Joint Executive Team Mid Year Review 2018/’19

Joint Executive Team Mid Year Review 2018/’19
7th November 2018

Index Introduction 2018/19 Quarter 2 Achievements & Challenges
3 Introduction & Attendees 4 Well-being Objectives & Priorities 2018/19 Quarter 2 Achievements & Challenges 5 Key Achievements & Challenges 6 IMTP Accountability Requirements 7-27 Areas for Discussion: Across all Wellbeing objectives Separate slide pack Areas for Information only (unless item raised): Performance against IMTP trajectories Performance against Annual Plan priorities Looking Ahead: IMTP 2019/20 – 2021/22 28 Looking Ahead 29 Where are we now 30- 33 A Health, Caring Powys – Health & Care Strategy 33-34 Alignment to A Healthier Wales 35 Ambition & Opportunities 36-38 North Powys Rural Regional Centre 39 Advancing Rural Primary and Community Care 40 Tackle the Big 4 through Strategic Commissioning & Outcomes-focused approach 41 Digital First 42 Workforce Futures Questions

Introduction & Attendees
Carol Shillabeer Chief Executive Officer Hayley Thomas Director of Planning & Performance Mandy Collins Board Secretary Patsy Roseblade Interim Director of Primary Care Julie Rowles Director of Workforce & OD Wyn Parry Medical Director Eifion Williams Director of Finance Rhiannon Beaumont-Wood Interim Director of Nursing Catherine Woodward Director of Public Health Rhiannon Jones Director of Community Care, Mental Health and Therapies

Well-being Objectives and Priorities
Our Vision: A Healthy, Caring Powys Core Well-being Objective 1 FOCUS ON WELLBEING PRIORITIES Community Development Prevention & Health improvement Supporting Carers Core Well-being Objective 2 PROVIDE EARY HELP AND SUPPORT PRIORITIES Information, Advice and Assistance Population Screening Diagnostics Long Term Conditions Tackle Adverse Childhood Experiences Core Well-being Objective 3 TACKLE THE BIG FOUR PRIORITIES Mental Health Cancer Respiratory Conditions Circulatory Conditions Core Well-being Objective 4 ENABLE JOINED UP CARE PRIORITIES Primary Care Care Coordination and Urgent Care Planned Care Specialised Care Quality, Safety and Patient Experience Enabling Well-being Objective 1 DEVELOP WORKFORCE FUTURES PRIORITIES Engagement and Well-being Recruitment and Retention Education and Development Delivery and Process Enabling Well-being Objective 2 PROMOTE INNOVATIVE ENVIRONMENTS PRIORITIES Capital and Estates Innovation, Research and Development Enabling Well-being Objective 3 PUT DIGITAL FIRST PRIORITIES Digitally Enabled Care Digital Infrastructure Digitally Supporting Joined Up Care Enabling Well-being Objective 4 TRANSFORMING IN PARTNERSHIP PRIORITIES Good Governance Planning, Performance and Commissioning Financial management Collaborative Powys Regional Working

Achievements & Challenges April-September 2018/19
Items for discussion Items identified ‘for discussion’ Note - comprehensive report against all wellbeing objectives and organisational priorities follows in separate slide-pack ‘for information’

Compliance with IMTP Conditions
Update Quality Ensure quality standards are maintained and improved. Wellbeing of Future Generations/meeting the needs of your population Continue to prioritise and realise benefits of collaborative arrangements. Ensure OOH development and risks are managed. Performance Meet IMTP profiles and targets, report quarterly. Progress towards Year 2 and 3 targets. Continue to develop commissioning arrangements. Continue robust delivery, monitoring and performance management. Ensure well-being objectives consistent with and supported by planning arrangements. Close monitoring of RTT. Continue to develop Rural Regional Centers. Continue to develop long term plans. Continue to develop preventative work. Finance Deliver balanced financial plan. Demonstrate benefits of additional WG investment. Regional Planning Extend collaborative working and regional planning. Specific Issues: Resolve workforce planning issues for SWP and ACA. Work with stakeholders to explore transformation solutions and models of care.

