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

2. 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”

3. 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Some outdated buildings and facilities / I.T. / Informatics / infrastructure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
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4. 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
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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”

5. TCS Programme - Phase 2 Timeline
Consultation Documents
‘Ready for
Extraordinary Board’
5 Apr 2018
Updated 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.

7. 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

8. 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.
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9. 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. 
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10. 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”