1. Programme for Health Service Improvement “Have Your Say” Stakeholder Event 24 th July 2007 CARDIFF AND VALE NHS TRUST YMDDIRIEDOLAETH GIG CAERDYDD A’R FRO

2. Purpose Opportunity to  inform and influence local plans  consider together key issues emerging

3. Why do we need to change….?  Review of Health and Social Care in Wales Need to rebalance system Improve performance Full engagement  Designed for Life World class services  Community Services Framework

4. Community Services Framework … More services in the community Better use of primary care contracts Develop preventive approach Manage resource shift Achieve improved integration “Policy and planning must reflect presumption that services will be community based, unless pressing reasons dictate a different model..” “Develop credible case for change with public and clinicians”

5. But much already achieved in Cardiff and the Vale of Glamorgan…  “Wanless” action plans  Primary care contracts  Emergency services  Maternity services  Children’s services  Mental health services  Etc.,

6. The Programme for Health Service Improvement… Established in early 2006  Shared commitment to provide high quality services…  Shared recognition that status quo not sustainable…  Shared recognition that we are not using existing resources as effectively as we could….  Need to work together to rebalance and refocus services…  Need for greater focus on improving health and wellbeing…  Need to improve efficiency and effectiveness…

7. PHSI - Rebalancing Care Community Based Services Hospital Services

8. Key Deliverables  Strengthening of primary and community based care Improving health, reducing inequalities Improving access Reducing avoidable admissions  Replacement solution for Rookwood and Westwing Estate no longer fit for purpose  High quality long term care  Maintaining momentum for change in mental health services Working together as a health community

9. Key principles  A shift of focus from illness to health  Improve quality, safety and outcomes  Right care, right time, right place, right professional  Focus on services and patient experience  Maximise resources to achieve excellence Working together as a health community

10. Developing Primary and Community Based Services Patients will have access to:  High quality primary care practices working within defined localities  Strengthened community based services Supporting people with long term conditions e.g. diabetes and heart disease Meeting needs of children and young people Supporting frail elderly

11. Cardiff Localities – Emerging Map 91,693 (18 practices) 93,902 (12 practices) 82,640 (13 practices) 81,700 (11 practices) Health Resource & Treatment Centres New Community Health Centres

12. Vale Localities – Emerging Map Western Vale 26,678 (3 practices East Vale 38,003 (7 practices) Central Vale 54,974 (7 practices)

13. Examples of Locality Services Rehabilitation and reablement teams Day case surgery (local anaesthetic) Specialist rehabilitation Outpatient clinics Diagnostics Patient education and support Community nursing teams Minor emergency services Day therapy services Child health clinics Community mental health teams Therapy services Locality Resource Centre Co-ordinating “out of hospital” services for local communities Local Authority Services Voluntary Sector Services Asylum Seekers services Sexual Health services

14. Primary Care and Community Based Services – Deliverables 2007/08  New models for long term conditions to be introduced Case management, new pathways for stroke, diabetes, COPD, heart failure  CRI business case prepared by Autumn 2007  Consensus on “localities” for the purpose of planning and delivery of integrated services  Proposals for practice developments and other community services (resource centres & health centres)

15. The now…. Llanishen Clinic Colcot Health Centre Gabalfa Clinic

16. The Future – Resource & Treatment Centres & High Quality Estate

17. Rehabilitation and Reablement  New models of care – earlier intervention to help maintain independence with locality focus Changing demography Patient expectation Technology  Joint commissioning frameworks with local authorities for long term care

18. Rehabilitation & Reablement – Deliverables 2007/08  Extension of existing reablement & rehabilitation services to ensure equity of access  Agreed model for rehabilitation and reablement services  Clear commissioning framework for long term care which addresses DToCs  Options for re-provision of Westwing and Rookwood prepared for formal consultation in early 2008