Objective 1: Focus on Well-Being
Prevention & Health Improvement Smoking Cessation Smoking prevalence reduced to 18% (June18) Treated smokers during Apr-Sept increased by 27% compared to 17/18 Targeted approach with Housing Association, dental & optometric practices Progress with pregnant women recognised at RCM Conference 2018 Immunisations Issues of supply - working with Clusters & GP practices (aTiV vaccine) Midwife Led Flu immunisation pilot commenced in October 2018 Review of appointment system for primary immunisation

Objective 2: Early Help and Support
Information, Advice & Assistance Choose Pharmacy Implemented in 22 of 23 Powys practices Total of 831 patients registered for common ailment service to June Making Every Contact Count 500 people trained, 12 MECC ‘champions’ trained in motivational interviewing Evaluation underway with physiotherapists to assess whether visual aids can increase the frequency of MECC conversations ‘Inequality audit’ conducted Community Connectors 10 connectors in post; significantly positive impact Runner-up in NHS Awards Diagnostics RTT risks in endoscopy (retirement of GP endoscopist) being managed (Longest waiter 15 weeks sigmoidoscopy; longest urgent waiter 8 weeks for gastroscopy) Specialist nurse recruited for endoscopy to increase capacity (commencing Feb 19) Improvement actions in place to recover position by year end including joint working with neighbouring HBs Redevelopment of endoscopy suite in Mid Powys Fragility of in reach services in Powys managed via SLA

Objective 3: Tackle the Big Four
Mental Health Dementia Establishing new Dementia Home Treatment Service (South Powys) Under RPB: ‘Live Well’ and ‘Age Well’ Partnership Groups taking forward Powys’ response to ‘A Dementia Friendly Nation’ “Hello, My Name is Rita” Software procured to improve patient experience Mental Health Measure Assessments: Achieved Interventions: Improving but not yet consistently achieved (staffing gaps) Part 2: Achieved Part 3: Achieved Part 4: Achieved

Mental Health Integrated Mental Health Services Joint plans being developed including: Integration of NHS & Social Services Adult Mental Health Teams Redesign of Community Mental Health Services Redesign of Mental Health Services for Older adults with a focus on integration of physical and mental health Psychological Therapies Key area of focus for improvement Review current capacity/capability, plus recruiting specific increased capacity Key priority – roll out Silver Cloud “Blended c-CBT” in all GP Practices Tier 2 Eating Disorder Service being established Refreshed Talk to Me 2 Suicide and Self Harm Prevention approach agreed CAMHS Early Intervention Improvement Plan for children in crisis, service capacity increased, new 14 year+ pathway for 1st episode psychosis under development New strengthened Leadership & additional staff recruitment (2 CAMHS Psychiatrists) Significant improvements in Assessments & Interventions and target achievement Neurodevelopmental pathway implementation – some challenges

Cancer Single Cancer Pathway Highly complex pathways; however implementation plan in place Tracker 7 “live” ahead of schedule Managing cross border issues SCP demand and capacity modelling: risks related to in-reach session fragility; resource intensive Cancer Measure Data challenges Wales & England (NHS Digital solution found) Largely compliant, however some hot spots Breach management via Commissioning Assurance Framework Working with Macmillan Powys Improving Cancer Journey Programme launched - £413k Macmillan funding Primary Care Clinical leadership role appointed Very successful Primary Care Cancer Workshop hosted in May 2018

Objective 4: Joined Up Care
Primary Care Out of hours Work Stream 1 - Current Shropdoc provision: extension of current out of hour’s model and core contract arrangements until 31st March 2019; Procurement process and model redesign for all components of the contract - Project Brief ( 3rd November 2018) - Confirm core components of the out of hours model and in hours offer (9th Nov 2018) - Options Appraisal Final Report 19th December 2018 Work Stream 2 – NHS Wales 111 Call Handling and Clinical Triage. Successful transition of call handling and stage 1 clinical triage from Shropdoc to the 111 service on 3rd October Work Stream 3 - Local Clinical Service - Business Continuity Plan developed Work Stream 4 – In Hours Local Clinical Services (October 2018) to do an in house comparison as part of Work Stream 1 (combine).

