1. Dr Sue Fish Clinical Programme Director Mid Wales Healthcare Collaborative MID WALES HEALTHCARE COLLABORATIVE

2. Mid Wales Healthcare Study  October 2014 - Mid Wales Healthcare Study Prof Marcus Longley, WIHSC  Terms of Reference - To identify the issues and potential solutions (including models) for providing accessible, high quality, safe and sustainable healthcare services, which are best suited to meet the specific needs of those living in Mid Wales

3. Mid Wales  Flexible boundaries  Shaped by patient flows - current and future  Different for different services  Ceredigion, Powys, Meirionnydd

4. Findings of the Study  The healthcare services of Mid Wales are extremely fragile  Recruitment and retention of the workforce is problematic  The current training for health care professionals does not meet the needs of rural healthcare  Difficulty in accessing CPD for the workforce and maintaining professional networks

5. Findings of the Study  Appropriate quality outcome measures for rural healthcare need developing  There is a near-dysfunctional level of mistrust, misunderstanding and concern with Health Boards’ plans and a new engagement strategy with staff and the public needs developing  Transport and access for patients is problematic  There is no one model of healthcare that would be appropriate to replicate in Mid Wales  Further work needs to be done to embed the Welsh Language in the provision of healthcare

6. What do other countries teach us?  No panaceas, but plenty of good ideas:  Different approaches to staff training  New roles  System planning  Clinical networking  Public engagement  Shared use of public facilities

7. Recommendations 1. Mid Wales Healthcare Collaborative 2. Public engagement 3. Local action on primary care 4. National Primary Care Plan 5. Future strategic role for Bronglais General Hospital 6. Clinical engagement on service models 7. Cardiology to be re-examined 8. New look at General Surgery and Maternity/Obstetrics 9. Improved access 10. Advanced capabilities in the ambulance service 11. Telehealth 12. Centre of excellence in rural healthcare

8. Progress  Co-chairs and Programme Director appointed  Mid Wales Healthcare Conference – March 2015  Mid Wales Healthcare Collaborative Team appointed  4 MWHC Board meetings held – Governance Structure and approach to developing the Centre of Excellence in Rural Health agreed  Full commitment for the work of the MWHC from CEOs and chairs HDUHB, BCUHD, PtHB, WAST, CeredigionCC, GwyneddCC, PowysCC  Workshop to discuss the Centre of Excellence in Rural Health 31 st July 2015  Relationship between MWHC and Mid and West Wales Health and Social Care Collaborative agreed

9. 1. Mid Wales Healthcare Collaborative  A joint Committee of the three Health Boards, including the Chair and Chief Executive of each, and an independent Chair for the Committee appointed by the Minister.  Accountability to the three Health Boards and also to Welsh Government and to the scrutiny mechanisms for local government.  It should shape the Mid Wales commissioning intentions of the three Health Boards by implementing the recommendations of the study and be held accountable for its work by the Minister for Health and Social Services or the Deputy Minister for Health.

10. Statement of Intent  The Mid Wales Healthcare Collaborative will work with providers and communities to plan and deliver safe, sustainable, high quality and accessible health and social care services for the population of Mid Wales.

11. Governance Structure

12. 2. Improved Public Engagement  A series of public and staff co-design workshops will be held across Mid Wales in 2016 to listen to what our stakeholders are telling us and to work with members of the MWHC to develop solutions to the issues raised.

13. 3.Local Action on Primary Care  Ensure primary care staff have access to CPD  Develop a training scheme for Physicians Associates  Develop the virtual ward model further

14. 4.National Primary Care Plan  Welsh Government launched ‘A planned primary care workforce for Wales’ on 17th July 2015.  Foundations for a more robust approach to workforce planning  Support the continued development of primary care clusters  Investing in the wider primary care workforce  Stabilising key sections of the current primary care workforce

15. 5 - 8. Bronglais General Hospital  Recruitment to Consultant posts at Bronglais General Hospital currently filled with locums including a joint post with PtHB to recruit a consultant in Care for the Elderly to work in Newtown and Llandrindod  Work is ongoing to develop a community cardiology service in Mid Wales to support the consultant cardiologist  Local senior manager, doctor and nurse have been appointed  A review is being undertaken to ascertain what is required to reinstate colorectal surgery at Bronglais General Hospital and agree the surgical services model  Work is ongoing to agree the appropriate consultant led obstetric and gynaecology model  Recruit additional new nursing staff to Bronglais General Hospital  Provide an additional 12 beds at Bronglais General Hospital

16. 9. Improved Access  Implement a system to offer hospital out-patient appointment times which are aligned to suitable transport alternatives  Improve access to land and air emergency patient transport

17. 10. Welsh Ambulance Service  Train advanced paramedic practitioners to work in Mid Wales

18. 11. Telehealth  Scoping exercise of current telehealth projects suitable for role out across Mid Wales will be completed by December 2015

19. 12. Centre for Excellence in Rural Health  The three Health Boards, working with local universities and others, should develop and support a centre of excellence in rural healthcare, with a particular focus on research, development and dissemination of evidence in health service research which addresses the particular challenges of Mid Wales. This has great potential to carry out work of relevance internationally. its core purpose would be to establish a critical mass of applied research excellence, conducting new work on the healthcare challenges of Mid Wales, and working closely with local clinicians, managers and others to apply the lessons from experience elsewhere. One by-product of this will be to generate a new level of credibility in the region which should help to recruit strong candidates for local clinical posts.

20. 12. Centre for Excellence in Rural Health

21. Centre of Excellence in Rural Healthcare  Discussions on going with Coleg Cymraeg  Aberystwyth University is establishing the Centre of Excellence in Rural Healthcare Research  Scoping what our partner universities are already doing of relevance  MWHC on the rural health workstream of the ARCH initiative

22. Contact us and further information  General Hospital, Caradog Road, Aberystwyth, SY23 1ER  Phone: 01970 635819  Contact Email : mwhc@wales.co.ukmwhc@wales.co.uk  Internet : www.wales.nhs.uk/midwalescollaborative/ www.cymru.nhs.uk/grwpcydweithredolycanolbarth  Facebook : Mid Wales Collaborative  Twitter: @DrSueFish

23. Any Questions?