1. Joint Executive Team Meeting 2013/14
4 June 2014
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2. Introduction Overview of 2013/14
Critical Issues in 2013/14 and challenges for 2014/15
Integrated Medium Term Plan
Emerging and developing priorities
Research Development and Innovation
Workforce and Organisational Development
Governance
Conclusion
Presenter: Tracey Cooper

3. Overview 2013/14 Refreshed strategy
Health Improvement Review conclusion
New programmes implementation
Excellent cancer detection rate
Measles response
Observatory reports
Health Technology Funding
Another year balanced financially
Presenter: Huw George

4. Critical issues 2014/15 Smoking rates Screening uptake Immunisation
Relationship with health boards and the wider system
Focus on outcomes
Presenter: Huw George

5. Smoking cessation Insert name of presentation on Master Slide
Presenter: Peter Bradley

6. Successes and concerns
Reduced waiting times to 6 days
Increased appointment availability
Increased translation of contacts into treated smokers
Improved performance management
New initiatives
Smoking in pregnancy pilots potential
Need to change service delivery model to reach 16% target
Significant progress and improvements:
Improved performance management data; clear responsibility for collection/aggregation; innovation in collection of GP data
Monthly performance meetings with agreed targets
New initiatives (Stoptober, freephone service, use of social media, more time in face to face delivery)
Smoking in pregnancy pilots showed significant future potential
Current performance (April 2014) demonstrates significant progress, including:
reduced waiting times (6 days)
increased appointment availability
increased translation of contacts into treated smokers
Need to change service delivery model to reach 16% target
Presenter: Peter Bradley

7. Actions for 2014/15
Formal agreement with DsPH and joint action plans and performance meetings
Targeted action
Service delivery model options appraisal
Brief interventions training programme
Social marketing campaign
‘Stoptober’ campaign
Online booking, apps etc
Formal agreement with DsPH
Joint monthly local performance meetings using real time local data
Joint local action plans, including targeted action at vulnerable groups and those with increased prevalence
Options appraisal on model for service delivery
Rolling programme of brief interventions training
Locally tailored social marketing campaign across Wales
‘Stoptober’ campaign
Online booking, apps etc
Presenter: Peter Bradley

8. Immunisation Presenter: Quentin Sandifer
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9. Successes and concerns
Successful measles outbreak response
75,000 MMR vaccine doses delivered
Highest ever MMR uptake for Wales
96.5% for MMR1 at 2 years
92.6% for MMR2 at 5 years
Tier 1 target for childhood vaccination at age 4: 87.5% (target: 95%)
Successful response to the largest measles outbreak in Wales in 20 years delivering over 75,000 MMR vaccine doses
At the same time implemented 4 new vaccine programmes; changes to Men C, Rotavirus, Shingles for 70 and 79yr olds and flu for children
Highest ever for Wales MMR1 (96.5% at 2yrs) and MMR2 (92.6% at 5yrs)
Tier 1 (childhood vaccination age 4) across Wales 87.5% (target 95%)
Presenter: Quentin Sandifer

10. Successes and concerns
Flu vaccination
2.5% increase in under 65 at risk
No change in over 65 flu rates
Only one NHS organisation on target
Only achieved 2.5% increase in under 65 at risk and no change in over 65 flu vaccination rates
Only one health organisation achieved 50) staff flu vaccine
Presenter: Quentin Sandifer

11. Actions for 2014/15
Surveillance of disease, epidemiological analysis and interpretation of vaccination uptake data
Inform policy and guidance
Support partner agencies to meet targets
Inform and educate NHS Wales and the population
Provide surveillance of disease, epidemiological analysis and interpretation of vaccination uptake data by practice, cluster, LA, HB and Wales wide, for NHS action, challenge by Welsh Government and public scrutiny
Continue working with Welsh Government to inform on policy and guidance
Work with partner agencies (Welsh Government, health boards, third sector) to support meeting targets
Continue to work to inform and educate across NHS Wales and the general population
Presenter: Quentin Sandifer

12. Screening Presenter: Quentin Sandifer
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13. Successes and concerns
Implemented AAA and newborn bloodspot and change in age range for cervical screening
Developed new sickle testing protocol
First home nation to go fully digital in breast screening
Consistently highest cancer detection rate of any UK breast screening programme
Implemented AAA and newborn bloodspot and change in age range for cervical screening
Developed new sickle testing protocol, now endorsed nationally
First home nation to go fully digital (breast screening).
Consistently highest cancer detection rate of any UK breast screening programme
Presenter: Quentin Sandifer