Primary Care GMS Managed Practice x1 July 2018, progressing well Significant Sustainability Risk: x 3 practices Dental 5 high risk dental practices, 2 managed practices Extended Community Dentistry Services including mobile clinic Eye Care On track: Preparation for introduction of new Eye Care Measures; Development of the local Glaucoma pathway; First IP optometrist working in Powys (but requires approval to hold FP10)

Planned Care Powys “Provider” achieving RTT target but high risks to delivery include: Fragility of in-reach services managed via SLAs/LTAs Diagnostics (largely endoscopy) English Providers RTT trajectories agreed with WVT/RJAH to achieve 36 week target by 31/3/19 (note – some risk dependent on impact of Winter) Podiatry improvement plan in place: Increasing capacity through recruitment, short term locum capacity, temporary relocation (centralising) of clinic locations until Q3, equalisation of lists, review of booking and waiting list management Overdue Follow-ups a key focus

Care Coordination and Unscheduled Care Delayed Transfers of Care Unscheduled Care DTOCs achieved; some risk particularly in North Powys system with changes to A & E/USC flows in SATH Ambulance: some variability in weekly performance persists MIU performance remains 99+% Winter Integrated Winter Resilience Plan led by PTHB with key partners including: WAST, PCC & PAVO. Targeted areas for resilience include: Community Pharmacy Common Ailments Scheme Expanding the use of MIU as a first port of call for WAST to assess and avoid DGH transfer if safe and feasible Patient Flow Coordination Unit - directing system flow and demand & capacity ‘Powys to Assess’ discharge model providing rapid access to community resources Lean approach – A Plan for Every Delay

Quality, Safety, Patient Experience Healthcare Acquired Infections 23% reduction in confirmed cases of clostridium difficile (10 cases) compared to Q1/Q (13 cases) Zero cases of MRSA,MSSA, E Coli, Pseudomonas aeruginosa and Klebsiella sp blood stream infections New project has commenced collaborating with the continence team, Infection Prevention and Control supported by 1000 lives around the management and diagnosis of UTI’s & catheter usage within the HB Healthcare Acquired Pressure Ulcers 75% reduction in grade 2 pressure ulcers reported in our community hospitals for Q2 (2018/19 = 5 compared to 2017/18 = 20) Overall pressure ulcers acquired in hospital for all ages show a 12 month moving average reducing for all locations in Powys European Pressure Ulcer Advisory Panel 2018 (Rome) Quality Improvement Projects Awards with WWIC - Winner Concerns Management (incidents, complaints and claims) Improving trend in the number of closed formal Concerns responded to within 30 working days Closure compliance rate for Q2 2018/19 varies from 50%-100% (small numbers). Currently working on clearing long standing open SIs. PSOW – public interest report on Retro CHC published PROMs and PREMs International Consortium on Health Outcomes Measurement (ICHOM) Project – positive progress so far Cataract PROM Pilot in BWMH OPD CMATS Physiotherapy PROMs & PREMs Project Peri-Natal Mental Health POEMs project

Quality, Safety, Patient Experience – Commissioned Services WVT Improvements in mortality rate 1st time since 2016 Community hospital transfers significantly reduced RTT funding secured & alternative option of RJAH now available for orthopaedic new referrals Harm reviews - no significant harm Emergency activity climbing less steeply than for other commissioners of WVT CQC S29a RTT Senior IP&C Nurse member of Hereford IP&C Forum SaTH CQC Section 31 Emergency Department concerns: Management of sepsis Monitoring and identification of deteriorating patients Corridor care & boarding not safe Significant staffing deficits NB: Telford A & E overnight closure Unannounced inspection of maternity services PTHB CEO level escalation under the CAF PTHB action plan: Stream 1: Responsible commissioner, assurance, intelligence Stream 2: Emergency Stream 3: Maternity/Midwifery Stream 4: Communication and handling Commissioning Q&S Enhanced monitoring concerns, serious incidents, driven by improvements in availability of information PTHB Q&S lead participates in RCA investigations, actions taken & lessons learnt ensuring assurance regards improvements, with harm reviews completed as needed to ensure no harm to Powys residents Participating in mortality reviews for WVT, SATH and RJAH

