient centred self managed care

• Improved performance to deliver consistent outcomes

• Targeted shift of resource to community

Workforce• Review and redesign• Employer of choice• Exemplar for training

Gwasanaethau Cymuned – Model gofal /

Community Services – Model of care

• Integrated community services – NHS, local authority, voluntary sector working together

• Moving from reactive crisis management to proactive management and prevention

• The bridge between primary care and acute hospital

• Gwasanaethau cymunedol integredig – GIG, awdurdod lleol, sector gwirfoddol yn cydweithio

• Symud o reoli argyfwng yn ymatebol i reoli rhagweithiol a rhwystro

• Y bont rhwng gofal cychwynnol ac ysbyty llym

Blaenoriaethau ar gyfer blwyddyn 2

/ Priorities for year 2

• Prevention• Localities• Efficiency and

productivity• Mental health• Reduce reliance on

out of area providers

• Strategic change

• Rhwystro• Cymdogaethau• Effeithiolrwydd a

chynhyrchiant• Iechyd meddwl• Lleihau dibyniaeth ar

ddarparwyr y tu allan i’r ardal

• Newid strategol

Arweiniad ar ymgynghori ac ymgysylltu ar newidiadau i’r

gwasanaeth iechyd /Guidance for

consultation and engagement on health

service changes

Y Cyd-destun / The context

• S183 Deddf GIG (Cymru) 2006 ...dyletswydd i gynnwys ac ymgynghori

• Rheoliadau CIC (Cyfansoddiad, Aelodaeth a Gweithdrefnau) (Cymru) 2010 …..rôl y CIC

• cyd-gloi cyfrifoldebau’r BI a CIC

Egwyddorion cenedlaethol ymgysylltu â’r cyhoedd yng Nghymru

Ymchwiliad Pwyllgor ar Adolygiadau GIG ac Arweiniad ar Ymgysylltu ac Ymgynghori

• S183 NHS (Wales) Act 2006 …duty to involve and consult

• CHCs (Constitution, Membership

and Procedures) (Wales) Regs 2010 …..role of CHC

• interlocking responsibilities of HB and CHC

National Principles for public engagement in Wales

Committee Inquiry on NHS Reviews and Guidance on Engagement and Consultation

Yr arweiniad newydd...prif faterion / The new guidance…key issues

• Mwy o bwyslais ar ymgysylltu parhaus a llai ar ymgynghori ffurfiol

• Proses dau gam – trafodaeth eang ac yna ymgynghori ffurfiol ar gynigion a werthuswyd

• More emphasis on continuous engagement and less on formal consultation

• Two stage process – extensive discussion then formal consultation on evaluated proposals

Ymgysylltu barhaus / Continuous engagement

• At the earliest opportunity

• With citizens, staff, staff representatives and professional bodies; stakeholders, third sector and partner organisations

• Considering local interests

• Equality and diversity

• Ar y cyfle cynharaf• Gyda dinasyddion,

staff, cynrychiolwyr staff a chyrff proffesiynol; rhanddeiliaid, y trydydd sector, a sefydliadau partner

• Cysidro diddordebau lleol

• Cydraddoldeb ac amrywiaeth

Lefelau Cynnwys / Levels of Involvement

e.e. Fforymau Pobl Hŷn, Grwpiau Defnyddwyr a

Gofalwyr Iechyd Meddwl

Dyletswyddau cydraddoldeb – ymgysylltu a chynnwys grwpiau

cydraddoldeb

Cynllunio ar gyfer claf a

gofalwr unigol

14 Ardal Leol

6 sir

BI PBC

Gwasanaethau Rhanbarthol

Grŵp yn benodol i gyflwr neu

glefyd

Gwasanaethau ysbyty

(dosbarth cyffredinol)

llym x 3

Grwpiau cymuned

e.e. Fforymau’r Galon, Grwpiau

Cynghori Diabetes,

Grwpiau Canser

Gwasanaethau arbenigol

e.g.:Older people’s

forums,Mental Health

User and Carer groups

Individual patient and

carer planning

14 Localities

6 counties

BCU HB

Regional services

Condition or disease specific

group

Acute (district general) hospital

services x 3

Community groups

e.g.:Heart forums,

Diabetes Advisory

Groups, Cancer groups

Specialised services

Equality duties – engage and involve equality groups

Ymgynghori ffurfiol / Formal consultation

• About substantial change

• Discussion with advisory forums; staff; CHC; Local Service Boards; other key partners

