1. Launch of 1000 Lives Plus Tuesday 11th May 2010
Mr Paul Williams, CEO, NHS Wales
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2. ‘Count me in!’ 1000 Lives Plus
Am pleased to be here today as we launch the next phase of this inspiring and pioneering work – the 1000 Lives Plus
When I attended the last Learning Session in September last year it was very clear to me then that significant achievements were being made in so many areas that we had mainstream this work. There could be no going back to our old ways of working.
I gave a firm commitment that I would ensure that this work is at the centre of NHS Wales and today I am reaffirming that commitment.
Through the 1000 Lives Campaign we have demonstrated that we can achieve excellence – but that excellence now has to become the norm everywhere - for every patient – in every setting – all of the time.
When we know that we have tried and tested interventions that can avoid our patients being harmed there can be no justification for any organisation, any team not adopting them.
1000 Lives Plus

3. Context Quality and safety are central to the NHS agenda in Wales
A focal point for the 5 year Strategic Plan
Convert success into expectation
Improving the quality and safety of the care that we provide to the citizens of Wales is fundamental to all that we do
It is what we must concentrate our energies and resources on - doing the right things and getting them right first time – doing the things that make a difference to peoples lives
Doing new things or doing things differently is about challenging the status quo, but as the saying goes
“ If you always do what you always did, you will always get what you always got”
We cannot afford to do that in the NHS for so many reasons – the ever increasing demand on services, our ageing population as well as the significant financial challenges that we all face
Reducing waste, variation and harm must be central to all that we do and that why I have made it central to my 5 year Strategic, Workforce and Financial Framework
I was particularly encouraged by a message I received from Dr Duncan Wiiliams a GP from Hywel Dda who has been engaged with this work locally in his practice and has felt supported to ‘do the right thing’ for his patients. He has rightly suggested that as well as focussing on doing those interventions that we have shown to work that "If we know an intervention we used to give never worked or risks more harm than good, then every patient has the right to expect their health service and professional to change their practice to embrace this new safer working practice"
I’m sure we all endorse that
1000 Lives Plus

4. Congratulations!
As well as looking forward I do want to look back over the past 2 years.
We can all be proud of the achievements and improvements that we have seen during this time
The 1000 Lives Campaign has shown what a difference that can be made when we are all united in working towards one goal – and what could be better than saving more lives and harming less patients
We have seen improvements the length and breadth of the country and what we can particularly proud of is that we are the only country in the world to have embraced the whole healthcare system including our primary care and ambulances services
So I want to say Congratulations and Thank-you to you all for all that you have done – and to all your colleagues who can’t be here today please take that message back

5. Commitment at all levels
I have never known an initiative in NHS Wales that has been so well known, so well received and produced change at so many levels.
We often talk about how we should achieve clinical engagement. The Campaign has shown us what that really means and what it looks like in practice
The campaign has also shown us that the engagement of all staff at all levels is crucial to success
It is our frontline staff who so often know what needs to change and where the solutions lie – but they need to be supported and enable to do so by their leaders at all levels.
1000 Lives Plus

6. The Difference it has made
For example:
Transforming Care – spending more time with patients
Achieving 638 days = 12,760 patient days without a hospital acquired pressure ulcer
Implementing the WHO Surgical Checklist
Primary Care – better warfarin management
And many, many more…
Transforming Care: The programme aims to improve the patient experience -by using effective tools and methods staff are able to redesign processes releasing time which is reinvested in patient safety and quality of care. On two wards at Withybush Hospital in West Wales nurses are now spending one third more of their time with patients and this continues to grow.
Morriston Hospital is leading on the prevention of hospital acquired Pressure Ulcers, with their award winning “SKIN Bundle” now being rolled out.
The pioneering work on Anglesey ward has resulted in them having gone 638 days without an ulcer - but this must be the norm everywhere
WHO Surgical Checklist – using the quality improvement methodology to roll this out to every operating theatre in Wales
Primary Care: GPs have worked to improve the reliability of instruction given to patients, particularly in relation to warfarin
1000 Lives Plus