Objective 5: Workforce Futures
Engagement & Wellbeing High level of engagement in PADR continues (83% against 85% standard) NB: in staff survey 90% of respondents indicated PADR in last 12 months; more to do on effectiveness Occupational Health & Rapid Access offers strengthened: Rapid access to physiotherapy via self-referral, Direct referral for staff to the Centre for Long Term Condition Management Rapid telecom access service introduced New online CBT service ‘SilverCloud’ introduced New staff counselling provider appointed Wellbeing at Work Corporate Standards preparation – new ideas being implemented Training Framework compliance 82% against standard of 85%

Objective 5: Workforce Futures
STAFF SURVEY 50% response rates (highest of all HBs) – up from 35%. Continued positive improvements since the 2016 survey. Overall engagement score of 3.92 (out of 5) is well above the Welsh average. Almost all areas of survey improved upon 2016 – several significantly & above NHS Wales average on almost all scores and many significantly higher Line manager scores very positive – almost all significantly higher than NHS Wales average Senior managers & Executive team significantly higher then Wales average Communication – key improvements & significantly above Wales average Learning & Development – progress in most areas & above Wales average Highlighted areas of concern: Stress at work; harrassment, bullying and abuse; Welsh Language; change in the organisation Staff Engagement The Staff Survey results, alongside the Chat to Change approach, Well-being at Work Group, and CEO Roadshows are being used as a vehicle to engage with staff and enable two way conversation. A range of staff engagement activities have taken place: apple picking, healthy lunchbox competition, Well-being Roadshows, local exercise classes.

Objective 6: Innovative Environments
Capital & Estates Progress Discretionary Capital Programme – on track for year-end delivery. ICF capital funding to support key projects: North Powys Rural Regional Centre Project Integrated Workforce/Organisational Development Hub Community Mental Health Services Hub ISO Stage 1 audit has been completed, procedures established and a work programme in place to achieve accreditation Llandrindod project delivered with only slight slippage for asbestos removal (2 weeks) August 2018 Renal Business Justification Case in Llandrindod approved by Welsh Government. Machynlleth Full Business Case submitted. Strengthened Capital/Estates Systems/Processes including positive progress with audit/estates compliance Challenges Fraud: 3 defendants guilty in relation to matters that occurred in 2014/15 Kier Contractor internal restructure negatively impacting on Machynlleth and Llandrindod Projects Machynlleth Project - Planning delay affecting the WG approval process

Objective 7: Digital First
Digitally Supporting Joined Up Care WCCIS in 83 Teams with 513 Users Live, roll out of 80 devices for staff to access WCCIS & Wi-Fi has been installed in 8 surgeries to support implementation Welsh 111 service, System developed and in place for 111 Service (CAS System) to link with Shropdoc (Adastra system) allowing relevant patient data to be exchanged in real time Cross Border eReferrals, live in all 3 English hospitals on the Welsh Border WCP/GP Record is live in 6 Wards WCP MTeD has become well established in 6 Wards, impacts include Reduction in unintended changes to medication therapy following discharge/transfer GP Test requesting (Results viewing) live in 8/16 Practices live (50%) provides GPs with access to the national database of laboratory test results Digital Infrastructure Disaster recovery Plans developed as a single integrated plan for health and council ICT: Improved IT responsiveness to serious incidents including cyber attacks Improved business continuity Alternative communication channels developed in case any incident impacts traditional comms (e.g. National Whatsapp groups)