• Agree on process and content

• Minimum of 6 weeks formal consultation

• CHC can object on process or outcome

• Am newid sylweddol• Trafodaeth â fforymau

ymgynghorol; staff; CIC; Byrddau Gwasanaethau Lleol; partneriaid allweddol eraill

• Cytuno ar broses a chynnwys

• Lleiafrif o 6 wythnos o ymgynghori ffurfiol

• Gall y CIC wrthwynebu ar broses neu ganlyniad

Newidiadau gwasanaethau brys /

Urgent service changes

• In the interests of the health service OR risk to safety or welfare of patients and staff

• Must attempt to inform all relevant interests

• Should then follow usual consultation processes

• Er diddordeb y gwasanaeth iechyd NEU beryg i les neu diogelwch cleifion a staff

• Rhaid ceisio hysbysu pawb â diddordeb perthnasol

• Dylid ddilyn prosesau ymgynghori arferol wedyn

Urddas mewn Gofal: Ymateb i Adroddiad y Comisiynydd Pobl Hŷn (Mawrth 2011) /

Dignity in Care: Responding to the Older People's Commissioner Report (March 2011)

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• The report was received on the 14th March 2011. 12 recommendations to improve the care of older people in Welsh hospitals.

• On March 15th we received the Patient's Association Report: The Lottery of Dignified Care.

• Health Boards were required to respond by Tuesday 14th June 2011.

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• Cafwyd yr adroddiad ar 14 Mawrth 2011. 12 o argymhellion i wella gofal pobl hŷn yn ysbytai Cymru.

• Ar 15 Mawrth, cawsom Adroddiad Cymdeithas y Cleifion: Y Loteri o Ofal Urddasol.

• Roedd gofyn i Fyrddau Iechyd ymateb erbyn dydd Mawrth 14 Mehefin 2011.

•Cymerwyd amser i sicrhau fod Bwrdd y Cyfarwyddwyr yn arwain ar y gweithredu;

•Rhannwyd yr ymateb rhwng Bwrdd Iechyd Prifysgol Betsi Cadwaladr, Cyngor Iechyd Cymuned Betsi Cadwaladr ac

Arweinwyr Awdurdodau Lleol.

Cyflwynwyd yr ymateb / The response has been submitted

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•Time has been taken to ensure that the Board of Directors lead on implementation;

•Response shared with Betsi Cadwaladr University Health Board Cadwaladr Community Health Council and Local

Authority Leads.

Bydd gan BIPBC:

• Siarter Urddas;• Cynllun gweithredu ar

gyfer gofalu am bobl hŷn a phobl hŷn â dementia ;

• Gwell gofal mewn ymataliad;

• Gofal a thosturi i fynd â’r agenda urddas a pharch yn ei flaen;

• Preifatrwydd i drafod – oddi wrth y gwelyau;

• Gwella cynllunio rhyddhau.

Prif Themâu / Key themes

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BCUHB will have:

• A Dignity Charter;• An action plan for caring

for older people and older people with dementia;

• Improved care in continence;

• Care and compassion to take forward the dignity and respect agenda;

• Privacy for discussion - away from the bedside;

• Improvements to discharge planning.

• Cyffredinol: graddfa gofal yn dda/ardderchog 92%.

• Cyffredinol: meddygon a nyrsys yn cydweithio’n dda 92%.

• Meddygon: hyder ac ymddiriedaeth bob amser 82%.

• Ysbyty: ystafell neu ward yn lân iawn/gweddol lân 94%.

• Ysbyty: toiledau ac ystafelloedd ymolchi’n lân iawn/gweddol lân 90%.

• Ysbyty: gel golchi dwylo’n amlwg ac ar gael i gleifion ac ymwelwyr 94%.

• Gofal: digon o breifatrwydd bob amser wrth gael eu harchwilio a’u trin 88%.

• Llawfeddygaeth: risgiau a manteision wedi eu hegluro’n glir 81%.

Ein sgôr boddhad cleifion / Our patient satisfaction scores

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• Overall: rating of care was good / excellent 92%.

• Overall: doctors and nurses worked well together 92%.

• Doctors: always had confidence and trust 82%.

• Hospital: room or ward was very / fairly clean 94%.

• Hospital: toilets and bathrooms were very / fairly clean 90%.

• Hospital: hand-wash gels visible and available for patients and visitors to use 94%.

• Care: always enough privacy when being examined or treated 88%.

• Surgery: risks and benefits clearly explained 81%.