7. Simple things make the difference..
“When you are struggling to recover and desperate for rest, there is nothing more annoying than being unable to sleep because of sudden noise from bins being slammed shut.”
“The new bins made a big difference to my time on the ward and certainly made my recovery more restful.”
Vicky Cole, Critical Care Patient at Cardiff University Hospital of Wales
Making changes is not all about new technology and high cost drugs it is often the most basic of things that can make such a fundamnetal difference to the quality of a patients care
For instance during a fundamentals of care audit on the Critical Care unit at Cardiff’s University Hospital of Wales and from feedback from patients, one of the main complaints was the noise from bins being slammed shut. Further investigation found the noise from the bins to be louder than telephones ringing, monitor alarms or staff talking between beds.
By introducing new bins, patients are able to get more sleep as a result and staff find it easier to concentrate on their work. It is a simple but important change to the patient’s environment which has made a clear difference to the quality of care received.
1000 Lives Plus

8. How have we improved outcomes?
852 lives have been saved by NHS staff in Wales in the first 18 months
More than 29,000 episodes of harm have been averted in the first 12 months
These figures say it all – but the challenge now is to maintain that momentum and I look forward to receiving each organisations aims and plans for how they will be taking this forward locally
1000 Lives Plus

9. 1000 Lives Plus All Wales resource to support Health Boards and Trusts
Evidence-based change methods
Measurement support
Communication support
Making the possible the expectation
I don’t underestimate the challenge that the 1000 Lives Plus programme has set out
To be a success it must be a team effort – support will continue to be provided by the central team
It is crucial that we learn together – and share what works and what does not work
That is the only way we will achieve the level of transformation that is required to deliver world class healthcare by 2015
1000 Lives Plus

10. Improving use and understanding of data
Clinical Coding
Mortality Data
Trigger Tools
This will drive and move to an outcome
focus.
We will only know if we are achieving that level of success if we can see improvements in outcomes
This is another area where we need to up our game and focus our energies on understanding and using the data available to us
We have to have sustainable improvement in the quality and reliability of clinical coding – how can we hope to plan and provide safe services without this basic knowledge
I have been encouraged by the spread and development of trigger tools now in use across Wales – their use now to be the norm in everyday practice.
1000 Lives Plus

11. Mortality
Mortality data is so often in the news these days – we can no longer justify not being open and transparent about our mortality rates. I am grateful to the Medical Directors for the work that they are doing to take this forward. I appreciate there is more to do to ensure that we use this data in intelligent ways and as part of a range of measures that gives us the assurance that we need in knowing that we are providing high quality safe care
Mortality is coming down in Wales as this slide is showing
There is now doubt that it can come down even further – at least a further 5% reduction this year is possible and what I am wanting to see across every organisation
* Please note truncated axis

12. Harm Harm is coming down in Wales
Latest 9 months data reported all below the mean average which represents a shift in the mean.
We have to maintain this achievement and bring this level down even further

13. Reducing Infections A major contributor to reducing harm and mortality
Mandatory Interventions
The work on reducing infections is a major contributor to the reduction in mortality and harm.
None of the measures to reduce HCAIs are difficult to understand or to deliver, but all measures need to be consistently applied for all patients to ensure that we see reductions in the numbers of cases of infection that we see.
It is for these reasons that HCAI features prominently in the mandatory interventions for 2010/11
1000 Lives Plus

14. Source: Welsh Healthcare Associated Programme, Public Health Wales
A steady rise in numbers of C. difficile cases was seen in Wales between 2006 and Healthcare organisations in Wales have responded to this increase in cases and there is evidence (see above) that improvements have been seen during 2009, however the Winter of 2009 – 2010 has been challenging and we must sustain the improvements seen to date.
The AOF for 2010 – 2011 includes a target to reduce cases of C. difficile in the over 65 year age group by 20%, this is a minimum requirement and I hope that the reduction in cases will be much greater than this.
(The data shown is a run chart of the numbers of cases per month, the pink line shows the 12month moving average for C. difficile in Wales – this allows the trend to be looked at by “smoothing out” the seasonal variation that we see in C. difficile cases with the peaks normally occurring in the winter months)
Source: Welsh Healthcare Associated Programme, Public Health Wales