14. Successes and concerns
Health board performance (timeliness) against provision of diagnostic assessment services e.g. colonoscopy (up to 11 weeks) and cervical histology (up to 6 weeks)
Poor uptake in bowel programme and falling uptake in breast programme
Health board performance (timeliness) against provision of diagnostic assessment services, for example, colonoscopy (up to 11 weeks) and cervical histology (up to 6 weeks)
Poor uptake some new programmes (bowel) and falling uptake in existing programmes (breast); shared issue across the whole of the UK.
Presenter: Quentin Sandifer

15. Actions for 2014/15 Targeted support to health boards
Formal project to address uptake
Cervical modernisation programme and HPV ‘test of cure’ in September and planning for triage in cytology
14-day turnaround time cervical screening methodology
Improving breast and cervical timeliness
Transfer of diabetic retinopathy service
Targeted support to health boards that have difficulty meeting key service standards
Formal project initiated to address uptake
Cervical modernisation programme and HPV ‘test of cure’ will be implemented in September and planning for triage in cytology
Implementation of English 14-day turnaround time cervical screening methodology
Working with Improving Quality Together team on timeliness in breast (assessment and results) and cervical (results) programmes
Subject to formal response from Welsh Government, implement transfer of diabetics retinopathy service from Cardiff and Vale to PHW
Presenter: Quentin Sandifer

16. Transforming health improvement
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Presenter: Peter Bradley

17. Successes and concerns
Completed review: Transforming Health Improvement in Wales
Not reaching large proportion of the population
Some had no evidence base
Established programme to oversee implementation of recommendations
Disinvestment process
Ongoing delivery of ‘legacy’ programmes
Completed review and published Transforming Health Improvement in Wales (THIW) (September 2013)
Showed current programmes not reaching large proportion of the population and some had no evidence base.
Established THIW programme to oversee implementation of recommendations
Disinvestment process in line with review recommendations
Ongoing delivery of ‘legacy’ health improvement programmes
Presenter: Peter Bradley

18. Actions for 2014/15
Transforming Health Improvement programme on schedule
Infrastructure established
Ongoing engagement with DsPH/local teams
Expert groups to report by end July 2014
Detailed work plans by November 2014
Implementation of work plans from November
Health Improvement Alliance to promote innovation and advocacy
THIW programme infrastructure, including three life course collaboratives, established
Ongoing engagement with DsPH/local teams
Expert groups to consider current issues, trends and best practice in the respective areas (by end July 2014)
Transformation of information into detailed work plans by multi sector life course collaboratives (by November 2014)
Implementation of work plans from November onwards
On schedule to deliver THIW programme in line with agreed timescales
Development of multi agency Health Improvement Alliance to promote innovation and advocacy
Presenter: Peter Bradley

19. Healthcare associated infections
Integrated Medium Term Plan &
Budget Setting
Presenter: Quentin Sandifer

20. Successes and concerns
Epidemiological intelligence, direct support and published outputs
BCUHB Clostridium difficile outbreak
Review of death certification associated with Clostridium difficile
Health board targets and Code of Practice
Downward trend in Clostridium difficile (-19.2%); increase in MRSA (+2.5%); increase in MSSA (+3.2%)
Epidemiological intelligence (monthly HCAIs data since July 2013), direct support (5/7 health boards), and published outputs (trigger tools, prescribing data, Public Health Wales offer for large scale change) to inform local health board action
Urgent review of and ongoing support to BCUHB in response to the Clostridium difficile outbreak in 2013
Review of death certification associated with Clostridium difficile with recommendations for action
Prepared new targets for health boards at Welsh Government request and drawn up a Welsh Code of Practice, both awaiting publication by the Welsh Government
Recent downward trend in Clostridium difficile (-19.2%) but slight increase in MRSA (+2.5%) and slight increase in MSSA (+3.2%) [all Wales figures]
Presenter: Quentin Sandifer

21. Actions for 2014/15
Provide epidemiological analysis and interpretation of bacterial infections
Continue working with health boards including support to large scale change
Continue to advise and inform policy on HCAIs
Lead all-Wales action planning on antimicrobial resistance
Provide epidemiological analysis and interpretation of bacterial infections for NHS action, challenge by Welsh Government and public scrutiny
Continue working with local health boards including support to large-scale change
Continue working with Welsh Government to advise and inform policy on HCAIs
Lead all-Wales action planning on antimicrobial resistance to inform Welsh Government policy and local health board prescribing
Presenter: Quentin Sandifer

22. Clinical microbiology
Presenter: Quentin Sandifer
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23. Successes and concerns
Second ever network service to attain full CPA accreditation
Single central laboratory established in Rhyl, Wrexham service transfer and single North Wales microbiology service
Modernisation programme to achieve a single, national, managed microbiology service network
Director of Operations
Second network service to attain full CPA accreditation
Single central laboratory established in Rhyl, Wrexham service transferred from BCUHB to PHW, and single PHW managed North Wales microbiology service now being implemented
Microbiology modernisation programme has commenced to achieve a single, national, managed microbiology service network
Appointed first ever Director of Operations to start August 2014
Presenter: Quentin Sandifer