Objective 8: Transforming in Partnership
Good Governance Risk Management Improvement Plan developed and will be implemented by the end of Quarter 4 Additional corporate governance resources secured & appointments made GDPR awareness and compliance programme progressed with an Electronic Information Asset Register (IAR) launched at the end of May over 90 assets recorded. Active participation in national Blood Inquiry Hosted functions (CHCs, Health and Care Research Wales) governance focus Welsh Language Peer review completed and Improvement Plan developed Response to draft Compliance Notice submitted by the 10 October deadline. Now working with Welsh Language Commissioners Office to develop final Notice Recognised as key area for focus

Planning, Performance and Commissioning Fragile Services ABUHB Paediatrics & Neonatal Services at Nevill Hall temporary suspension – update due Nov-19 BCUHB Special Measures BCUHB provided upper GI cancer service via NHS England but Countess of Chester has served notice to cease the service by the end of March 2019 Trauma & Orthopaedics - BCUHB is currently outsourcing orthopaedics services to RJAH CVUHB RTT approach to send low complexity needs (Trauma & Orthopaedics) to independent NHS providers C&VUHB has temporarily suspended all new referrals to the Immunology Service (January 2018). CTUHB Service strengthening following review of perinatal incidents including deaths HDUHB Proposed repatriation of appropriate Orthopaedic work from Bronglais Hospital to Powys Midlands Partner-ship FT The MPFT is only treating vulnerable children from other local authorities in an emergency. Alternative arrangements via PTHB CAMHS team. Not an LTA issue – HIV services were stopped but immediately re-instated through PTHB intervention. Working to resolve funding issues between England and Wales related to responsible body guidance. SATH Ophthalmology (Routine New Referrals) - All Ophthalmology services, which had been suspended, recommenced as planned on the 1st April 2018 with the exception of Adult squint which will restart, following consultant training, in October, 2019. Suspended Neurology outpatient services new patients (including urgent referrals) from March 2017 Maternity Services - On the 12th of April 2017 the English Secretary for Health announced an investigation of perinatal deaths associated with maternity services provided by SATH. An unannounced inspection has resulted in Regulator action in September 2018 for midwifery services. There have been temporary closures of Midwife Led Units with insufficient notice. Key Notice received that service will no longer be provided Service has been temporarily suspended Significant risks in terms of service continuity

SATH A&E - Sustainability of unscheduled and planned care services. An unannounced inspection in August 2018 has led to Regulator action. On the 27th September, 2018 the SaTH Board agreed to the temporary closure of the PRH A&E department overnight hrs to 08.00hrs – probably from around early December. Vascular Services –NHS England review shows RSH potentially not sustainable service (of 7 centres they are the most fragile). Adult contact lens service stopped due to staffing issue on the 5th of October 2018 (Moorfield only alternative) WVT The Clinical Services Strategy review risks centralisation of some services across the Hereford and Worcestershire STP area – particularly Stroke. There are significant recruitment difficulties within WVT. The Male Infertility consultant retired in August The alternative provider being used by the CCG is in the private sector. PTHB is trying to identify an NHS provider or Shared Services. Attempts are being made to commission this using Cwm Taf, but there is slow progress. Patients from the South may need to use BPAS in the interim. Gloucester The Allergy/Immunology service has been temporarily closed – this is an open access service. Patients requiring this service are currently being redirected to North Bristol Trust (April 2018). RJAH RJAH has reported the fragility of spinal services. Warrington NHS Trust has temporarily closed their spinal disorder service for new admissions - this decision impacted on operational capacity in RJAH. Therapy led residential Pain Clinic. No longer provided. Patients referred into PMS within PTHB Secondary care chronic pain service closure from March 2019. On 11th September, 2018 RJAH received notice from Wolverhampton that the visiting Paediatric Rheumology services will not continue. Worcester Special Measures. Dermatology Services were outsourced to the private Sector Please see the reference to vascular services in relation to SaTH above. WHSSC Neurology (South Wales) Neurosciences review underway Cystic Fibrosis There is insufficient capacity across England and Wales to meet revised Government targets for Thrombectomy