15. HCAI More than C. difficile
Surgical Site Infections
Urinary tract infections related to catheters
Respiratory tract infections e.g Ventilator associated pneumonia
Medical Device related infections e.g blood stream infections
Healthcare associated infections are infections that occur in relation to the delivery of healthcare wherever it is delivered (hospital or community). The commonest HCAI in Wales are surgical site infections, respiratory tract infections and urinary tract infections. Blood stream infections secondary to the use of central lines and peripheral venous catheters are also significant.
Through the 1000 Lives campaign a number of these infections have been tackled through the content areas of Reducing Surgical complications, the critical care content area and the HCAI content area
It is not difficult to see why this is area which is so prominent within the 1000 Lives Plus Mandatory Measures

16. The year ahead Engagement with all the mandatory interventions
At least a 5% reduction in mortality and harm over the next year
I am pleased that every organisation will engage with all the mandatory interventions as part of 1000 Lives Plus.
I expect the improvements to continue, and I am looking for at least a 5% reduction in mortality and harm over the next year.
I am also looking forward to hearing from the Medical Directors how their local plans, based on local issues, will help us attain this goal.
1000 Lives Plus

17. Public Service in Wales – the wider picture
The First Minister’s Challenge and Expectation
Better Outcomes for Tougher Times: The Next Phase in Public Service Improvement
Invest- to- Save Fund
Enhanced recovery after surgery
Public services face an unprecedented challenge over the next few years. At the core of that challenge is the need to deliver improved services and better outcomes for the people of Wales with the same or less.
There are seven areas for action set out in the paper:
Lining up around outcomes for citizens and communities
Offer public services that are more responsive to citizens –
Greater operational efficiency
Collaborating locally and regionally
Improving performance – by moving away from targets to focus more on outcomes.
Better information and evidence
Incentivising and enabling improvement across public services
The NHS has been successful in a number of areas to secure funds under the ‘Invest-to Save’ scheme and I was particularly pleased to hear Jane Hutt AM, Minister for Business announce last week that the bid to take work forward to enhance recovery after surgery under the umbrella of the 1000 lives programme had been awarded almost one million pounds to support Health Boards in achieving better surgical outcomes for patients over the next 2 years.
1000 Lives Plus working with clinicians from Cardiff and Vale University Health Board obtained the grant to enable each hospital in Wales to invest in equipment and key staffing to ensure all patients experience excellent standards of care by reducing the length of stay for patients, post-operative complications and cancelled operations.
The First Minister cites the 1000 Lives Campaign when he describes his vision for public services in Wales – we are a role model- we must live up to that and lead the way in making sustainable improvements in healthcare for the people of Wales
1000 Lives Plus

18. Pace, challenge and success
Must now be core business
Turn evidence into expectation
Strong leadership is key
Realising the benefits of NHS Reforms
Better outcomes for the people of Wales
In conclusion
The spotlight is on us to deliver better public services like never before
Change is vital and must be sustainable
We must strive to achieve excellence in all that we do
It won’t be achieved without strong leadership from the Board down and throughout the organisation
We must realise the benefits and the opportunities that our new integrated structures bring – use the expertise in public health available to use to ensure a whole system approach
The citizens of Wales – our patients- have a right to expect no less
1000 Lives Plus

19. we can do it for everyone in Wales.
If we can improve
care for one patient,
then we can do it for ten.
If we can do it for ten,
then we can do it for a 100.
If we can do it for a 100,
we can do it for a 1000
And if we can do it for a 1000,
we can do it for everyone in Wales.
This is the challenge for us all
Thank you
I look forward to hearing of your progress and achievements over the coming months