19. Rookwood independent evaluation – January 2006 Rookwood: “The deficiencies of the building are amplified by the long stay nature of many patients, whose privacy and dignity is severely compromised by the nature and quality of facilities. The buildings are well beyond their intended service life and provide some of the poorest facilities that we, as an experienced healthcare practice, have encountered.” Powell Dobson Architects

20. Westwing independent evaluation – January 2006 Westwing: “The facility is now grossly substandard, which is detrimental to both the quality and delivery of service to patient and staff morale. The building is not capable of providing the modern facilities or quality of environment necessary to meet the aspirations of consumers in the NHS” Powell Dobson Architects

21. M ental Health Services Hospital… -Closure of inpatient ward (Whitchurch) Community… - 1 st Crisis Team (May 05) -2 nd Crisis Team (June 06) -Crisis House (Oct 06) -Crisis Recovery Unit (May 07)

22. Mental Health – Deliverables 2007/08 Work continuing with aim of enabling reprovision of Whitchurch by 2009/2010  Purchase and development of Iorwerth Jones  Progression of Llandough MHSOP Assessment Unit and Whitchurch new build

23. “The Institution” From: Whitchurch 1908

24. “The Future”

25. Unscheduled Care  Improving access to primary care  Developing alternatives to admission  Improved integration across providers (primary care, ambulance, social care, hospital services etc.,)  Reducing confusion

26. Other key areas  Hospital services Opportunities for services to be provided in community based settings Opportunities for improved quality and efficiency Improved environment Strategy for Specialist/Regional services, including the Children’s Hospital for Wales

27. In summary – The Emerging health care map Increasingly local care – less care in main acute hospitals Primary care practicesResource centres and community based services Acute and emergency hospitals rehabilitation and reablement Specialist community rehab beds Outpatients Minor emergencies Day-therapy services Day-case surgery – local anaesthetic Diagnostics (such as X-ray) Patient Education and support Local Authority Services Primary care team and therapy Services Minor procedures Clinics (for example diabetes and CHD) Tertiary and specialised services Elective (non-urgent) surgery Inpatient cancer services Complex diagnostics Specialist outpatients Secondary emergency services Acute women’s and children’s services Major accident and emergencies Well-men and well-women clinics Rehabilitatio n support Voluntary sector services Community services Local facilities throughout the area Resource centres serving networks of @ 50 – 80,000 populations University Hospital of Wales, Llandough Increasingly specialist care – more care in major hospitals

28. Summary  Improving services ….  Closer to home…..  Better access to hospital services….  Better environments ….  Soon….

29. Next steps….preparing for consultation  What might we be formally consulting on in 2008? New resource centres and community health centres  (Noting CRI consultation already done) New rehabilitation provision…. (including Westwing/Rookwood)

30. Emerging Timetable  Health Social Care & Wellbeing Strategies Consultation October – December 2007 To provide opportunity for formal engagement with communities on priorities for service improvement  PHSI Consultation Formal consultation proposals for change early 2008

31. Key Messages  Better primary and community based services are essential to help people maintain health and independence  Long term care should not be provided in “institutions” whenever possible  Hospital care must be safe, high quality and efficient, provided in an environment fit for purpose

32. Discussion Groups  Rehabilitation and Reablement How can we support people to maintain their health and independence? What can we doing to improve integration? How should we provide long term care? What should replace Westwing and Rookwood? Facilitator: Sue Revell

33. Discussion Groups  Community Services How should we describe these services? “primary care” “level one” “community services” What should be provided locally? How local is local? Are there opportunities for partnership working that we are missing? Facilitator: Mike Walsh

34. Discussion Groups  Long Term Conditions Can we do more to support people in managing their conditions? What? Should we be identifying and support those people most at risk? How? Are there opportunities for partnership working that we are missing? Facilitator: Katie Norton

35. Discussion Groups  Unscheduled Care What is an unscheduled care need? What are the main concerns about the current services? What needs to change? How do we improve understanding? Are there opportunities for partnership working that we are missing? Facilitator: Suzanne Davies