Collaborative Powys Engagement on the Powys Public Service Board's Wellbeing Vision and Objectives. Section 33 Care Home Commissioning – Operational Group overseeing ICF Capital – Extra Care Housing major project Regional Partnership Board progressing key priorities under the following partnership groups: Start Well Live Well Age Well Cross cutting themes & resource group. Social Care – Challenges and opportunities/Children’s Services/Adult’s Services (PCC) – CIW Report. Regional Working A complex set of commissioning and provider arrangements for Powys residents Significant concurrent consultations managed during the first 6 months. External Change Programmes Betsi Cadwaladr UHB Living Healthier, Staying Well WHSSC Thoracic Surgery Hywel Dda UHB Transforming Clinical Services Major Trauma Centre and Major Trauma Network Arch Regional Collaboration Programme Shrewsbury and Telford Hospital Trust Future Fit Abertawe Bro Morgannwg UHB Service Changes Herefordshire and Worcestershire STP Aneurin Bevan UHB Clinical Futures Programme Mid Wales Health and Care Joint Committee Cardiff and Vale UHB Shaping our Future Wellbeing South East Wales Regional Planning Committee Velindre NHS Trust– Transforming Cancer Services South West Wales Regional Planning WAST

Public Engagement Significant engagement programme: 111 launch Dental services changes (Builth) Future Fit – extensive consultation – over 3,000 Powys respondents (highest of any consultation process) Hywel Dda ‘Our Big NHS Change’ consultation Thoracic surgery There have also been significant requirements for local engagement and communications (NB: positive feedback from the CHC)

Financial Management Risks & Opportunities Finance Month 06 IMTP Original £3.5m ‘Risk’ Plan 2018/19 but balanced over 3 years Non recurrent actions identified to deliver in year breakeven 18/19:- Operational underspends Funding and Balance Sheet Opportunities Key pressure area Commissioning linked to English Provider Activity Looking ahead: Increased focus on Value Based Health Care and potential opportunities in line with the Efficiency Framework: Presentation to Executive Team to raise awareness Build into longer term sustainability plans 2018/19 Savings Targets (1.1% of Resource Limit)

LOOKING AHEAD IMTP 2019/20-21/22

Where are we now? Embedded planning approach resulting in fourth Year of IMTP Approval Approved joint Health and Care Strategy: ‘A Healthy, Caring Powys’ ; the RPB Area Plan Approved PSB Well-being Plan Draft ‘Strategic Intent’ published for Mid Wales Joint Committee for Health and Care

A Healthy, Caring Powys

Our Approach to the IMTP 2019/2022
Our ambition for is framed by the delivery of the second year of the ‘A Healthy, Caring Powys’: Powys Joint Health and Care Strategy (also the RPB Area Plan). The strategic objectives and priorities remain the same and there is a strong alignment with the ambition of A Healthier Wales We are strengthening key areas this year including primary and community care, the Big Four, Digital and Workforce. Underpinning Organisational Development Framework realigning organisation to delivery of the Strategy, including the role and function of Clusters. Regional working arrangements are even more significant this year, with the recognition of Mid Wales as a regional planning area. Powys has a unique position as a commissioner across an extensive and complex set of provider arrangements in both England and Wales and our IMTP will continue to reflect this whole system approach. The North Powys (Newtown) Rural Regional Centre remains a key priority for development and investment. It will largely ‘look like’ last year’s plan, in a more concise form, to ensure continuity and consistency with our long term strategy.