24. Actions for 2014/15
Automated technology into bacteriology service in North Wales
Develop formal commissioner-provider model for microbiology services
New performance management framework
Secure full clinical microbiologist engagement in local HCAI action
ISO accreditation by June 2016
Infectious diseases genomics service
Introduction of automated technology into bacteriology service in North Wales
Develop formal commissioner-provider model for microbiology services including national diagnostic and clinical service specification
Implementation of new performance management framework to include key national indicators
Secure full clinical microbiologist engagement in local HCAI action planning and implementation
Commenced implementation of ISO to achieve accreditation by June 2016
Continue to engage with Welsh Government, Cardiff and Vale Health Board, and Cardiff and Swansea Universities to make the case for an infectious diseases genomics service
Presenter: Quentin Sandifer

25. Service user experience
Presenter: Rhiannon Beaumont-Wood
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26. Successes and concerns
Improved organisational focus
Service User and Learning Panel established
User experience, complaints/concerns learning & monitoring now combined
National core questions do not adequately capture requirements
Planning/evaluating changes to services
Creation of agreed PIs
Better use of existing IT products
Improved organisational focus.
Established service user & learning panel.
Identified Executive/Non Executive Director leads
CHC rep
User Experience, Complaints/Concerns learning & monitoring now combined
National core questions do not adequately capture requirements.
Planning/evaluating changes to services.
Creation of agreed PI’s.
Better utilisation of existing IT products
Presenter: Rhiannon Beaumont-Wood

27. Successes and concerns
Service example: Stop Smoking Wales client feedback 1 Jan 2014 – 31 March 2014
96% + of clients (263 individuals) were satisfied or very satisfied with the support they received
Service example: SSW. Client feedback 1 Jan 2014 – 31 March 2014 showed over 96% of clients (263 individuals) were satisfied or very satisfied with the support they received to stop smoking
Presenter: Rhiannon Beaumont-Wood

28. Actions for 2014/15 Improve data capture Agree approach to reporting
Dedicated resource
Improved methods for sharing learning
Performance framework being developed
Agree and start Board reporting
Identify methods to inform service users of improvements resulting from feedback
To improve the obtaining of data from Service User Feedback
Agree consistent approach to data capture and reporting methods
Dedicated resource
Improved methods for sharing learning
Performance framework being developed.
Agree and commence reporting arrangements to the Board
Identify methods by which Service Users will be informed of the improvements made as a result of feedback.
Presenter: Rhiannon Beaumont-Wood

29. Relationship with health boards
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Presenter: Huw George

30. Relationship with health boards
Need clarity on roles and responsibilities
Hold each other to account
Pilot work with Cardiff and Vale
Including key areas, specification based, agreed action, for implementation in September
Executive to Executive discussions
Betsi Cadwaladr
Critical performance issues and ownership
Presenter: Huw George

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Presenter: Mark Dickinson

32. Successes and concerns
Refreshed strategy - Summer 2013
Developed priorities for action - Autumn 2013
Developed initial draft IMTP - January 2014
Refinement and strengthening of plan
Plan and balanced budget approved by Board - March 2014
Plan not approved and requirement to produce one year plan by June 2014
Refreshed strategy in Summer 2013
Developed priorities for action in Autumn 2013
Developed initial draft IMTP by January 2014
Refinement and strengthening of plan with input from Board and Welsh Government
Plan and balanced budget approved by Board and submitted to Welsh Government in March 2014
Plan not approved and requirement to produce one year plan by June 2014
Presenter: Mark Dickinson

33. Successes and concerns
Development of, and reporting against, Quality and Delivery Framework
Contribution to Public Health Outcomes Framework
Development of further performance indicators
Presenter: Mark Dickinson

34. Actions for 2014/15 Operational Plan 2014/15
Key areas to be further strengthened and developed
Updated sections on smoking and screening performance submitted
Divisional Directors leading development of relevant sections
To be approved by Board on 26 June
Key areas to be further strengthened and developed:
quarterly profiling of planned actions and performance
trajectories of planned performance improvements
more detail on the specific actions to improve performance
strengthening of specific deliverables
additional information on delivery of WG priorities
Updated sections on smoking and screening performance submitted to Welsh Government for feedback
Divisional Directors leading development of relevant sections of the operational plan
Operational Plan to be approved by Board on 26 June 2014 and submitted to Welsh Government
Presenter: Mark Dickinson

