Transforming Clinical Services Mid Wales Joint Committee Glan Wnion Leisure Centre, Dolgellau 12th March 2018 “Safe, Sustainable, Accessible and Kind”

Clinical sustainability Setting the scene - “Safe, Sustainable, Accessible and Kind” Long-term strategic issues that need addressing… Clinical sustainability Financial sustainability Responding to legislative and statutory MWHC / ARCH collaboratives “Safe, Sustainable, Accessible and Kind”

Setting the scene Patient Focus Key drivers… Inequalities and variation in care e.g. 10 years life expectancy gap Have patient experiences and outcomes at the heart of how services will move forward by showing more kindness, empathy and understanding Demography-driven demand Recruitment and retention of our staff Performance pressures e.g. waiting times Some outdated buildings and facilities / I.T. / Informatics / infrastructure Remoteness and rurality - access to services “Safe, Sustainable, Accessible and Kind”

TCS: The journey so far Phased approach to strategic transformation The Transforming Clinical Services Programme is now firmly established and we entered Phase ‘Design’ when the Phase 1 Case for Change Output Report was signed-off at the Public Health Board Meeting on Tuesday 21 November 2017. Phase 1 Discover Developing the strategic case for change. Phase 2 Design “Safe, Sustainable, Accessible and Kind” Developing the future options for Hywel Dda. 1. DISCOVER 2. DESIGN 3. DELIVER Phase 3 Deliver Implementation of the agreed option(s). “Safe, Sustainable, Accessible and Kind”

TCS Programme - Phase 2 Timeline Consultation Documents ‘Ready for Extraordinary Board’ 5 Apr 2018 Updated 21.02.18 v3 Consultation Documents ‘Ready for Design and Translation’ 9 Mar 2018 Phase 2 - Start Options Development ‘Long list’ 27 Nov 2017 Phase 2 - End Present Report Public Board Meeting 27 Sept 2018 Options Scoring ‘Starts’ 5 Feb 2018 Consultation ‘Analysis Report’ 10 Aug 2018 Staff and Stakeholder Challenge 12 week formal consultation Public Consultation End 12 Jul 2018 Consultation ‘Closing Report’ 13 Sept 2018 Board Meeting TCS Update 29 Mar 2018 Public Consultation 19 Apr 2018 through to 12 Jul 2018 Options Scoring ‘Ends’ 14 Feb 2018 Criteria Setting competed by end of Jan 2018 Nov 2017 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Sept 2018 Options Development ‘Conference Workshop 1’ 18 Dec 2017 DSG 22 Jan 2018 DSG 19 Feb 2018 DSG 26 Mar 2018 DSG 30 Apr 2018 DSG 21 May 2018 DSG 18 Jun 2018 DSG 16 Jul 2018 DSG 20 Aug 2018 DSG 17 Sept 2018 Options Development ‘Conference Workshop 2’ 11 Jan 2018 Extraordinary Board Meeting ‘Go or No-Go Decision to Proceed’ 19 Apr 2018 Design Steering Group (DSG) The TCS Programme Governance Group overseeing all work during Phase 2.

Modeling - methodology and assumptions The model contains a range of interlinking assumptions for future scenarios – see master assumptions document for more detail Baseline Population Change Site / Service Options Development Drivetimes Admission Reduction Assumptions Bed Discharge Assumptions Outpatient Activity Changes A&E/MIU Activity Changes Daycase Activity Changes Acute to Community Step Down - Bed Days Out of Hospital re-provision and model of care

Bronglais General Hospital: Future model In all options, Bronglais General Hospital continues to have an important role in providing services within the hospital setting and also as an outreach into Ceredigion, South Gwynedd, Mid and North Powys.  Our ambition is to strengthen current services and where clinically appropriate expand or develop to provide a greater range of services for the people of mid-Wales.  Bronglais will provide 24/7 Accident & Emergency (A&E) services, supported by Intensive Care, general surgery, general medicine, trauma and orthopaedics, obstetrics and gynaecology, paediatric, anaesthetic and diagnostic services.  Our plans for the A&E department include streaming patients direct to the most appropriate clinician and a Medical Assessment Unit (12hr) for patients requiring a number of investigations or a period of observation. GP out of hours service will be located in A&E. Where patients need to be transferred for more specialist care, Bronglais will be able to stabilise the patient’s condition prior to transfer. “Safe, Sustainable, Accessible and Kind”

Bronglais General Hospital: Workforce We are about to launch a major recruitment campaign for Bronglais. Looking to the future: We are exploring innovative staffing arrangements to respond to recruitment challenges and make best use of the skills of our staff and support career progression and development. Some of the Consultant input for our services will be as part of a network within Hywel Dda and in some cases as part of a network arrangement with other Health Boards and NHS Trusts in England.  We are already seeing the great contribution that Advanced Nurse Practitioners are making in some of our services and we plan to develop more of these posts to enhance and strengthen our medical teams.  We are also exploring how we can work with Aberystwyth University and the Open University to support training for nurses and therapists.  We aim to create a career pathway for Health Care Support Workers who wish to progress to nurse training and this will help us to “grow our own” future workforce.  “Safe, Sustainable, Accessible and Kind”

Bronglais General Hospital: Community Support Bronglais is committed to supporting the proposed new model for community care, and will develop productive links with GPs and community teams which will help us to improve the way we care for patients and families.   We will provide opportunities for staff to rotate and gain experience in other settings.  We will provide outreach services from the hospital either in person or using Tele-Health facilities to give specialist support to GPs and community teams.  Some of our GPs have areas of special interest and expertise and we will seek ways to make the best use of these skills both in the hospital and in the community. “Safe, Sustainable, Accessible and Kind”