Feedback on IMTP 2018/19 Welsh Government - IMTP Accountability Letter “This is an important statement about the development of integrated planning within PTHB and demonstrates a growing maturity within your organisation.” “I was very encouraged to see the restructuring of your plan to align further with both your Health & Care Strategy and the Well-being of Future Generations Act.” Well-being in Wales: the journey so far, Future Generations Commissioner for Wales (2018) “It is pleasing to see that some health boards are eagerly grasping the opportunities the Act presents, such as Powys Teaching Health Board challenging the national guidance to create well-being objectives that better suited their context and their population.” Internal Audit – Joint Planning Framework Substantial Assurance on the ‘Golden Thread’. “It is clear that close partnership working needed to deliver the Welsh Government’s partnership and integration agenda has been achieved…. the health board plans and wider long-term partnership plans are clearly aligned…. priorities are clearly linked from Welsh Government aspirations to engagement with the Powys population, through to long term partnership plans.”

Alignment to A Healthier Wales: The Quadruple Aim
Improving Population Health and Well-being Better quality and more accessible health and social care services Higher value health and social care A motivated and sustainable health and social care workforce Focus on Well-being Provide Early Help and Support Tackle the Big Four Enable joined Up Care 4. Enable Joined Up Care 6. Promote Innovative Environments 7. Put Digital First 8. Transforming in Partnership 2. Provide Early Help and Support 3. Tackle the Big Four 6. Promote Innovative Environments 7. Put Digital First 8. Transforming in Partnership 4. Enable Joined Up Care 5. Develop Workforce Futures 6. Promote Innovative Environments 7. Put Digital First 8. Transforming in Partnership

Alignment to A Healthier Wales: Design Principles
National Design Principles Powys Delivery Principles 1. Prevention and Health Improvement Safety Independence Voice Personalised Seamless Higher Value Evidence Driven 9. Scalable 10.Transformative Do What Matters Do What Works Meet Greatest Needs First Offer Fair Access Be Prudent Work with People and Communities

Powys Ambition and Opportunities
There are significant opportunities for development which include: North Powys (Newtown) Rural Regional Centre - Meeting the strategic challenge in North Powys, addressing local deprivation and inequity and advancing community development through an innovative and exciting partnership approach. Advancing Rural Primary and Community Care – Ensuring that primary and community care can thrive through developing new rural models to deliver more care in primary and community settings and increasing levels of integration between services, agencies and professions. Putting Digital First - Scaling up and rolling out innovative digital solutions as enablers to strategic change and as key components of operational delivery of services and shared care with citizens. Workforce Futures – Bringing a reality to integrated workforce planning, with potential for developing an academy/faculty for rural health & care approach (with HEIW & other partners) Developing Whole System Commissioning and Outcomes- Clinical Change programme focused on Big 4 through implementing our Strategic Commissioning Framework. Potential to develop all Wales approaches and best practice.

North Powys (Newtown) Rural Regional Centre
Why Newtown? Levels of deprivation – High number of children on the child protection register, WIMD scores relating to health and economy, high number of homelessness, large increases in reported crimes. Strategic importance Potential for strengthened strategic relationships between Bronglais DGH, Shrewsbury hospital and effectively responding to public consultations and proposed service changes. Currently no theatre provision in North Powys, services are currently provided from a number of sites and a number of buildings are in poor conditions. A number of potential development opportunities in Newtown: School development (21st century funding), New extra care facility, Relocation air ambulance potential, Council back office review. Extensive opportunities for integration at a partnership level. Health and Care Campus – A Partnership Approach Integrated working with education, housing, health and social care. Greater integration and co- location of services. Economic development and regeneration of the town. Greater alignment of timetable and plans.

North Powys Rural Regional Centre
Population Outcomes Approach Multi-agency Inter-generational Wellness Campus Improved Health and Wellbeing Care Closer To Home Better Experience and Outcomes Innovative, Digital, Sustainable Environment Better Education, Training and Development. More Sustainable Workforce