35. Actions for 2014/15 Integrated Medium Term Plan
Formal review of 2013/14 planning process
Key areas to be improved and specific actions
Revised plan submitted by January 2015
Further development of Quality and Delivery Framework
Complete Public Health Outcomes Framework
Formal review of 2013/14 planning process
Recommendations and proposed planning cycle for 2014/15 to be considered by Board and Executive Team during summer
Key areas to be improved and specific actions include:
Better alignment with health board IMTPs – meetings with health boards, including Directors of Planning and Directors of Public Health, to be undertaken during summer
Refinement and alignment of priorities – process to take into account emerging findings from THIW etc., discussions with key partners and Welsh Government policy
Greater integration of service, workforce and financial planning - internal working arrangements and processes strengthened
Clearer links between key public health outcomes, specific performance measures and SMART actions
Presenter: Mark Dickinson

36. Emerging issues Presenter: Peter Bradley
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Presenter: Peter Bradley

37. Emerging issues Unscheduled care Prudent healthcare
Large-scale change in relation to physical activity
Primary care vision
Health inequalities
Public Health Bill support and co-ordination
Presenter: Peter Bradley

38. Research and development
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Presenter: Peter Bradley

39. Research and development
New Policy, Research & Development Division and Director
Reorganisation including new governance structure and new strategy
Research activity funds increase of £129k
Co-bidder for research grants
Establishment of new Policy and Research Division & Divisional Director (2013)
Major reorganisation, including new governance structure, development of new strategy focused on:
Encouraging research, improving the research environment and attracting investment
Developing evidence for action
Adoption of outcomes based commissioning approach to ensure value form third party providers
Successful in gaining research activity funds (£129k increase for 2014/15
Recent successes in becoming co-bidder for research grants
Presenter: Peter Bradley

40. Research and development
Presenter: Peter Bradley

41. Workforce and Organisational Development
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Presenter: Ruth Davies

42. Successes and concerns
Work around culture and values
Developing leadership and management
Improved statutory and mandatory training
Work on staff appraisals
Presenter: Ruth Davies

43. Actions for 2014/15 Work on values and culture
Leadership and management development
Learning and development plan
Further work on mandatory training
Upward feedback survey on staff appraisals
Presenter: Ruth Davies

44. Governance Presenter: Keith Cox
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Presenter: Keith Cox

45. Successes and concerns
Interim arrangements to cover vacant Chief Executive and absence of Chair
Vacancy for local authority member
Trade union/staff representation
First Annual Quality Statement
Staff engagement on Francis Review
Programme to review accommodation needs and ways in which we work
Board
Interim arrangements to cover the vacant Chief Executive and absence of the Chair
Long standing vacancy for the local authority member
Lack of trade union/staff representation
Board development
Working with Academi Wales in two-part board development
Identifying and developing bespoke board
Good Governance Institute to identify particular development needs
Annual Quality Statement
First Annual Quality Statement
Received valuable feedback from the peer review
Statutory and mandatory training
Drive during the year to bring numbers to acceptable levels
Francis Review
A series of staff engagement sessions
Leadership and management development
Develop a leadership and management programme for the organisation.
Work around our culture and values.
Taken forward work on staff appraisals.
Our Space
Staff based in over 50 different locations around Wales.
Our Space is a programme which is reviewing our accommodation needs and the ways in which we work.
Presenter: Keith Cox

46. Actions for 2014/15
Interim arrangements to cover the local authority Board vacancy
Work to encourage BMA representation
Good Governance Institute ‘rapid review’ of Board, governance and risk management arrangements
Work with Academi Wales
Board Development programme
Board
New Chief Executive has been appointed.
The Chair has resumed normal duties.
Interim arrangements to cover the Local Authority Board vacancy. Trade union representation at Board meetings.
Work is continuing to encourage BMA representation.
 Board Development
The Good Governance Institute a ‘rapid review’ of our Board, governance and risk management arrangements.
Feedback to the Chair and Chief Executive shortly.
Inform a programme of Board Development with Academi Wales.
Annual Quality Statement
Earlier this year, making sure it fits better with the Annual Governance Statement and Annual Report.
Presenter: Keith Cox

47. Actions for 2014/15 Annual Quality Statement
Francis Review report to Board in June
Final decision on accommodation and ways of working options by September
Statutory and Mandatory Training
Mandatory training still requires further improvements.
 Francis Review
Staff engagement sessions completed and areas for further work identified. A report for the Board meeting in June.
 Leadership and Management Development
Leadership and management development training, along with master classes have been delivered. Values and culture work is in our plans for this year and a learning and development plan is being developed.
An upward feedback survey on staff appraisals is currently in progress.
 Our Space
Stage one completed (identified options for both accommodation and ways of working).
Short list will be prepared by the end of June.
Final decision September 2014.
Presenter: Keith Cox

48. A healthier, happier and fairer Wales
Continued progress in 2013/14
Build on our success
Continue to develop the organisation and Board
Focus on delivery
Focus on outcomes
Presenter: Tracey Cooper