Where are we now.. Initial feasibility work
END STAGE JANUARY 19 Gather intelligence Vision & Scope Workshop 1 5th Nov 2018 Site option appraisal Workshop 2 23rd Nov 2018 Feasibility / Conclusion Workshop 3 13th Dec 2018 North Powys Drop in Event 20th Nov 2018 Existing provision / challenges Future service needs / opportunities Existing estate condition/ site surveys Assessment of available sites for development. Emerging themes in relation to service needs. Develop vision for North Powys. Assess benefits. Co-location/ integration opportunities Service scope. Gather on service options Gather views on criteria that could be used to make a decision between sites. Identify potential additional stakeholders. Consider outputs from engagement event and re-visit service scope. Agree criteria to assess sites. Assess suitability of known sites. Identify a preferred site. Share outcomes of technical appraisal and physical requirements on preferred site. Key issues highlighted. Spatial strategy showing how possible uses for the preferred site for together Discuss next steps. Cabinet & Board approval of report Formal initiation of programme Refine service scope for the new development

Advancing Rural Primary & Community Care
Revised care pathways that allow more care to be provided in primary care settings and provide increase opportunities for primary care service delivery. Scaling up the ‘transformed’ model for Rural Primary & Community Care Strong platform to build on: have most elements of the primary care model in place Key opportunity: Scaling up across the county (need to strengthen OD & improvement capability for scaling/spread) Workforce pipeline & professional practice & supervision framework Expansion of social prescribing/community connectors Fully integrated teams – increased focus on social work/care Out of hours and in-hours primary care – same model through 24/7 Scaling total triage – to improve clinician management of complex cases Maximising pharmacy and other modes Maximising direct access to therapy Diagnostics and Point of Care Testing critical Digital solutions key

Tackle the Big 4 through Whole System Commissioning and Outcomes-focussed approach
Cancer Mental Health Respiratory Health Circulatory Clinical Change programme approach Whole system commissioning Utilising the learning from our mental health experience Underpinning value based approaches Step up the care closer to home offer New/strengthened relationships with Welsh HBs in particular – changing from SLA in-reach to more joint appointments Clinical leadership across the system Programme directly interconnects with ‘Advancing Rural Primary and Community Care’ transformation priority 31

Digital Programme focus:
Digital First Digital Programme focus: - Scale up digital care that works: - need investment in scaling/spreading Implement/maximise national programme solutions & infrastructure Pipeline development of transformative technology for care Develop plan to pilot and implement further health and care enabling digital applications wearable devices and online tools. Introduction self-referral service for Silvercloud online CBT upscale across Powys and Roll-out nationally across Wales Digital Care Scale up Florence text service, MY COPD, CAMHS ‘Think’ Text Project & Neurological Apps use of Skype and remote consultations to support delivery of care including Invest in your Health remote sessions. National programmes & infrastructure development Complete WCCIS Complex national implementations – cross organisational GP practice system change over – help manage implementation risks Cyber security; system resilience; business continuity; IG Test, evaluate and implement further health and care enabling digital applications, wearable devices and online tools. Digital innovation pipeline Integral part of IRIS (Innovation, Research and Improvement Service) Connecting to understand potential of AI Partnership with industry

Workforce Futures Integrated Workforce Planning
RPB funded Integrated Workforce Planner appointed Establishment of integrated workforce hub Broad definition of workforce to include unpaid carers, volunteers, independent sector, independent contractors, nhs and local government Workforce Futures Framework in development to underpin delivery of ‘A Healthy, Caring Powys’ Develop plan to pilot and implement further health and care enabling digital applications wearable devices and online tools. Introduction self-referral service for out nationally across Wales Academy/Faculty for Rural Health & Care Significant support for an Academy/Faculty approach - will need investment Multi-sectoral and whole system (volunteers, social care, community health, doctors, therapists, planning, finance, leadership & management etc) Engagement with HEIW – further work with Social Care Wales required Engagement with education providers already advanced Physical and digital approaches – potential for simulation, remote learning approaches Focus on excellence in learning environment – new HCSW practice support post now in place as key building block Significant expertise across the system already developed, e.g. Community Pharmacy, Specialist Nurses, Consultant Practitioner, Training Practices

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Joint Executive Team Mid Year Review 2018/’19

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